Background: Sexual and reproductive healthcare services (SRHS) are an environment where medical care relevant to sexual violence and abuse (SV) is available. However, barriers to disclosure need to be overcome to allow timely access to this care. There is limited research identifying and explaining how interventions remove barriers and create a safe and supportive environment for disclosure. The purpose of this review was to develop and refine theories that explain how, for whom and in what context SRHS facilitate disclosure. Methods: Following published realist standards we undertook a realist review. After focussing the review question and identifying key contextual barriers, articles pertaining to these were identified using a traditional systematic database search. This strategy was supplemented with iterative searches. Results: Searches yielded 3172 citations, and 28 articles with sufficient information were included to develop the emerging theories. Four evidence-informed theories were developed proposing ways in which a safe and supportive environment for the disclosure of SV is enabled in SRHS. The theories consider how interventions may overcome barriers surrounding SV disclosure at individual, service-delivery and societal levels. Conclusions: Benefits of SRHS engagement with health promotion and health activism activities to address societal level barriers like lack of service awareness and stereotypic views on SV are presented. Although trauma informed practice and person-centred care were central in creating a safe and supportive environment for disclosure the review found them to be poorly defined in this setting.

背景：性与生殖保健服务 (SRHS) 是提供与性暴力和性虐待 (SV) 相关的医疗护理的环境。然而，需要克服披露障碍，以便及时获得这种护理。识别和解释干预措施如何消除障碍并为披露创造安全和支持性环境的研究有限。本次审查的目的是发展和完善理论，解释 SRHS 如何、为谁以及在什么情况下促进披露。方法：按照已发布的现实主义标准，我们进行了现实主义审查。在聚焦评论问题并确定关键的上下文障碍后，使用传统的系统数据库搜索来识别与这些障碍相关的文章。该策略辅以迭代搜索。结果：搜索产生了 3172 次引用，并纳入了 28 篇具有足够信息的文章来发展新兴理论。开发了四种基于证据的理论，提出了在 SRHS 中为披露 SV 提供安全和支持性环境的方法。这些理论考虑了干预措施如何克服个人、服务提供和社会层面的 SV 披露障碍。结论：提出了 SRHS 参与健康促进和健康行动主义活动的好处，以解决社会层面的障碍，如缺乏服务意识和对 SV 的成见。尽管创伤知情实践和以人为本的护理对于创造一个安全和支持性的披露环境至关重要，但审查发现它们在这种情况下的定义不明确。