Forced Sexual Initiation Associated with Poor Health Outcomes in Women

Experts estimate that over 3.3 million women in the United States are forced or coerced into their first sexual experience, according to a recent study in JAMA Internal Medicine.

These women also have higher rates of reproductive, gynecologic, and general health issues later, the authors said.

The findings are based on data from 13,310 women aged 18 to 44 who responded to the National Survey of Family Growth between 2011 and 2017. Conducted by the Centers for Disease Control and Prevention, this survey addresses general and reproductive health, among other topics.

After adjustments, 6.5% of the respondents said that their first sexual experience was not voluntary.

The authors defined forced sexual initiation as “an unwanted first sexual intercourse that is physically forced or coerced.” The World Health Organization considers forced sexual initiation to be a form of sexual violence.

Assailants coerced the women in a variety of ways. Approximately 56% of the respondents said their assailant used verbal pressure, and 46% were physically held down. About a quarter of the women were physically threatened or physically harmed.

For women who were forced, the average age of sexual initiation was 15.6 years. About three quarters of these women were younger than age 18, and almost 7% were 10 years old or younger. The mean age of their assailant was 27 years.

In contrast, women whose first sexual experience was voluntary had a mean age of 17.4 years at sexual initiation. About 61% of these women were younger than 18, and 0.1% were age 10 or younger. Their partner’s average age was 21 years.

A number of health outcomes were more common in women who experienced forced sexual initiation:

Unwanted first pregnancy
Pelvic inflammatory disease
Problems with ovulation and menstruation
Illicit drug use
Fair or poor health status
Difficulty completing tasks owing to a physical or mental health condition
Women who had had forced experiences were also more likely to:

Be nonwhite
Have been born outside the United States
Have incomes below the poverty level
Lack a college education
“However, as presented in these data, all demographic groups reported substantial rates of forced sexual initiation,” the authors noted.

They were not certain exactly why forced sexual initiation was associated with poor health outcomes, writing “Our findings are compatible with the hypothesis that experiencing sexual violence at a time of heightened psychological and physical vulnerability may have long-term deleterious sequelae.”

The researchers stressed the need for public health initiatives to prevent forced sexual initiation and sexual assault.

“A substantial proportion of American women may experience forced sexual initiation, and the individual and public health implications of this exposure are far reaching,” they concluded.


Aghjayan, Rita

“Forced Sexual Initiation Linked to Adverse Health Outcomes for Women”

(October 3, 2019)

JAMA Internal Medicine

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