A pioneer in supporting victims of domestic and sexual violence, Emmanuelle Piet, MD, is a physician specializing in maternal and child health and a gynecologist in Seine-Saint-Denis, France. She has also been an active campaigner as the president of the Feminist Collective Against Rape in France. She recalled a moment from the 1970s when a postpartum patient she had advised to abstain from sexual intercourse replied, “If you think I’m the one who decides.”

Speaking at the Paris Women’s Health Congress 2025, Piet shared insights drawn from decades of clinical experience.

Since then, she has routinely offered her patients medical certificates contraindicating sexual intercourse in the postpartum period when they reported being pressured or struggling to refuse sexual relations. She described this approach as the first step in identifying situations of abuse. “Some partners refuse to acknowledge this medical advice, and others go so far as to reject the use of lubricant — prescribed when no better option exists to ease a woman’s physical suffering — because they do not want sex to be painless,” she said.

She explained that men’s violent behavior is rooted in control. This control may involve belittlement, humiliation, social and even geographic isolation, shifting blame, and alternating between affection and hostility toward the victim. “These are the women who seem to agree with every recommendation but then do not follow through,” she said. “They miss examinations, arrive late, or are noncompliant. When clinicians look more closely, they often discover that the partner tore up the prescription or refused to bring her to the appointment.”

Pregnancy frequently marks a turning point. “For 40% of victims, violence begins during pregnancy, and for another 20%, its frequency increases,” she added. “More than a quarter of pregnancies ending in abortion are linked to domestic, sexual, or partner violence.”

After childbirth, controlling partners may continue to exert pressure by undermining the mother’s choices and actions with the newborn and criticizing breastfeeding or routine care. Because partners often attend consultations, clinicians should ensure that mothers are seen alone during the first two postpartum visits. If the father is present, a two-stage consultation can be offered, with one part conducted as a couple and the other part conducted with the patient alone. This straightforward approach can help identify partners who resist without a clear reason.

Clinical Approach

She emphasized the importance of asking open-ended questions, such as how things unfold when a woman does not want to have sex, which often allows victims to speak. Clinicians should avoid questioning how the victim reacted, even with good intentions, because this can reinforce guilt. Instead, the message should be clear: the victim is not responsible, the behavior is unacceptable, and support is available. Resource helplines, local referral pathways, and reporting options should be provided.

A medical certificate is a medicolegal document that objectively records the physical and psychological effects of violence. It may be issued by any doctor, midwife, or dentist who assumes professional responsibility for its content. When correctly completed, the certificate can be used as evidence immediately, following a court order or a victim’s complaint, or later in expert assessment or judicial proceedings. In France, online medical certificates must follow the specific templates provided by the National Council of the Order of Physicians.

Pauline Saint-Martin, MD, PhD forensic physician and professor, head of the Institute of Forensic Medicine in the University Hospital of Tours, Tours, France, reviewed the required structure.

• Identification of the healthcare professional and patient and the circumstances under which the certificate was issued, either at the patient’s request or following a judicial requirement.

• Three key dates must be specified: the date and exact time of the examination, with the time being particularly important when the assessment is performed within 48 hours; the date the violence occurred, as reported by the patient; and the date the certificate is written.

• The account of events should be concise and strictly factual, using neutral wording such as, “The patient states that she was the victim of…”

• The complaints section should list the symptoms reported by the patient at the time of the consultation, for example, “She reports…”

• Clinical examination should comprehensively document all observed physical and psychological consequences, including the type, size, shape, and anatomic location of any physical injuries; psychological effects, such as sleep disturbances or behavioral changes; and pain without visible injury, which may have later functional consequences, such as the recurrence of pain from a previous sprain following a fall caused by violence.

• Total incapacity for work is not mandatory, although it is required in cases involving judicial requisition.

Legal terms such as rape or harassment must not be used, and the perpetrator of violence must not be identified. The certificate is filed in medical records, and women who do not wish to keep it are not required to obtain a copy.

Judicial Reporting

Judicial reporting to the public prosecutor in France, which constitutes an exception to professional confidentiality, is authorized but not mandatory in specific situations under Article 226-14 of the French Penal Code.

• Reporting may be conducted with the victim’s consent when she is an adult and not in a situation of vulnerability or incapacity.

• The victim’s consent is not required if she is a minor or if she is unable to protect herself because of her age or physical or mental disability.

• When the victim is minor, reporting must always be accompanied by a safeguarding notification to the La Voix de l’Enfant association in France, which is responsible for collecting and assessing reports of children at risk and providing legal support.

• A physician may report the situation without the victim’s consent if, in conscience, the clinician considers that an adult victim is in immediate danger and under the influence of another person. When a report is made under these conditions, the physician cannot be held responsible.

The speakers reported having no relevant conflicts of interest.

This story was translated from Univadis France, part of the Medscape Professional Network.