Sexual Abuse

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• QWhat are the effects of sexual abuse on pregnancy?

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  A Boston Women's Health Book Collective , Administration, answered

  Some of us have experienced sexual abuse in childhood or as adults. The aftereffects of abuse vary in severity, but they can last a long time. Abuse issues are sometimes triggered unexpectedly during pregnancy, labor, and birth, in the form of conscious memories or flash backs to the abuse, or unconscious body memories (tension, anger, sick feelings, or other discomfort) when a woman is reminded of the abuse in some way.

  Common triggers for those of us who are survivors include vaginal exams or other invasive procedures, and pain during or after childbirth, especially in the vagina, but also in the abdomen, back, breasts, and perineum. Our interactions with our care providers - authority figures who may expect compliance and trust - may remind us of our perpetrator or perpetrators, with whom we may have felt helpless, unequal, submissive, or overpowered. Control over our bodies, our contractions, or the emergence of the baby - and being controlled by the baby, whose needs come before our own, can be major issues for us. We may associate a lack of control with being abused. We may have learned that remaining in control is essential to safety and being out of control is threatening.

  Reminders during pregnancy or labor to "relax and it won't hurt," to "yield" or "surrender" to the contractions, to "trust your body" or "do what your body tells you to do" may have an effect opposite to the one intended, if we have learned to guard against giving up control in abusive situations. Abuse experiences may also leave us feeling that our bodies are damaged and untrustworthy.

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• QWhat to do if I face past sexual abuse feelings during childbearing?

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  A Boston Women's Health Book Collective , Administration, answered

  Recognize and accept that some fears and concerns make sense. Sexual abuse (or any other abuse) rarely leaves the victim free from aftereffects. Give yourself permission to be afraid or concerned.

  Try to separate your present pregnancy and upcoming birth and parenthood from your past abuse. Now you are older and more able to bring your wisdom and self-knowledge to these new challenges. Consider working with a trauma therapist or counselor who is knowledgeable about childbearing or reading books for survivors that contain suggestions for dealing with triggers and reducing your concerns.

  Decide whether or not to disclose your abuse history, along with issues it has brought up for you, to your care provider. Some caregivers are interested in emotional issues and are both willing and able to respond to your needs, while others may not have the skills needed to help you. If you are comfortable disclosing your history to your midwife or doctor, you can work together to plan your care so that it will be sensitive to your history. If you are uncomfortable with your provider, you may want to change to another person with whom you can establish a trusting relationship.

  If possible, have a doula (birth assistant) at your birth, one whom you trust. Share your fears or concerns with her, so that she can help you deal with them. She does not need to know about your abuse history in order to provide emotional support and help.

  Write a birth plan that is friendly and flexible yet clearly explains your preferences and fears.

  If you have a partner or other support person, enlist his or her support in dealing with this. You may want to tell your support person about specific settings or examinations that make you uncomfortable and work with her or him ahead of time on some ways to help you in these situations.

  With good communication, self-help tools, and caring support from your loved ones, doula, and health care providers, your chances of having a rewarding pregnancy, birth, and postpartum experience are greatly increased.

• QWhat is sexual harassment?

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  A Boston Women's Health Book Collective , Administration, answered

  Sexual harassment is unwanted sexual attention. It includes leering, pinching, patting, repeated comments, subtle suggestions of a sexual nature, pornography in the workplace, and pressure for dates. Sexual harassment is not limited to the workplace or school. It occurs in doctors with patients, welfare workers with clients, and police officers with the public. Sexual harassment involves the abuse of power. In addition to men harassing women, women can harass other women, and men can be harassed by other men or by women. Because sexual harassment can escalate, people who are sexually harassed are at risk of being physically abused or raped.

  In the workplace, women may experience a direct or implied threat; such as "Have sex with me or you will be fired"(called quid pro quo). A hostile work environment can interfere with your ability to do your job, whether the harasser is an employer, a supervisor, a coworker, a client, or a customer.

  Socializing at work often includes flirting or joking about sex. Although it may be a pleasant relief from routine or a way to communicate with someone you are interested in, this banter can turn insulting or demeaning. It becomes sexual harassment when it creates a hostile, intimidating, or uncomfortable working environment. Refusal to comply with the harasser's demands may lead to reprisals, which can include escalation of harassment; poor work assignments; sabotaging of projects; denial of raises, benefits, or promotion; and the loss of the job with only a poor reference. Harassment can drive women out of a job or the workplace altogether. Poor women, immigrant women, older women, and teenagers are especially vulnerable to sexual harassment because of difficulty in finding other employment.

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• QWhat are the effects of rape on the victim?

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  A Boston Women's Health Book Collective , Administration, answered

  Rape can cause physical injuries to any part of the body. Therefore, you should request for a thorough examination that includes and/or results in the following:

  • A verbal history of the sexual assault and related medical concerns. You will be asked to give a detailed description of the assault, which will be written down. Although it may be difficult to talk about these details, they are important so that the medical provider knows where to check for injuries and what evidence to document, such as bruises, scrapes, and other injuries.
  • A pelvic exam. In collecting evidence, the practitioner will look for the presence of semen if you were raped by a man. However, semen may not be present after a vaginal or anal rape. The practitioner will also comb your pubic hair for the possible presence of the perpetrator's pubic hair. This medical evidence will be made available to police or others only with your written permission.
  • Examination and treatment of any external injuries. The practitioner will examine you for any external injuries and may photograph bruises or other marks to document the assault. If bruises emerge after the exam, take pictures of them and call the examiner so that the information can be added to your record.
  • Treatment for prevention of sexually transmitted infections (STIs). The practitioner will recommend giving you two shots of an antibiotic in your buttocks.
  • Treatment for prevention of pregnancy. If it is possible that you will become pregnant as a result of the rape, the doctor or nurse may offer you emergency contraception, sometimes called "the morning-after pill".
  • Information about AIDS/HIV. It is possible to be infected by HIV through a sexual assault. To treat potential HIV infection, you need medication immediately. Although not available everywhere, there are promising new treatments that help prevent HIV infection if taken right away. However, these drugs are controversial and you should take them only after they have been fully explained to you.
  • A follow-up exam. Although you may feel physically recovered shortly after the rape, ensure there is a follow-up visit that includes tests, treatment for STIs, and a pregnancy test.
• QWhat is sexual abuse of children?

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  A Dr. Howard Fradkin, PhD , Psychology, answered

  Males and females can be survivors of sexual victimization. This is a broad term that includes sexual abuse, sexual assault or rape. Sexual victimization consists of any overt or covert sexual behavior (s) by which the abuser–who could be male or female-chooses to take advantage of a power differential with a dependent or vulnerable victim in order to satisfy the abuser’s needs without the consent of the victim. I emphasize the word “chooses” because it squarely places the responsibility for the abuse on the abuser.

  In most cases, a person known to the victim commits sexual victimization; therefore another very important aspect of the abuse is the betrayal of trust between the victim and the abuser. This is especially true when the sexual victimization is committed by a person who holds some role of protection for the victim, such as parents, older siblings or relatives, babysitters, coaches, religious leaders, and organizational leaders.

  Whereas sexual abuse in the past was a term used to describe victims under legal age, and sexual assault or rape were terms used for adult victims, these distinctions are currently changing. Rapes can be done by people known to the victim, or they may be total strangers. Rape and sexual assault may involve physical violence as well.

  Although sexual victimization involves sexual behavior, it is not an act of sex, as sex is a mutually consensual activity. Overt sexual behaviors include any penetration, no matter how slight, of the mouth or anus with any body part of the abuser or any object used by the abuser. Covert sexual behaviors consist of non-penetration behaviors, and cover a wide gamut. Included behaviors are inappropriate hugging or kissing, showing pornography, taking sexually explicit or erotic pictures or movies of vulnerable victims, inappropriate touching of a victim’s genitals or body, and making sexual comments. Covert incest, or mother-son or father-son enmeshment, can also include behaviors when parents make their children into their romantic partners in place of an adult.

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• QWhat are the lifelong consequences of sexual abuse in childhood?

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  A Dr. Howard Fradkin, PhD , Psychology, answered

  The consequences of sexual abuse vary from survivor to survivor, but if you put a group of men and women survivors in a room and created enough safety, they likely would say many of the same things about their lives.

  They would talk about struggles with self-esteem, oftentimes feelings of self-hatred they may have led to feeling suicidal, struggles with wanting to act on suicidal impulses, and for some, dealing with the after-effects of suicide attempts. Many survivors will never read these words because they did not get the help they needed and tragically ended their lives.

  There is hope and healing possible for all survivors, I believe.

  Many survivors face many difficult mental health challenges, including major depression; anxiety issues, including panic attacks;  post traumatic disorder—including symptoms like flashbacks, intrusive memories, and hypervigilance; compulsive behaviors and addictions-including alcoholism, drug addiction, sex addiction, gambling addictions, and workaholism.

  Many survivors struggle with allowing any intimacy in their lives. Their ability to trust has been so wounded that they are unable to allow anyone to even be kind to them. They expect people will hurt them and reject them, so they keep people at a distance.

  Sexual orientation confusion, sexual functioning difficulties, and poor body image are also common problems. Some survivors struggle with eating disorders, including bulimia and anorexia.

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• QHow do traffickers work?

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  A Raychelle C. Lohmann, MS, LPC , Psychology, answered on behalf of Top 10 Social HealthMakers

  Child and teen sex trafficking often starts between the ages of 12 and 14. Many of these girls have been abandoned, have run away from home, or have been sold into the trade. They live on the streets and feel that the only way to support themselves financially is to solicit their bodies for sex. It’s not uncommon for these youths to fall victim to drug abuse...and the only way to support their developing habit is to make money by selling their bodies. Sex traffickers lure and prey upon these vulnerable and needy teens. They know the these children won’t make it on their own so they abduct them, pressure them through deception, make false promises, force them to leave home, and keep them from any hope of reconnecting with someone they know by isolating them from civilization. The pimps become the sole provider and the teen becomes a silent prisoner to his/her own life. Many of these teens are helpless and have no other means to survive.

  So - who is stealing the innocence and childhood from these teens? I wish I could paint you a mental picture of the typical trafficker, or pimp...but I can’t. Traffickers come from every walk of life. Both men and women run sex rings and it's a profitable criminal industry. Traffickers who have a ring of victims, usually have a "bottom," or the person who’s at the top of prostitution ladder. This person is usually a victim that has been with the trafficker for a long time and has earned his or her trust. The bottom is responsible for collecting money from the teens, disciplining them, and getting new recruits. 

  If you suspect child sex trafficking or human trafficking, report it. Call the National Human Trafficking Resource Center (NHTRC) at 1-888-373-7888. This is a national, toll-free hotline, with specialists available to answer calls from anywhere in the US, 24 hours a day, seven days a week, every day of the year related to potential trafficking victims, suspicious behaviors, and/or locations where trafficking is suspected to occur.

  
  

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• QWhat is prostitution and sex trafficking?

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  A Raychelle C. Lohmann, MS, LPC , Psychology, answered on behalf of Top 10 Social HealthMakers

  Sex trafficking, as defined by the National Institute of Justice, is a type of human trafficking that is defined as recruiting, enticing, harboring, transporting, providing or obtaining either by an adult for commercial sex by force, fraud or coercion, or a juvenile for commercial sex, regardless of the means. In most cases, these women and children are coerced into prostitution by pimps. So basically, it is the sexual exploitation of children and women. It forces them to trade their bodies for money. Although comprehensive research is lacking to document the number of youths engaged in prostitution in the United States, it is estimated 293,000 American youths are currently at risk of becoming victims of sex trafficking.

  Child and teen sex trafficking often starts between the ages of 12 and 14. Many of these girls have been abandoned, have run away from home, or have been sold into the trade. They live on the streets and feel that the only way to support themselves financially is to solicit their bodies for sex. It’s not uncommon for these youths to fall victim to drug abuse...and the only way to support their developing habit is to make money by selling their bodies. Sex traffickers lure and prey upon these vulnerable and needy teens. They know the these children won’t make it on their own so they abduct them, pressure them through deception, make false promises, force them to leave home, and keep them from any hope of reconnecting with someone they know by isolating them from civilization. The pimps become the sole provider and the teen becomes a silent prisoner to his/her own life. Many of these teens are helpless and have no other means to survive.

  If you suspect child sex trafficking or human trafficking, report it.

  Call the National Human Trafficking Resource Center (NHTRC) at 1-888-373-7888. This is a national, toll-free hotline, with specialists available to answer calls from anywhere in the US, 24 hours a day, seven days a week, every day of the year related to potential trafficking victims, suspicious behaviors, and/or locations where trafficking is suspected to occur.

   

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• QHow can I protect myself and others from rape?

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  A Boston Women's Health Book Collective , Administration, answered

  Most sexual assaults are committed by someone you know rather than a stranger. In either case, you can take steps to protect ourselves.

  • Safety in social situations. Pay attention to how you feel. If you want to end a date or leave a party, say so, even if you are afraid or embarrassed. If you drink alcohol, keep an eye on your drink. Drugs are available that can be slipped into drinks to tranquilize a person and induce a blackout.
  • Safety in intimate relationships. Learn to recognize potentially abusive relationships. An abusive or unhealthy relationship involves disrespect, fear, jealousy, possessiveness, and controlling behavior.
  • Safety at home. Make sure entrances are well-lit and windows and doors are securely locked. Use only your last name on your mailbox. Find out who is at your door before opening it for anyone.
  • Safety in your neighborhood. Arrange to walk home with people you trust. Get to know the people who live in your apartment building or on your street.
  • Safety on the street. Be aware of what is going on around you. Walk at a steady pace, and look as if you know where you are going. Dress so you can move and run easily. If possible, walk in the middle of the street, avoiding dark places and groups of men. Carry a whistle around your wrist. Always check the backseat of your car before getting in, and keep the car doors locked while driving. Avoid groups of men on public transportation. Avoid hitchhiking.
• QWhat are the signs of being sexually harassed?

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  A Boston Women's Health Book Collective , Administration, answered

  Because there is such a taboo against identifying sexual harassment, when you first experience it, you may only be aware of feeling stressed. You may develop a headache, anxiety, or resistance to going to work in the morning. It may take you a while to realize that these symptoms come from being sexually harassed. You may blame yourself and wonder if you did something to provoke the harassment. You may also be afraid to say no or to speak out because of possible retaliation. But, when you take the risk and talk to other women, you find others who are being or have been harassed and have responses similar to yours.

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