Childhood Sexual Abuse and Adulthood Gynecological Issues
CW/TW: mention of childhood sexual abuse
There are a lot of stigmatized topics in the discourse of sex and relationships. One of the subjects that is often ignored is sexual health. Although there are some areas that are more openly discussed, like sexually transmitted diseases or prevention of unwanted pregnancies, other areas generally lack open discussions. I am talking about gynecological health in particular. Gynecology had for a long time been limited to the occasional cancer diagnosis and pregnancies. Conditions like PCOS, PMS and PMDD, vaginismus and different pain and discomfort experiences are understudied. It is not surprising though, with centuries of misogyny in the hard sciences and a focus on the male anatomy whenever medical issues were addressed (the wandering uterus, anyone?).
More so, the gynecological health of survivors of sexual abuse during childhood has long been ignored. Sexual abuse is still a very stigmatized topic, and especially when it has happened during childhood. Many feel discomfort talking about it or bringing it up, and that includes medical professionals. Add to that the fear of speaking up among survivors, repressed or dissociated memories and that many survivors avoid going to a gynecologist in the first place because of potential triggers. So we have a huge group of women who do not get support, who get the wrong support and who face double stigma for having gynecological issues and being survivors of sexual trauma.
Before continuing, I want to clarify that I am talking about women who had a female reproductive system when they were children, and still have that female reproductive system during adulthood. So this includes everyone on the gender spectrum with that particular characteristic, and excludes anyone who had gender reassignment surgery. The reason for that is that there is no research on those groups in the areas of childhood sexual abuse and adulthood sexual and hormonal conditions just yet. And my own experiences might not apply to those particular physical bodies. This is not meant exclusionary or to judge, but to make sure that I don’t speak on the behalf of those who don’t share my experiences. And so that I can base some of my thoughts on available scientific research.
My Gynecological Issues
I have been having gynecological issues for most of my life. But because I don’t trust medical professionals much and I do not like being naked around others or anyone touching me, I hadn’t been to a gynecologist before the age of 23. And I only went because I hadn’t had my period for five months and was concerned. That is when I got diagnosed with PCOS for the first time. And because men still think that women are just overreacting, I was diagnosed three additional times, every time by a male gynecologist. I had the cameras inside me, I had blood drawn and all my hormones checked. Knowing that I have PCOS, I thought that most of my issues must surely come from that condition. Only, they did not.
I ended up in the ER a couple of times in my 20s with severe pelvic pain, and the same happened a few times in my 30s too. But every time, they didn’t find anything. There was nothing wrong with me, there was nothing found and I was sent home with painkillers. I have had periods with huge amounts of discharge but yet again, there was nothing found to be wrong with me. And every time I have a yeast infection, I get quite extreme symptoms. Also, I get a lot of yeast infections out of nowhere although I am following all the advice there is to follow.
And there is the issue with sexual pleasure. I am either hypersensitive or I feel nothing at all. I can get an orgasm within ten seconds or whatever I get after 20 minutes is not very relieving. There are times when sex feels extremely uncomfortable and even painful, and other times, I feel absolutely nothing. I can have a penis inside me and I am numb down there. I couldn’t tell you if something was there or not.
And I thought all this was related to my PCOS. And my bipolar disorder which can give you periods of certain moods and symptoms that also affect your sexuality and libido. But it has only been after supporting many women who have been through abuse during childhood and who described similar issues, that it got me thinking. Maybe there is a correlation between sexual abuse during childhood and issues with your gynecological health during adulthood?
Childhood Trauma and Physical Health
I knew that there is a general understanding that a traumatic upbringing can lead to physical and mental health conditions during adulthood. Chronic pain conditions, chronic fatigue syndrome, thyroid conditions, IBS, diabetes, cancer, heart issues. They all have a much higher prevalence among childhood trauma survivors than the general population. You can put a lot down to somatization, of course. Emotional pain often expresses itself in physical pain. But there are also a lot of studies that talk about the consequences of a constant threat response, adrenaline and hormonal dysfunctions, and the sympathetic and parasympathetic systems. Chronic stress messes up your body in the long term.
Chronic stress can increase inflammation in the body, and inflammation has been associated with a broad range of illness, including cardiovascular disease and autoimmune diseases, says Roberts. Early trauma disrupts the inflammatory system. This can lead to long-term aberrations in this system and chronic health problems triggered by constant inflammation. Typically, the more trauma you’ve experienced, the worse your health is.Source
Childhood Sexual Abuse and Adulthood Gynecological Issues
So it makes sense that this sort of response would also affect your gynecological health. But not only that, the actual physical trauma can lead to a lot of physical issues as well. I know that most would assume that I am talking about actual tears and injuries. But it is not that. The human body is pretty adjustable, and especially if it is a muscle like the vaginal canal is. The horror images of little girls needing emergency surgery to get stitched back together are not very common in reality.
Yes, there is pain and there is injury but it is not as severe as one might image most of the time, especially if the sexual abuse is long-term. So while there are obvious signs that can be seen in survivors of sexual trauma, they are not something that are a “proof” of anything having happened. And believe me, every time I question my own memories or want to deny that sexual abuse happened during my childhood, I want to use it as an argument. My vagina looks pretty normal, only a few tears here and there. Those can have happened easily differently. But that is a false argument. Sexual abuse during childhood does not necessarily show in physical evidence like that.
I think a lot of women do not know that certain issues that they have can come from sexual abuse during their childhood. Shame, guilt and denial are strongly linked here, and repressed memories and dissociation are a reality for many. So if you are not even much aware of the things that have happened in your past, how can you make the connection? I know that there has been a lot of lobbying against the idea of repressed memories and dissociative amnesia. There is still a general idea in society that they are questionable concepts. But the theory of repressed memories and dissociative amnesia being made up has been disproved by scientific research and studies, and the lobbygroup has been dismantled a few years ago.
So there are probably millions of adults worldwide who have been through abuse during their childhoods who either don’t remember or think they are lying and must be making it up. And I think that could be one of the reasons why the research into the topic of correlation between that sort of abuse and adulthood gynecological issues has only just started. People don’t talk about it and definitely wouldn’t just bring it up with their doctor. So the vast effect on a lot of gynecological issues was not obvious for a long time.
Let me give you some numbers that are based on research and are not just taken out of the air. Estimates of the prevalence of childhood sexual abuse among females in the general population vary from 7% to 38%. Rates of up to 62% have been reported when abuse not involving contact is included (such as exhibitionism or obscene phone calls). For most survivors the abuse was not a one time occurrence but happened over many years. The abusers were often close family members, with fathers, grandfathers and uncles being the most common perpetrators. Most cases are never brought up with medical professionals or reported, due to shame, guilt and fear. What is important to note is that most women who have been through sexual abuse during childhood also have been through emotional and other physical abuse. So in what way certain kinds of abuse affect long term medical issues, can be difficult to differentiate. (source)
One interesting and very worrying fact is that girls who have been sexually abused during childhood, and also been through other kinds of abuse, tend to start puberty earlier, for example grow breasts at an earlier age, they get their period earlier. Scientists suggest that it has to do with a malfunctioning hormonal response. If you are under constant threat, it has an effect on your physical health and your systems works as if you need to defend yourself all the time. The body’s evolutionary goal and use is to procreate. So if there is a threat that you might not live long, the body wants to get you ready to bear children as quickly as possible before you die. It is really sad, when you think about it.
Studies have shown that there are many gynecological conditions that are a lot more prevalent among childhood sexual abuse survivors than they are in the general population of women. These include incontinence, PMS, PMDD, vaginismus, pelvic pain conditions, yeast infections, heavy discharge, dyspareunia (pain during intercourse), complications during pregnancy, anorgasmia (inability to orgasm), dyuria (pain when urinating), heavy periods (Menorrhagia), problems passing urine, dysmenorrhoea (painful menstruation), cervical and ovarian cancer and a low libido. (source) The list is long and based on several studies examining the correlation between childhood sexual abuse and adulthood gynecological issues.
A lot of these issues and conditions could have physical causes. I wouldn’t want anyone to dismiss something because they have been through abuse during childhood. Psychosomatic issues can also cause many of those conditions, as in current anxiety issues or fears. But there is strong evidence that if you have been through sexual childhood abuse, you might end up with a lot of physical conditions in the future, and those include gynecological issues.
I am not sure how the knowledge of the connection between childhood sexual abuse and adulthood gynecological issues is already affecting treatment or will affect treatment in the future. But I believe it is yet another reason to for society to put a lot more effort into preventing or disrupting abuse during childhood. Not only because of the future sufferings of those victims, but also because, logically, it would even save money in the health care system (because sadly that is the incentive decision makers often need. It is all about the money).
As for me personally, it is all still a very confusing topic. The nature of my trauma is difficult for me to comprehend and there are many days that I am questioning if I am making it all up, or if I am faking my current illnesses. But then I get the pelvic pain or the discharge, and I get reminded of that something just isn’t right with me, and that there is no denying of it.