Domestic and sexual violence have almost certainly been with us ever since human history began. For centuries they have been largely ignored and even now all we see is the tip of the iceberg. Fortunately more attention is now focused on them as major societal problems. Nonetheless there is still widespread ignorance, particularly in the health professions, as to the nature and scale of the problem. I recently chaired a Department of Health Taskforce on Violence Against Women and Children and was appalled by the numbers of people affected - not just by serious sexual crimes but also by all forms of domestic violence. I was particularly impressed by the numbers of unrecognised cases in general practice, emergency departments and hospital outpatient services even when obvious triggers were present - with some notable exceptions.
I was also disappointed by the lack of attention given to sexual and domestic violence in medical school curricula and postgraduate training programmes. There should be much more focus on multi-disciplinary working with close contact between different agencies. Often mechanisms are in place but are underused.
The Taskforce brought some attention to the issues involved but did not solve the many problems. The present volume goes some way to rectifying this. It is a superb vade mecum which should be required reading at an early stage for all health professionals but particularly those working in general practice and long-term conditions. It should also be freely used in training health care professionals. I cannot commend it to you strongly enough!

Contributors vii

Foreword ix

Introduction xi

1 The Epidemiology of Gender-Based Violence 1

2 'Culture' and Violence 5

3 Domestic Violence and Abuse 9

4 The Impact of Trauma 17

5 Children 21

6 Sexual Assault of Men and Boys 27

7 Identifying Domestic Violence and Abuse 30

8 Community-Based Responses to Domestic Violence 37

9 Sources of Referral and Support for Domestic Violence 41

10 Perpetrators 46

11 General Practice 50

12 Emergency Medicine and Surgical Specialities 54

13 Elder Abuse 59

14 The Dental Team 62

15 Mental Health Services 64

16 Women's, Reproductive and Sexual Health Services 69

17 Female Genital Mutilation 72

18 Sexual Violence: What to Consider First 74

19 Rape and Sexual Assault: Medical and Psychosocial Care 82

20 Documenting in the Notes 87

21 Law and Prosecuting Practice in Relation to Serious Sexual Assaults and Domestic Violence 90

22 Writing a Statement as a Professional Witness 93

23 Going to Court 97

24 Violation of Professional Boundaries 100

25 Moving Forward: Developing Care Pathways within the Health Service 103

26 Moving Forward: Pursuing a Career and Implementing Better Services 106

Appendix A Useful Resources 109

Appendix B CAADA-DASH Risk Identification Checklist 111

Index 115

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