CONTENTS
- The World Takes Notice
- Intimate Partner Abuse
- Sexual Coercion
- Impact on Reproductive Health
- Threats to Health and Development
- Health Providers Play a Key Role
- An Agenda for Change
HIGHLIGHTS
- What lies behind violence?
- Culture: a double-edged sword
- Child sexual abuse is widespread
- Violence harms women in many different ways
- *Pullout guide: What Health Providers Can Do
- Responding to violence: Lessons learned
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The Center for Health and Gender Equity (CHANGE) is a research and advocacy organization that seeks to integrate concern for gender equity and social justice into international health policy and practice. CHANGE staff can be reached by e-mail at change@genderhealth.org or at http://www.genderhealth.org.
December, 1999
Series L, Number 11
Issues in World Health
Violence Increases Risks for
Other Gynecological Problems
Although chronic pelvic pain is commonly caused by adhesions, endometriosis, or infections, about half the cases of chronic pelvic pain do not have any identifiable pathology. A variety of studies have found that women suffering from chronic pelvic pain are consistently more likely to have a history of childhood sexual abuse (456), sexual assault (80, 90, 125, 230, 369), and/or physical and sexual abuse by their partners (401, 403).
Past trauma may lead to chronic pelvic pain via unidentified injuries, by stress, or by increasing women's susceptibility to somatization, the expression of psychological distress through physical symptoms (125, 145, 259). Also, sexual abuse in childhood has been linked to increased sexual risk-taking and thus to STIs, which can lead to chronic pelvic pain, often due to pelvic inflammatory disease.
Other gynecological disorders associated with sexual violence include irregular vaginal bleeding (180), vaginal discharge, painful menstruation (184, 230), pelvic in- flammatory disease (402), and sexual dysfunction (difficulty in orgasms, lack of desire, and conflicts over frequency of sex) (184, 402, 403). Sexual assault also increases risk for premenstrual distress, a condition that affects 8% to 10% of menstruating women and causes physical, mood, and behavioral disruptions (183). The number of gynecological symptoms appears to be related to the severity of abuse suffered, whether there was both physical and sexual assault, whether the victim knew the offender, and whether there were multiple offenders (181, 182).
