For more than 3.3 million adult US women, their first sexual experience is rape
About 1 in 16 women in the US were physically forced or coerced into having sex for the first time. In an analysis of 13,310 women, 6.5% of the respondents reported a forced first sexual intercourse experience, which is equivalent to more than 3.3 million women between the ages of 18 and 44, says the research team.
According to the findings, women who were forced into first-time sex were more likely to have an unwanted first pregnancy or abortion, as well as other gynecological and general health problems.
"For more than 3.3 million reproductive-age women (1 in 16 in this age group), the first experience with intercourse was involuntary. A practicing physician is likely to see several patients each week who have experienced this form of trauma," says the research team from Cambridge Health Alliance, Cambridge; Harvard Medical School, Boston; and City University of New York, Hunter College, New York.
To estimate the prevalence of “forced sexual initiation” among US women, the researchers analyzed data on 13,310 adult women respondents to the 2011-17 National Survey of Family Growth. The National Survey of Family Growth is a cross-sectional, nationally representative survey conducted by the Centers for Disease Control and Prevention (CDC) that collects data on family life, marriage and divorce, pregnancy, infertility, use of contraception, and general and reproductive health.
The World Health Organization (WHO) recognizes forced sexual initiation - an unwanted first sexual intercourse that is physically forced or coerced - as a distinct form of sexual violence. According to estimates, forced sexual initiation is a global problem whose reported prevalence varies widely from 0.8%9 to 38%.
“Numerous recent high-profile allegations of sexual violence and the social movements that gained momentum in response to those events - such as #MeToo, #TIMESUP- have increased public awareness of the high frequency of sexual violence against girls and women in the US. Sexual violence is defined by the National Institute of Justice as a constellation of crimes, including sexual harassment, nonpenetrative sexual assault, and rape. More than 40% of women have experienced some form of sexual violence in their lifetime, of whom half have been raped. Exposure to sexual violence has been associated with a wide range of adverse health outcomes,” says the study published in JAMA Internal Medicine.
What did the researchers find?
According to the study findings, nearly three-fourths (74.7%) of women who were forced into first-time sex were younger than 18 years at the time of sexual initiation as compared to 60.5% of women with a voluntary sexual introduction. Further, 6.8% of women who reported forced first-time sex were aged 10 years or younger as compared to 0.1% of women who voluntarily had sex during their first experience.
Compared with women with voluntary sexual initiation, women with forced sexual initiation were less likely to be white, says the study. “Women who experienced forced sexual initiation were somewhat more likely to be born outside the US (21.5% versus 16.1%); have incomes below the poverty level (35.1% versus 24.9%), and less likely to be college-educated (23.9% versus 31.7). However, as presented in these data, all demographic groups reported substantial rates of forced sexual initiation,” the findings state.
The average age of the assailant at first forced sexual intercourse was six years older - 27 versus 21 - compared with the partner in a voluntary first sexual experience. Describing the type of coercion used by the assailant, the experts say that among women who reported forced sexual initiation, 50% reported coercion by a partner who was “larger or older,” 56.4% described experiencing verbal pressure, and 46.3% were held down. Women with forced sexual initiation also commonly reported being given a drug (22.0%) and experiencing a physical threat (26.5%) or physical harm (25.1%), says the analysis.
In an invited commentary, experts say that 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.
Adverse health impact
Women who were forced or coerced had increased rates of subsequent adverse reproductive, gynecologic, general health, and functional outcomes, the researchers found. According to the researchers, forced sexual initiation might be an important independent risk factor for adverse physical and mental health outcomes.
Women who were forced into having sex for the first time more frequently reported being in fair or poor health rather than in good, very good, or excellent health (15.5% versus 7.5%). These women also had difficulty completing tasks outside the home owing to a physical or mental condition (9% versus 3.2%).
Among other adverse outcomes, the researchers found that women who were forced were more likely to have experienced an unwanted first pregnancy (30.1% as compared to 18.9%); ever had an abortion (24.1% as compared to 17.3%); and to not have used birth control in their lifetime (2.6% vs 0.9%).
“Forced sexual initiation appeared to be associated with having received a diagnosis of pelvic inflammatory disease (8.1% versus 3.4%), endometriosis (10.4% versus 6.5%); and problems with ovulation or menstruation (27.0% versus 17.1%). There was no association between forced sexual initiation and reporting recent cervical cancer screening (27.4% versus 25.4%; or never undergoing HIV testing (16.0% versus 18.6%,” the findings state.
According to the research team, the mechanisms through which forced sexual initiation may be associated with adverse health outcomes, is not clear. They state while some previous studies have equated forced sexual initiation with childhood sexual abuse - which is known to be linked with adverse mental and physical health outcomes - the current findings suggest that adverse outcomes are associated with forced first-time sex, irrespective of which of the age at which it is experienced.
“Women who experience early sexual violence are at increased risk of repeated sexual victimization later in life, which may suggest that our findings reflect the composite outcomes of repeated sexual assault,” says the researchers.
The study findings underscore the need for public health strategies to prevent forced sexual initiation and other forms of sexual violence, say experts. “A substantial proportion of American women may experience forced sexual initiation, and the individual and public health implications of this exposure are far-reaching. Although additional research is needed, physicians should incorporate trauma-informed measures into their practices while advocating the reduction of structural causes of sexual violence,” says the study.
Other research, write experts in the invited commentary, has suggested that the long-term effects of sexual assault may be related to psycho-social factors, including subsequent social isolation, feelings of powerlessness, stigmatization, impaired emotional regulation, and engagement in poor health-risk behaviors.
“When taking a sexual history, clinicians should consider asking patients about their first sexual experience, including any force or coercion surrounding this event, to provide validation and education when needed, facilitate any necessary referrals, and address any negative health consequences,” they recommend.