The Health-Corrosive Effects of Sexual Coercion

"With millions of girls and women experiencing rape at their first sexual encounter, we urgently need a cultural change in gender relations."
"It has to begin with every public and private sphere, including medicine, valuing females and males as equals."
Dr.Steffie Woolhandler, primary care physician, professor, Hunter College, City University, New York

"Our findings would not have been influenced by the major cultural shift of the past two years. [The project] was spawned by our curiosity in keeping with the increased dialogue [around the prevalence of sexual violence."
Dr.Laura Hawks, research fellow, Cambridge Health Alliance, Harvard Medical School

"Our findings are compatible with the hypothesis that experiencing sexual violence at a time of heightened psychological and physical vulnerability [could have long-term negative effects]."
Study, published in JAMA Internal Medicine

"This study quantifies what we see ... every day, including the ways that sexual harassment, abuse, and assault are inextricably linked with health problems."
"Rape and sexual assault are much more common than generally recognized, and the effects on long-term health can be significant."
"This new study should underscore the need for all clinicians to be trained in providing care that is trauma-informed, meaning that the provider has the skills to responsibly and compassionately provide care and treatment so survivors feel supported rather than re-traumatized."
Gina Scaramella, executive director, Boston Area Rape Crisis Center

Getty Images

Forced sexual encounters have a disturbingly haunted and sinister effect on girls and women, preying on their mental health with a loss of emotional equilibrium that is long-lasting. A new study out of Harvard Medical School saw researchers estimate that approximately one in 16 women in data they studied had been coerced or physically forced into an experience they neither initiated nor wanted to occur, representing their first encounter with sex. In itself perhaps not as surprising as the deleterious health connection with those encounters and an increased likelihood of an unwanted first pregnancy or abortion, as follow-up.

According to the study published a week ago in JAMA Internal Medicine, 6.5 percent of women in the United States aged 18 to 44 years had experienced a forced initiation into sex. Those forced or coerced were in a younger age group and tellingly had a wide age difference with their rapist. The study arrived at an average age a woman would have been forced into a sexual encounter as her introduction to sex at 15.6, while the man assaulting her on average would be 27 years of age.

The National Survey of Family Growth, a survey conducted bi-yearly by the Centers for Disease Control and Prevention, represented the basis of the study analysis of the data collected between 2011 and 2017. The main purpose of the study was to determine the consequences of forced sex as an initial experience on long-term health, building on previous research that had associated forced sex encounters with an increase of sexually transmitted infections.

Additional findings were that women, coerced into sex as their initiating experience were subsequently likelier to have an unwanted first pregnancy, abortion, avoidance of birth control, diagnoses of pelvic inflammatory disease, endometriosis, ovulation or menstruation problems. In addition, these women were likely to report having difficulty in completing tasks as a result of a physical or mental condition, and just generally being in poor to fair health.

The National Survey of Family Growth, whose collected data formed the basis of the study results was based on 13,310 participants sorted into two groups based on responses to a specific question: Was your first vaginal intercourse "voluntary or not voluntary, that is, did you choose to have sex of your own free will or not?" Anyone reporting that first sexual encounter as not voluntary rated further questions respecting the method of coercion:

• Did you do what he said because he was bigger than you or a grown-up and you were young?
• Were you told that the relationship would end if you didn't have sex?
• Were you pressured into it by his words or actions, but without threat of harm?
• Were you threatened with physical harm or injury?
• Were you physically hurt or injured?
• Were you physically held down?

Verbal pressure was reported by 56.4 percent while 46.3 percent reported they were physically restrained. Half of those reporting non-voluntary sexual initiation stated they were coerced by someone bigger or older than they were, and 22 percent stated they were given a drug. Physical threats were reported by 26.5 percent, and 25 percent reported experiencing physical harm at the time they were coerced into a sexual encounter.

"These findings demonstrate that involuntary sexual experiences are often related to verbal or emotional coercion rather than physical force, while still having potentially powerful and negative consequences", responded two public health researchers at the University of California, San Francisco Department of Medicine, Drs. Alison Huang and Carolyn Gibson.

As for the most disturbing aspect of the study, according to researcher Dr. Hawks, was the revelation that women raped at sexual initiation were younger on average, while their assailants were older in comparison to couples who voluntarily became sexually active, women choosing their initial sexual encounters at 17.4 years of age, their male partners averaging 21 years of age. As compared to those who had been coerced, on average 15.6 years old, their aggressors 27. "That's just a very disturbing age and power discrepancy that we have to get our heads around", Dr. Hawks commented.

Perhaps predictably, women and girls of colour and those who live in poverty were somewhat likelier to experience forced sexual initiation. On the other hand, women of all races, ethnicities and income levels and social strata are at risk, pointed out Dr. Steffie Woolhandler, the study co-author. A previous analysis of data from the 1995 National Survey of Family Growth found that 9.1 percent of women ages 15 to 24 spoke of their first intercourse as non-voluntary.

The study authors concluded that health problems persisted not only with women who had been raped as children, but negative effects occurred subsequently irrespective of age at forced sexual initiation.

In this Jan. 20, 2018 photo, a marcher carries a sign with the popular Twitter hashtag #MeToo used by people speaking out against sexual harassment as she takes part in a Women's March in Seattle. According to a study published Monday, the first sexual experience for many U.S. women was forced or coerced intercourse in their early teens. (Ted S. Warren/Associated Press)