Trigger warning: This article contains material regarding sexual abuse and sexual trauma that some readers may find upsetting or disturbing.
Every 98 seconds someone in the U.S. is sexually assaulted, usually by someone they know well. The statistics on sexual assault are only part of the picture. What numbers and charts cannot tell you is that the legacy of sexual abuse can often lead to chronic pain. Chronic pain and sexual abuse are connected in ways that researchers are only now beginning to understand.
Sexual abuse isn’t an isolated incident
Sexual abuse is sexual activity that is unwanted, unwelcome, and unsolicited. The perpetrators of sexual abuse use threats, physical force, or the threat of physical force to take advantage of victims who either do not give consent or who are not able to give consent.
There are different types of sexual abuse and trauma.
- Sexual assault (adult or child): This includes rape, either by a single perpetrator or multiple. Rape includes any type of penetration, including oral sex.
- Partner sexual violence: 80% of sexual violence is perpetrated by someone the victim knows. Six of ten assaults occur in the house of a friend, relative, or neighbor. This is by far the most common type of sexual abuse.
- Incest: This is non-consensual sexual activity between related siblings.
- Sexual molestation: Sexual molestation is non-consensual touching of the sexual organs and the breasts.
- Sexual abuse of the elderly or disabled: This type of abuse is most often committed by caregivers.
Other less common but no less serious types of sexual abuse include:
- Sexual abuse of inmates
- Military sexual assault
- Sexual assault by or to people in the helping professions (e.g., doctors, nurses)
The process of abuse
It does not matter the type of abuse, how long it has occurred, or who the perpetrator is. Sexual abuse in any form for any period of time is a traumatic act. It has physical, emotional, and psychological effects. Although primarily seen as a physical act, sexual abuse does not occur in a vacuum.
Some victims of sexual abuse may have been “groomed” by their assailant for years, a process that creates deep psychological scars. In other cases, sexual abusers create an atmosphere of shame, silence, and isolation. Victims may feel helpless, hopeless, and deserving of the abuse they are facing.
Regardless of the circumstances, sexual abuse is linked to not only immediate physical and psychological responses but also long-term problems that include chronic pain.
What we know about chronic pain and sexual abuse
Researchers define trauma as a psychological reaction to an overwhelmingly terrible event. More and more, researchers understand that trauma can also cause a physical reaction. Researchers have noted an unmistakable link between chronic pain and the trauma of sexual abuse.
Sexual abuse can trigger chronic pain
Sexual trauma that is violent in nature (as opposed to coercive) can trigger chronic pain in a previously pain-free person. This may be a result of actual physical harm as a result of the act, or it may be a post-traumatic stress response. Although the vast majority of victims have some form of PTSD directly following their attack, as many as 50% of rape survivors experience PTSD symptoms for decades after their assault.
Part of this may be a physical response, but some of it is psychological. At its core, sexual abuse is about power and a violation of a person’s safety. Sexual trauma is a deeply damaging assault on a person’s ability to feel intimate. The body remembers this damage and may experience pain in close relationships.
Ananda Amstadter, Ph.D., an associate professor of psychiatry and psychology at Virginia Commonwealth University, notes that:
“…Since 75 percent of victims are attacked by someone they know, every person they meet and every situation they’re in can feel dangerous, making sexual assault difficult to cope with.“
That sense of safety is erased by the assailant.
The psychological effects of sexual trauma can cause not only anxiety and hypervigilance – two hallmarks of PTSD – but also chronic pain.
Sexual abuse as a cause of chronic pain
Especially in the case of childhood sexual abuse, this type of abuse can cause chronic pain in adults. Although accurate statistics are difficult to compile, somewhere between twelve and 40% of children suffer some form of sexual abuse in the U.S.
As adults, these survivors of abuse experience an elevated risk of different types of chronic pain, most commonly chronic pelvic pain. The American College of Obstetrics and Gynecology found that women who suffered both childhood and adult sexual abuse were much more likely to experience chronic pelvic pain than those women who had not survived abuse. These results were confirmed in later studies that showed statistically significant differences in the incidence of chronic pelvic pain in women who were sexually abused before their 15th birthday.
The psychological stresses of sexual abuse in early life also predisposes both men and women to chronic pain in later life, including fibromyalgia and migraine. Both men and women who survive childhood sexual abuse utilize healthcare resources at a greater rate, but sexual abuse is still often hidden behind other symptoms.
In addition to chronic pain, female survivors of sexual abuse present with other disorders, including gastrointestinal disorders and cardiovascular conditions. A hallmark of sexual abuse is also that pain perception is altered so that survivors are more sensitive to painful stimuli than those who did not surfer sexual abuse.
Sexual abuse writes its legacy on the body of the victim. Sexual abuse victims suffer not only the abuse, but also an increase in the lifetime diagnosis of somatic disorders such as gastrointestinal issues, anxiety, depression, nonspecific chronic pain, and chronic pelvic pain.
Who is most at risk?
Statistics support the idea that sexual abuse can happen to anyone regardless of age, gender, color, sexual orientation or socioeconomic status. That said, there are some risk factors that increase the chances of sexual abuse.
Women, children, and those living in a home with other forms of physical abuse are more likely to be victims of sexual abuse than other populations. Having a parent with mental health issues also increases the chances of sexual abuse.
For adults, risk factors of sexual abuse cross all demographic lines. A study in 1997 found that adults who grew up isolated in an unhappy home or lived for a time with only one parent were more at risk for sexual abuse. These two factors alone may describe at least half of all households in the U.S. today.
While things like mental or physical disability, including living with chronic pain, also increase the chances of sexual abuse, these are related risk factors not causes. Vulnerable populations e.g., those living in chronic pain) may be less able to defend themselves physically. They may also feel trapped by their condition and unable to leave an abusive situation.
Where to turn if you’re suffering from sexual abuse
It is important to recognize and note that victims of sexual abuse are not responsible for that abuse, regardless of what they wear, what they look like, or how much they have had to drink. It doesn’t matter if the victim actively fought an assailant or if they froze and were unable to move or prevent the abuse. Just as importantly, tt doesn’t even matter if the victim waits years to come forward. The most important thing is that victims are heard, supported, and helped.
By the time you finish reading this article, an average of six people in the U.S. will have experienced sexual abuse. If you are a current or former victim, get help. Starting today, take the following steps.
Step 1: If you are in a relationship with abuse, plan your exit
If you are experiencing sexual abuse in a relationship, plan your way out of that relationship. Many victims stay because they feel they have nowhere to go and no money to get there. A number of organizations offer emergency shelter, assistance, or information, including the following.
This is the largest anti-sexual violence organization in the U.S. They provide a 24/7 lifeline via phone or online and can help direct you to a local organization for further assistance. RAINN has provided help to over 2.5 million sexual abuse victims since 1994.
RAINN can put you in contact with emergency shelters. They can also contact local agencies that can physically assist you to leave your home.
Animal Welfare Institute
Many victims of sexual abuse or domestic violence stay because their abuser threatens to harm their pets. Use the Animal Welfare Institutes’ search tool to find a safe haven for your pet as well.
Step 2: Take immediate steps to ensure your safety
The period of time directly after an assault can be confusing, shocking, painful, numbing, or any combination of feelings. You may feel guilt. You might be in pain. And, you may feel frozen and unable to take action. If nothing else, call the RAINN 24/7 hotline at 1-800-656-HOPE. Their counselors will be able to provide whatever you need at that moment to help you take your next step.
Next, if you have a trusted friend you can call, call them and have them help you to the nearest emergency room, preferably one who staffs Sexual Assault Nurse Examiners (SANEs). These nurses are specifically trained to be gentle and slow in their treatment of victims.
Not everyone wants or can stomach a physical exam directly after an assault. It’s important to find medical providers who understand that. Gail Abarbanel, LCSW, director of the Rape Treatment Center at UCLA Medical Center – Santa Monica, instructs her staff to ask questions first before making any decisions: “The first thing we’ll do is figure out what [has happened] and explain what we do…different victims want different kinds of treatment.”
Some victims may choose not to report their assault. Many medical clinics will, with the victim’s permission, collect DNA samples when possible and freeze them in case the victim changes their mind. It’s important to remember that, as the victim, you get to choose how to proceed. Having a trusted friend with you can help you to advocate for yourself during this time.
Step 3: Get follow-up care
Follow-up care is a crucial part of recovery from sexual abuse. For victims of sexual assault, this may include follow-up physical exams to make sure that the body is healing properly. However, for all survivors of sexual abuse or trauma, follow-up care should include some form of therapy.
Therapy can help survivors of sexual abuse to release the guilt or fear they may continue to carry with them for years after their abuse. There are a number of specific therapies that can help survivors deal with the effects of abuse, including:
- Trauma-focused cognitive behavioral therapy (CBT)
- Eye movement desensitization and reprocessing (EMDR)
- Somatic experiencing (SE)
It may take some time to figure out which therapy will work, but it is important to seek help as soon as possible to begin to release the trauma and heal. There are even free online therapy options to begin this work in a more anonymous setting, but do use these selectively, especially as you’re getting started since many aren’t staffed by professional therapists.
If you are or were the victim of abuse, reach out today. Take the first step, whether that is:
- Telling a trusted friend, family member, or partner your experience
- Getting treatment for your chronic pain
- Looking for a qualified therapist
The sooner you start the process, the sooner you can give yourself the care you deserve and help release some of the pain your body has held onto.
The compassionate care providers at Pain Doctor offer trauma-informed chronic pain care. Get in touch today.