Sexual Violence Against Women: Impact on High-Risk Health Behaviors and Reproductive Health

This Applied Research paper provides a brief overview of research on the impact of sexual violence on females’ high-risk health behaviors and reproductive health, focusing on studies of sexual assault or rape experienced primarily during adulthood.

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Sexual Violence Against Women: Impact on High-Risk Health Behaviors and Reproductive Health by Sandra L. Martin and Rebecca J. Macy with contributions from Janice A. Mirabassi (June 2009).

In Brief:

Sexual violence experienced during adulthood may impact women's behavioral health and reproductive health. Research has found that women who have experienced sexual violence during adulthood are more likely than other women to use and abuse substances, including alcohol, illicit drugs and prescription drugs. A few studies have shown that women report initiating or increasing substance use after experiencing sexual violence; however, longitudinal research in this area is needed to clearly document the relationship between sexual violence and substance use/abuse.

Adult female sexual violence survivors are more likely than other women to engage in unsafe sex practices, including having multiple sex partners, not negotiating condom use, having sex with men who do not use condoms, trading sex for money/drugs, and having sex with an HIV-infected partner. Theorists propose that the links between sexual violence and unsafe sex behaviors are due to the trauma of sexual victimization; however, longitudinal research on this topic would help to illuminate ties between sexual violence and unsafe sex behaviors.

Sexual violence survivors often experience gynecologic injuries and other types of gynecologic symptoms. These include genital-anal trauma, dysmenorrheal (severe pain during menstruation), menorrhagia (excessive/prolonged menstrual bleeding), and sexual dysfunction.

Female sexual assault survivors often have elevated levels of sexually transmitted infections (STIs), including gonorrhea, chlamydia, syphilis, herpes simplex virus, human papillomavirus, and human immunodeficiency virus. One study estimated that 20% of sexual assault survivors who did not have a STI prior to the rape developed a STI within 2 weeks after the assault.

Research estimates a U.S. national rape-related pregnancy rate of 5% per rape among females of reproductive age. Although it is clear that even pregnant women may be sexually assaulted, there is little research concerning how such assaults affect gestation and pregnancy outcomes.

In summary, research has established links between women's sexual assault experiences and their behavioral and reproductive health. More longitudinal research is needed to clearly document the timing of sexual violence victimization and these health outcomes. Moreover, since most studies in this area focus on small convenience samples of women (such as patients), more research is needed with nationally representative samples of women.

Despite the methodological limitations of this research, taken together, the results have implications for practice and policy. Given that many sexual violence survivors experience behavioral and reproductive health problems, care providers in these areas are encouraged to screen their clients/patients for sexual violence and to provide trauma-informed services to sexual violence survivors. Policy makers and funders are urged to promote collaborative efforts to implement survivor-centered services within the legal, advocacy, and health service sectors.

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