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Construction and validation of an instrument that breaks the silence: the impact of domestic and/or sexual violence on women’s health, as shown during climacterium

Teixeira de Araújo Moraes, Sandra D. MD, PhD; da Fonseca, Ângela Maggio MD, PhD; Soares, José M. Jr MD, PhD; Bagnoli, Vicente R. MD, PhD; Souza, Marilena A. MD; Ariê, Wilson Maça Yuki MD, PhD; Baracat, Edmund Chada MD, PhD

doi: 10.1097/gme.0b013e3182214e12
Original Articles

Objective: The aim of this study was to construct and to validate a measure of the consequences of domestic violence on women’s health during climacterium.

Methods: A questionnaire was administered at the Outpatient Climacterium Clinic to 124 women aged 40 to 65 years who were the victims of domestic and/or sexual violence (experimental group). They were divided into three groups: (1) those who were victims of violence exclusively during childhood/adolescence, (2) those who were victims of violence exclusively during adulthood, and (3) those who were victims of violence throughout their lives. The instrument included 34 items evaluating the beginning, frequency, and type of violence; the search for health assistance and reporting of the violence; the violence and the number of comorbidities; and violence and the Kupperman Menopausal Index. We also included a control group composed of perimenopausal and postmenopausal women who did not experience any violence (n = 120).

Results: The instrument presented a Cronbach α = 0.82, good reliability among the examiners (+0.80), and a good possibility of reproducibility. The mean age of menopause was 45.4 years, and the mean age in the control group was 48.1 years. Group 1 showed a mean of 5.1 comorbidities, Group 2 had 4.6, and Group 3 had 4.4. Sexual violence (43.5%) and other types of violence both presented average comorbidities (4.60) but represented a significant impairment in the victim’s sexual life. There were significant associations in group 3 and a high Kupperman Menopausal Index score. In the experimental group, 80.6% did not seek health services for the violence they experienced.

Conclusions: The questionnaire presented good internal consistency and a validated construction. It can be easily reproduced and is indicated to evaluate the consequences of domestic and/or sexual violence on women’s health during climacterium.

This questionnaire evaluates the consequences of domestic and/or sexual violence on women’s health during climacterium.

From the Department of Gynecology, General Hospital, Medicine College, University of São Paulo, São Paulo, Brazil.

Received March 1, 2011; revised and accepted April 25, 2011.

Funding/support: This study was supported by the National Council for Scientific and Technological Development.

All authors contributed to the study design and implementation, data interpretation, and manuscript writing.

Financial disclosure/conflicts of interest: None reported.

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Address correspondence to: Sandra D. Teixeira de Araújo Moraes, MD, PhD, Av. Dr Enéas de Carvalho Aguiar, 255, 10° andar, CEP: 05403-000, São Paulo, SP, Brazil. E-mail:;

©2012The North American Menopause Society