Sexual function in women with a history of sexual assault: A cross-sectional study

There is inconsistency in the literature regarding how a history of sexual assault influences adult sexual function. Our objective was to investigate the association between a history of sexual assault (as a child, as an adult, or both) vs. no history of sexual assault and various aspects of sexual function, including sexual activity, overall sexual function, and specific subdomains such as desire, arousal, lubrication, orgasm, satisfaction, and pain.

For this cross-sectional descriptive study, 397 women (47% response rate) answered an online survey targeting validation of a pelvic pain questionnaire. Sexual function was measured using the Female Sexual Function Index (FSFI). History of sexual assault, demographic, gynecological, and other health-related variables were collected. Comparisons were done by chi square, variance, and multiple logistic regression analyses.

Of the 394 participants, 38 (9.6%) reported child sexual assault, 56 (14.2%) adult sexual assault, and 26 (6.6%) both child and adult sexual assault. Sexual activity did not differ between groups. Among the 261 sexually active participants, the total FSFI mean score was 26.4 (standard deviation 5.5). Women reporting adult sexual assault or both child and adult sexual assault had lower total FSFI mean scores than those reporting child sexual assault only or no history of sexual assault (p = 0.005). The same pattern was observed for the arousal (p = 0.008) and orgasm (p = 0.003) subdomains. In contrast, lower pain subdomain scores were reported by women with a history of child sexual assault or both child and adult sexual assault (p = 0.005). After adjustment for potential confounders, only adult sexual assault was associated with low overall sexual function (adjusted odds ratio 2.5, 95% confidence interval 1.2-5.2).

Our findings confirm the previously demonstrated association between a history of adult sexual assault and low overall sexual function. However, the different exposures seem to relate differently to the various dimensions of sexual functioning. It is essential that healthcare professionals treating individuals with pelvic pain or diminished sexual function remain vigilant to the potential impact of sexual assault history and are encouraged to address this issue proactively and sensitively in clinical practice.