Talking to your doctor about an abusive relationship

When Jayden called our clinic to talk about worsening migraines, a medication change was one potential outcome. But moments into our telehealth visit, it was clear that a cure for her problems couldn't be found in a pill. "He's out of control again," she whispered, lips pressed to the phone speaker, "What can I do?"

Unfortunately, abusive relationships like Jayden's are incredibly common. Intimate partner violence (IPV) harms one in four women and one in 10 men in the United States. People sometimes think that abusive relationships only happen between men and women. But this type of violence can occur between people of any gender and sexual orientation.

Experiencing abuse can be extremely isolating, and can make you feel hopeless. But it is possible to live a life free from violence. Support and resources are available to guide you toward safety — and your doctor or health professional may be able to help in ways described below.

What is intimate partner violence?

Intimate partner violence (IPV) isn't just physical abuse like kicking or choking, though it can include physical harm. IPV is any emotional, psychological, sexual, or physical way your partner may hurt and/or control you. This can include sexual harassment, threats to harm you, stalking, or controlling behaviors such as restricting access to bank accounts, children, friends, or family.

If this sounds like your relationship, consider talking to your doctor or health care professional, or contact the National Domestic Violence Hotline at 800-799-SAFE.

What does a healthy relationship look like?

Media images show us uniformly blissful relationships, but perfect relationships are a myth. This culture can make it difficult for us to recognize unhealthy characteristics in our own relationships. Respect, trust, open communication, and shared decisions are part of a healthy relationship. You should be able to freely participate in leisure activities or see friends without fear of your partner's reaction. You should be able to share your opinions or make decisions without fear of retaliation or abuse. Sexual and physical intimacy should include consent — meaning that no one uses force or guilt to compel you to do things that hurt you or make you feel uncomfortable.

How can a health professional help me?

Health professionals like doctors or nurses can take a history and assess how the abuse may be affecting your health, well-being, and safety. Trauma from IPV can cause visible symptoms, like bruises or scars, as well as more subtle symptoms like abdominal pain, headaches, trouble sleeping, or symptoms of traumatic brain injury. Health professionals can also provide referrals to see specialists, if needed.

With your consent, health professionals can take a detailed history, examine you, and document the exam findings in your confidential medical record. Let them know if you are concerned that your partner will view your medical record, so measures can be taken to keep it confidential. This documentation can help to strengthen a court case if you decide to pursue legal action in the future.

Additionally, you may be at risk for pregnancy or certain sexually transmitted infections (STIs). A health professional can perform tests for STIs or pregnancy and offer birth control options. Some forms of birth control are less easily detected by your partner, like an IUD, or a contraceptive implant or injection.

Health professionals can help you develop a safety plan if you feel unsafe. They can also help connect you with social services, legal services, and specially trained advocates. If you would like, health professionals can also connect you with law enforcement to file a report.

What is a sexual assault exam?

If you have experienced sexual assault within 120 hours (five days), you may be offered a sexual assault medical examination. This exam is voluntary. It is performed by a trained health professional and may include a full body exam, including your vagina, penis, or anus. It may also include taking blood, urine, or body surface samples and/or photographs that could be used during an investigation or legal action. You may be prescribed medication that could prevent infections or a pregnancy. You can click here to learn more about the sexual assault exam.

What can I expect if I talk to a health care professional about IPV?

Health professionals should listen to you supportively and without judgment. While not all health professionals are trained in trauma-informed care, it is your right to be treated with respect and empathy to help you feel safe and empowered. You should not be pressured to do anything you don't want to do. And this shouldn't change the care you receive. You have the right to decline any care you are not comfortable with. You get to decide how you want to proceed after you share information with your health care professional, whether that means seeking out legal support, making a safety plan to leave the relationship, or choosing to stay in the relationship and be connected to ongoing support. And you can choose not to share information about abuse at all.

Will the conversation be private and confidential?

These discussions should occur with you and your health professional in a private space. If your abusive partner accompanies you to your appointment, your health professional may ask them to leave the examination room for a period of time so that you have the privacy to talk openly. You can also ask to speak with the health professional alone.

In most cases, discussing your experiences with your health professional is confidential under HIPAA. All states have laws that protect children, elders, and people with disabilities from abuse of any kind. Your health professional is obligated in certain circumstances to report abuse, such as violence against a minor or vulnerable adult. However, only a few states require health professionals to report intimate partner abuse.

Where can I find more resources on IPV?

Want to learn more about IPV and how to seek help?

If you or someone you know you is at risk, call the National Domestic Violence Hotline at 800-799-SAFE (7233) or 800-787-3224. This hotline is for anyone, regardless of race, sex, ethnicity, gender identity, sexual orientation, religion, or ability.

If you are unable to speak safely, you can visit thehotline.org or text LOVEIS to 22522. They are available 24/7 by phone or with a live chat, and can work with you to find help in your area.

• RAINN (national resource for sexual assault and violence)
• Love Is Respect (national resource for dating violence)
• WomensLaw.org (legal information for women experiencing domestic violence)
• LGBT National Help Center (LGBTQ+ resources, including chat and peer counseling).