Adverse Childhood Experiences and Increased Prevalence of Hysterectomy in a Nationally Representative U.S. Sample

This study examined the associations between specific adverse childhood experiences (ACEs) and hysterectomy among adult women and assesses the dose-response relationship with cumulative ACE exposure. It extends prior work by evaluating individual ACE categories while adjusting for gynecological cancers, diabetes, obesity, and selected health-risk behaviors.

Data were drawn from the 2020, 2021, 2022, and 2024 Behavioral Risk Factor Surveillance System (BRFSS), including 119,165 women across 26 U.S. areas with available data on ACEs and hysterectomy. Multivariable logistic regression estimated associations between ACEs and hysterectomy, adjusting for covariates.

Approximately 24.2% of participants reported a history of hysterectomy, and 65.8% reported at least one ACE. All but one of the 11 ACE items were independently associated with higher odds of hysterectomy after adjustment for age, race/ethnicity, marital status, education, annual income, survey year, area, gynecological cancers, diabetes, obesity, physical activity, smoking, and alcohol consumption. The strongest associations were observed for childhood sexual abuse, including unwanted sexual touching and forced sexual intercourse. The ACE distribution was 34.2% for 0 ACEs, 33.5% for 1-2 ACEs, 15.5% for 3-4 ACEs, and 16.9% for ≥5 ACEs. The odds of hysterectomy increased in a dose-response manner with higher ACE exposure, becoming statistically significant at ≥3 ACEs after adjustment. The association between ACE count and hysterectomy did not differ significantly by age (p = 0.2464).

ACEs, particularly childhood sexual abuse, were associated with higher odds of hysterectomy. These associations persisted after adjustment for demographic, clinical, and behavioral factors, suggesting long-term gynecological consequences of early-life adversity.