Association Between Sexual Violence and Reported Anorectal Symptoms Among Adults: A Systematic Review

Individuals experiencing anorectal symptoms may report a history of sexual violence (SV) and conversely, survivors of SV may later report anorectal symptoms. However, the nature of the relationship between SV and these symptoms remains insufficiently understood. This review aims to systematically assess the reported prevalence and severity of anorectal symptoms, as well as their association with sexual violence, among adult survivors of both sexes.

Following the PRISMA guidelines, a systematic search of three databases, CINAHL, Embase, and MEDLINE/PubMed, was performed for quantitative observational studies concerning SV (rape, sexual harassment, childhood sexual abuse, female genital mutilation) as well as reported anorectal symptoms among adults. Cross-sectional, cohort, case-control, and case series studies published in English and French were included. The Mixed Methods Appraisal Tool (MMAT) was used for assessing the quality of included studies.

Thirteen studies met the inclusion criteria for data extraction. Most studies (12/13) were conducted in a medical setting with a cross-sectional design. Two cross-sectional studies assessed the prevalence of reported anorectal symptoms among SV survivors and 11 studies evaluated the prevalence of SV among patients with anorectal disorders. SV prevalence ranged from 4.1% to 62%. Constipation was the main studied symptom (9/13) followed by fecal incontinence (7/13), anorectal pain (2/13), and recto-vaginal fistula (1/13). Assessments for both SV and anorectal disorders lacked standardization, involving heterogeneous findings.

This review highlights the need for more specific research using standardized assessment of SV and anorectal disorders to better understand their association to improve trauma-informed care pathways.