Silence Hurts
Alcohol Abuse and Violence Against Women

Supplements

Assessing Sexual Abuse

Have you ever experienced sexual abuse?1

Check off any that apply during this particular relationship. Please use the following codes:

1 = Has not occurred
2 = Threatened
3 = Once
4 = Two to four times
5 = Five or more times, frequently

_____ Unwanted sexual advances
_____ Unwanted sexual gestures
_____ Using power to take advantage of a relationship
_____ Unwanted, direct requests that are sexual in nature
_____ Atmosphere that is hostile towards women
_____ Touching clothing and body areas in a sexual manner
_____ Unwanted or rough touching of genital areas
_____ Any sexual touching of minors
_____ Forcing vaginal intercourse, with or without orgasm
_____ Forcing oral sex
_____ Forcing anal sex
_____ Inserting objects into genitals
_____ Forcing masturbation
_____ Rough sex causing genital bruises or mutilation
_____ Forcing prostitution
_____ Forcing pornography
_____ Forcing sex with other people
_____ Forced viewing of others having sex
_____ Sexual contact with those who are known or suspected of having STDs
_____ Sexual contact when HIV positive
_____ Other sexual abuse

[1] Created by Dr. Lenore Walker, Domestic Violence Institute, Denver Colorado.

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