Forced sexual initiation linked to adverse health outcomes in women
Women who were physically forced or coerced into their first sexual intercourse were at increased risk for adverse outcomes in reproductive, gynecologic and general health, according to a study recently published in JAMA Internal Medicine. Researchers said one in 16 women in the United States experience forced sexual initiation.
“Discussing any form of sexual assault should be on the forefront of physician’s minds — as we’ve shown in this study, it may be crucial to understanding how to treat your patient,” Laura Hawks, MD, research fellow in the department of medicine at Cambridge Health Alliance and Harvard Medical School, told Healio Primary Care. “But providers need to be aware this is a sensitive and sometimes intrusive conversation, so trust is important. It can’t be a question that is asked merely for the sake of checking a box in the medical record.”
Hawks and colleagues analyzed responses from the National Survey of Family Growth from 2011 to 2017. The survey included a population-based sample of more than 13,000 women in the United States aged 18 to 44 years. Of those, 6.5% (95% CI, 5.9-7.1) reported forced sexual initiation, equating 3,351,733 million women nationwide.
The average age of respondents at the time of forced sexual initiation was 15.6 years (95% CI, 15.3-16), almost 2 years younger than the average age of those who reported voluntary sexual initiation, 17.4 years (95% CI, 17.3-17.5).
An unwanted first pregnancy was more common among women with forced sexual initiation compared with those who had voluntary sexual initiation (30.1% vs. 18.9%; adjusted OR = 1.9; 95% CI, 1.5-2.4), as were abortions (24.1% vs 17.3%; adjusted OR = 1.5; 95% CI, 1.2-2).
Compared with those who had voluntary sexual initiation, survivors of sexual initiation were also more likely to have endometriosis (10.4% vs 6.5%; adjusted OR = 1.6; 95% CI, 1.1-2.3), pelvic inflammatory disease (8.1% vs 3.4%; adjusted OR = 2.2; 95% CI, 1.5-3.4), and problems with ovulation or menstruation (27% vs 17.1%; adjusted OR = 1.8; 95% CI, 1.4-2.3).
Additionally, women who experienced forced sexual initiation were more likely to report illicit drug use, fair or poor health, and difficulty completing tasks due to physical or mental health conditions than those with voluntary sexual initiation.
“When we talk about sexual violence, we are really talking about a power imbalance between women and men,” Hawks told Healio Primary Care.
Hawks said the structures that uphold this imbalance need to be dismantled. These begin at home and in schools, and they can continue through college and into the workplace.
“We should also consider other common-sense measures such as informational programs to address sexual culture, consent and violence prevention skills, promotion of educational and career opportunities for women and girls, and ensuring safe environments within schools and work places.” – by Erin Michael
Disclosure: Hawks reports no relevant financial disclosures.