Childhood Sexual Abuse Childhood sexual abuse has a profound and potentially lifelong effect on the survivor. Although most cases of childhood sexual abuse are not reported by the survivor or her family, it is estimated that as many as one-third of adult women were sexually abused as children. Childhood sexual abuse is often accompanied by another type of household dysfunction, such as physical abuse, violence against other family members, or substance abuse by parental figures (114). Younger children are more often exposed to genital fondling or noncontact abuse (exhibitionism, forced observation of masturbation, or posing in child pornography), and children older than 10 years of age are more likely to be forced to have intercourse or oral sex (119). As children age, they are more likely to experience sexual abuse outside the home and more likely to be victimized by strangers. As adolescents, women survivors of childhood sexual abuse are at risk for early unplanned pregnancy, STDs, prostitution, further sexual abuse (revictimization), antisocial behavior, running away from home, lying, stealing, eating disorders and obesity, and multiple somatic symptoms (120). These women are more likely to engage in health risk behaviors such as smoking, substance abuse, and early sexual activity with multiple partners (121). They may be less likely to use contraception (122). Survivors often avoid pelvic examinations and are less likely to have Papanicolaou (Pap) tests because of the association between vaginal examinations and pain (125). They often receive inadequate prenatal care and are more likely than women who were not abused to experience suicidal ideation and depression during their pregnancies and to deliver smaller and less mature babies (114).
Obstetrician–gynecologists can assist their sexual assault patients by validating their feelings and concerns and giving them control over their examination. It is important to ask the patient for permission to perform the examination, give her the opportunity to have an advocate in the room with her, and let her know that she has the right to stop the examination at any time (114).
Survivors may be unable to trust or establish rapport with adults. Some women blame themselves for the abuse and come to believe that they are not entitled to assistance from others. Thus, they risk continuing to enter abusive relationships. Women survivors of childhood sexual abuse often develop feelings of powerlessness and helplessness and may become chronically depressed. They experience a high incidence of self-destructive behavior, including suicide and deliberate self-harm, such as cutting or burning themselves (114,124,125). The most extreme mental health symptoms in assault survivors are associated with the onset of abuse at an early age, frequent abuse over a long period, use of force, or abuse by a parent or other trusted individual. Survivors are at risk for becoming victimized again later in life (126). Of women who report being abused as children, 50% are abused again as adults. Women who are sexually abused as children carry the effects of abuse into adulthood. As adults, they have the same level of physical symptoms and psychological distress as women who do not report childhood sexual abuse but are currently experiencing sexual or physical abuse (127).
Women who were sexually abused as children or sexually assaulted as adults often experience sexual dysfunction and difficulty with intimate relationships and parenting (128).