Health Effects of Experiences of Sexual Violence For Women With Abusive Partners
Health Effects of Experiences of Sexual Violence For Women With Abusive Partners
Health Effects of Experiences of Sexual Violence For Women With Abusive Partners
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HEALTH EFFECTS OF EXPERIENCES OF SEXUAL
VIOLENCE FOR WOMEN WITH ABUSIVE PARTNERS
Kimberly K. Eby, MA
Michigan State University, East Lansing, Michigan, USA
Recently, increased attention has been paid to the issue of sexual vio-
lence both within and outside of ongoing, intimate relationships. Although
lated to the number of incidents of marital rape, and (c) marital rape
occurred with severe forms of nonsexual violence. Campbell (1989)
found that approximately half (49.9%) of the physically abused women
in her sample were sexually abused, most of them experiencing ongoing
violence.
With strong evidence that a substantial proportion of women in abu-
sive relationships are experiencing sexual violence, it is important to
explore the impact of sexual violence on women's health. Campbell and
Alford (1989) reported that the two most frequently recounted health
concerns of maritally raped women were painful intercourse (72%) and
vaginal pain (63%). Additional problems women attributed to their sex-
ual abuse included bladder infections, vaginal and anal bleeding, mis-
carriages and stillbirths, and STDs.
In 1974, Burgess and Holmstrom identified "rape trauma syndrome."
In the first phase of the syndrome, women experience a multitude of
somatic reactions in addition to the initial physical trauma. In the second
phase, they are at risk of developing phobias and nightmares related to
the trauma. Therefore, it is imperative to examine the potential relation-
ships between women's experiences of relationship sexual violence and
their experiences of physical health symptoms, particularly gynecological
symptoms. Although some researchers have assessed sexual violence and
the presence of gynecological symptoms, no study to date has documented
the relationship between sexual violence and physical health symptoms,
including gynecological symptoms. There is increasing evidence that
assessing risk for contracting an STD or HIV infection should be includ-
ed in health evaluations for women with abusive partners. The potential
for rape increases women's chances of exposure to an STD or HIV infec-
tion. The potential use and abuse of alcohol and drugs by women with
abusive partners may also result in substantial medical risks. A small pro-
portion of Campbell and Alford's (1989) sample (6.5%) reported that
Health Effects 565
METHOD
Setting
Research Participants
The participants in this study were the first 110 women who were
scheduled for regular project interviews beginning January 1992. The
women were asked at the beginning of their interviews if they would be
willing to answer additional questions regarding their physical health.
All of the women who were interviewed consented to complete the
health section of the interview.
Relevant demographic information regarding the research participants
is presented in Table 1. Ages ranged from 17 to 61 years (M = 28).
Forty-nine percent of the women were White, 42% were African
American, 5% were Latina, and 4% were Native American. The major-
ity (70%) of the women were currently unemployed, and 71% were
receiving some form of governmental assistance. A small percentage
(17%) were students. Forty-one percent of the women had not completed
high school, 22% had received their high school diploma or general
equivalency diploma, and 24% had some college education.
More than two thirds (69%) of the women had children currently liv-
ing with them (the mean number of children was two). Seventy-nine per-
cent of the women reported that they had ended or were ending their
566 K.K.Ebyetal.
Characteristic %
Age
17-19 years 13
20-29 years 51
30-39 years 26
Over 40 years 10
Race
African American 42
White 49
Latina 5
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Native American 4
Been employed in last 6 months 41
Education level
Less than high school 41
High school graduate/general equivalency diploma 22
Some college 24
College graduate/professional degree 8
Trade school 5
Receiving governmental aid 71
Children living with them 69
Currently in relationship with assailant 21
Procedure
Interview training. Undergraduate students were recruited on an
ongoing basis to conduct face-to-face interviews after a term of rigorous
training. The training used written material, films, and discussions about
the nature and dynamics of woman abuse. The interviewers learned
appropriate interview protocol through a written interviewer's handbook,
class discussion, and role-play interviews weekly throughout training.
Health Effects 567
Measures
Presence of sexual violence. The presence of sexual violence in the
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Risk for contracting STDs and HIV infection. The women's risk for
contracting STDs and HIV infection was assessed using a modified ver-
sion of the 17-item Risk Assessment Questionnaire currently used by the
county Health Department. The questionnaire included items relating to
the number of sex partners in the last year, use of alcohol or drugs during
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sex, use of condoms and foam during sexual activity, and knowledge of
partners' drug use. These items represent behaviors that put people at
risk for contracting an STD or HIV infection. Risk for contracting STDs
and HIV infection was scored item by item, such that responding posi-
tively to any one of the risk behaviors suggested being at risk for con-
tracting an STD or HIV infection. Correlational analyses were per-
formed on individual items, not on the total scale.
RESULTS
Sexual Abuse
Approximately one fourth (27%) of the women interviewed had expe-
rienced at least one type of sexual abuse. Eighteen percent of the women
indicated they had experienced "forced sexual activity." Twenty-two per-
cent reported that their partner had used threats to try to have sex with
them in the past 6 months and that their partner had used force to try to
have sex with them in the past 6 months.
%Who %Who
experienced considered it
Physical health symptom symptom a result of abuse
Low energy 88 57
Sleep problems 77 73
Headaches 77 71
Muscle tension/soreness 73 61
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Constant fatigue 68 65
Weight change 67 65
Back pain 63 62
Nightmares 62 66
Dizziness 61 52
Poor appetite 61 69
Migraine headaches 60 70
Acid stomach or indigestion 60 52
Feeling weak all over 59 62
Stomach pain 57 56
Heart pounding or racing 55 72
Muscle cramps 54 42
Hands trembling 53 64
Severe aches and pains 51 61
Numbness/tingling in body 51 43
Pains in heart or chest 49 72
Shortness of breath 48 53
Blurred vision 46 53
Constipation 46 39
Nausea and/or vomiting 44 50
Ringing in ears 44 44
Hot or cold spells 43 40
Faintness 40 57
Diarrhea 39 51
Pelvic pain 38 36
quently were low energy (88%), sleep problems (77%), and headaches
(77%). In addition, for the majority of the health symptoms, at least half
of the women believed that the abuse had contributed to their experienc-
ing the symptom. Physical health problems most often thought to be a
result of abuse were sleep problems (73%), pains in the heart or chest
(72%), heart pounding or racing (72%), and headaches (71%). Table 2
570 K. K. Eby et al.
Gynecological Symptoms
% Who
%Who considered
experienced it a result
Gynecological symptom symptom of abuse
Pelvic pain 38 36
Bladder infection 25 37
Missed menstrual periods 25 33
Vaginal bleeding/discharge 22 29
Painful intercourse 21 52
Painful urination 16 29
Unwanted pregnancy 6 29
Rectal bleeding 6 17
Infertility 5 40
Miscarriages 15
(not only in past 6 months)
Health Effects 571
tested for HIV infection, and 52% of the women reported that they had
been tested within the past 6 months.
Additional Analyses
DISCUSSION
had also been sexually abused. These results corroborate previous find-
ings that marital rape occurs in approximately 40% of cases of battering
(Campbell, 1989; Campbell & Alford, 1989; Shields & Hanneke, 1983;
Stark & Flitcraft, 1982). It is imperative to note that the women were
asked to report only on the past 6 months.
Participants also reported being frequently bothered by physical
health symptoms. Again, it is important to remember that women were
asked to think about only the past 6 months. The physical health symp-
toms reported by the women support other researchers' findings that
women with abusive partners are often bothered by these health prob-
lems (Kerouac et al., 1986; Rodriguez, 1989; Straus & Gelles, 1987).
Several of the health symptoms that the women attributed to abuse,
such as back pain and weight changes, have not yet appeared in the
medical literature as important symptoms to assess in women with abusive
partners. Disseminating this information to health care professionals is
vital so that women are not misdiagnosed and the true etiology of their
health problems is not overlooked. There is also a constellation of symp-
toms suggesting neurological damage (headaches, blurred vision, ringing
in ears, and dizziness) that, singly, would often be attributed to psycho-
somatic causes. Finally, another constellation of symptoms (nightmares,
difficulty sleeping, heart pounding, trembling, and shortness of breath)
is often associated with posttraumatic stress disorder, a diagnosis only
recently associated with battered women (Dutton, 1992; Woods &
Campbell, 1993).
A substantial group of women reported various gynecological symp-
toms, ranging from pelvic pain to missed menstrual periods to painful
intercourse. Interestingly, women appeared more reluctant to attribute
their gynecological symptoms than their other physical health symptoms
to their abuse. Not surprisingly, painful intercourse was the gynecologi-
cal symptom the women most often considered to be a result of abusive
experiences.
Health Effects 573
Overall, the risk behavior that emerged most frequently among the
women was the lack of condom and spermicide use while engaging in
sexual intercourse. Within the past 6 months, nearly two thirds of the
women who had been sexually active did not use condoms or spermi-
cides for protection from STD or HIV infection. For the participants who
had multiple casual sex partners (11%) or one-time, anonymous partners
(4%) or who paid or received money for sex (7%), the risk for contract-
ing an STD or HIV may have substantially increased. Furthermore, the
threat of a sexual assault is quite high for women with abusive partners,
even when they are separated from their assailant. Separation also
increases the probability that the assailant has been sexually active with
someone else and therefore contributes to women's risk.
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Aside from the lack of use of protection during sexual intercourse, the
vast majority of women did not appear to be engaging in behaviors that
would elevate their risk for contracting an STD or HIV infection, such as
sharing needles to shoot drugs, using dirty needles, or having sexual
partners who shot drugs. A factor that would certainly influence partici-
pants' risk but was not measured thoroughly was the risky behaviors and/
or sexual habits of the women's partners. For example, if the women's
partners changed partners frequently or engaged in unprotected sex, the
women's risk of contracting an STD or HIV infection would increase.
Finally, another factor that could elevate the risk of contracting an STD
or HIV infection for women with abusive partners is that their partners
may refuse to wear condoms or may threaten the women if they try to
force the issue.
Whereas the sexual violence scale was significantly correlated with
the overall physical health symptom scale, it was significantly correlated
with only some of the symptoms on the gynecological scale. The
strongest relationships were found between sexual violence and pelvic
pain, vaginal bleeding or discharge, and painful intercourse; moderate
relationships were found between sexual violence and miscarriages,
bladder infections, painful urination, and rectal bleeding. These results
support Campbell and Alford's (1989) finding that marital rape victims
reported extreme problems with painful intercourse and vaginal pain.
The evidence of strong relationships between sexual abuse and physi-
cal abuse and the physical health symptom scale indicated that there
indeed may be long-term health consequences for women in abusive
relationships. Although it was impossible to determine conclusively
whether experiences of sexual violence independently contributed to the
women's experiencing more frequent physical health symptoms, the
women who were sexually abused were also more severely physically
abused and experienced an increase in physical health symptomatology.
This suggests that the presence of sexual violence in an abusive relation-
574 K. K. Eby et al.
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