One in four women may experience a form of early life sexual trauma, with potentially long-lasting consequences on their health and functioning. Past research has suggested that women who are victims of sexual trauma or abuse may be at increased risk of genitourinary health problems [1,2]. However, these studies have focused almost exclusively on health outcomes in reproductive age women, with almost no research addressing potential long-term effects later in life. To address this gap, our study aimed to examine the prevalence of two types of potentially traumatic early sexual experiences in a nationally representative sample of community-dwelling older U.S. women and investigate their associations with late life symptomatic genitourinary dysfunction. We hypothesized that early exposure to sexual trauma would be associated with more frequent or persistent genitourinary symptoms in older age.

We analyzed cross-sectional data from U.S. women aged 50 years and older in the second wave of the National Social Life, Health, and Aging Project, a national cohort of older community-dwelling U.S. adults. During home-based visits from 2010-2011, women answered standardized questions about exposure to two forms of early sexual trauma: a) childhood sexual abuse (being touched sexually before age 12), and b) unwanted first sexual experience (forced or coerced first sexual intercourse). Women also answered structured self-report questions about the presence and frequency of: a) urinary incontinence and b) other urinary symptoms (such as feeling of incomplete emptying, slow urinary stream, straining to begin voiding, or difficulty in postponing urination). For this analysis, urinary incontinence and other urinary symptoms were classified as being clinically significant if they occurred at least a few times a month. Women also answered questions about the presence of genital/sexual dysfunction symptoms in the past 12 months, including trouble lubricating, not finding sex pleasurable, and experiencing physical pain during intercourse (if sexually active). Genital/sexual symptoms were considered clinically significant if participants reported experiencing them for a several month period in the past year. Multivariable logistic regression models examined the odds of each genitourinary outcome predicted by each form of early life sexual trauma, adjusting for age, race/ethnicity, and education as demographic covariates that might confound associations.

Of 1,745 women (age range 50 to 91 years), 11% reported a history of childhood sexual abuse and 39% an unwanted first sexual experience. Forty-one percent reported urinary incontinence and 17% reported other urinary symptoms at least a few times a month, and 26% had trouble lubricating, 10% experienced pain during sex, and 17% did not find sex pleasurable for at least several months of the past year. In multivariable models, childhood sexual abuse was associated with late life pain during sexual activity [OR 1.9, 95% CI 1.1-3.3] and other urinary symptoms [OR 1.9, 95% CI 1.2-3.1]). Unwanted first sexual experience was also associated with late life symptoms of lack of pleasure with sex [OR 1.7, 95% CI 1.1- 2.5]), but not urinary incontinence or other urinary symptoms in adjusted analyses [Table 1].

Our study identified associations between two types of traumatic early life sexual experiences and multiple types of genitourinary symptoms in a national sample of older community-dwelling women. These findings raise the possibility that early life sexual trauma exposure may be an under-recognized marker of risk for late life genitourinary dysfunction in women.

Findings from this national sample of older community-dwelling women underline the importance of recognizing early sexual trauma exposures as a potential lifelong risk factor for adverse genitourinary health outcomes. This research provides new insights to suggest that healthcare providers may need to consider the potential impact of sexual abuse on genitourinary health and function in women across the lifespan. Early detection may help clinicians gauge female patients’ risk for genitourinary or sexual decline later in life, aid in prevention, or guide delivery of trauma-informed care in older age.

Pulverman, C. S., Kilimnik, C. D., Meston, C. M. (2018). The Impact of Childhood Sexual Abuse on Women's Sexual Health: A Comprehensive Review. Sexual Medicine Reviews, 6(2), 188-200.
Vézina Gagnon, P., Bergeron, S., Frappier, J., & Daigneault, I. (2018). Genitourinary Health of Sexually Abused Girls and Boys: A Matched-Cohort Study. The Journal of pediatrics, 194, 171-176.