By conservative estimates, one out of every four women in our country is sexually abused before reaching 18 years of age. The definition of sexual abuse includes rape, molestation, and/or incest. The experience of this type of abuse typically causes profound psychological trauma which reaches into adulthood.
The development of post-traumatic stress disorder (PTSD) frequently occurs as a response to the terrifying, uncontrollable, and overwhelming nature of the sexual violation. Sexually traumatic experiences may later globally affect areas of sexual expression, and influence the development of personality. As awareness of the problem of sexual trauma in women grows, women’s health care providers are frequently incorporating a history of sexual trauma into the routine health history portion of the physical examination.
An increasing body of literature exists examining the relationship between the history of sexual trauma and a variety of somatic physical complaints. A small number of articles exists, anecdotal in nature, examining the labour and delivery experiences of women with a history of sexual trauma. Very little research exists examining the relationship between sexual abuse and a woman’s antenatal experience of pregnancy. Before practitioners can address the needs of pregnant women with a history of sexual trauma, their understanding of those special needs must be expanded.
At this time, practitioners are unable to definitively state that the standard of care offered pregnant women is appropriate and sufficient to meet the needs of those with a history of sexual abuse. Until more is understood about the experience of pregnancy for these women, practitioners will continue to have difficulty addressing this issue meaningfully. It is difficult to obtain an accurate estimate of the incidence of sexual abuse of women in our country. When individuals believe they have a condition that society in general views with disgust, the natural tendency is to conceal that condition. Certain experiences carry with them an associated stigma and shame. Sexual abuse is one of these experiences.
Because of the stigma associated with being a victim of sexual abuse, too frequently women are not asked about this history and may feel too much shame to volunteer such information. Additionally, psychological defence mechanisms, such as repression and dissociation, may make it difficult to identify women with a history of sexual trauma. Fortunately, this is changing as health care practitioners become aware of the prevalence of sexual abuse among women and children in our country, and are incorporating sexual abuse screening into routine care.