What are you afraid to miss?
Part 2
An ongoing series from the Partnership to Eliminate Child Abuse
Stephen Wright, MD, FAAP
Childhood Sexual Abuse
Implications for Adults
Given that 90% of childhood sexual abuse goes
unreported, it is fair to say that 90% of CSA
victims do not get the proper intervention they
need and deserve in childhood.
It is important to note that while not
everyone who reports a history of childhood
sexual abuse develops health problems, many live with a variety of
chronic physical, behavioral, and psychological problems that bring
them into frequent contact with health care practitioners.
Because health care practitioners do not routinely inquire about
childhood sexual abuse, its long-term effects are under recognized,
its related health problems are misdiagnosed, and it is often not met
with a sensitive, integrated treatment response.1
Indeed, childhood sexual abuse can have a devastating impact
on adults’ lives, often resulting in adult experiences of shame,
powerlessness, flashbacks, nightmares, severe anxiety, depression,
alcohol and drug use, feelings of humiliation and unworthiness,
ugliness, and profound terror.2 They frequently have difficulty with
intimate relationships and parenting, may suffer from the symptoms
of post traumatic stress disorder, and may isolate themselves from
their community and peers.3
Victims of childhood sexual abuse are also often repeat victims of
domestic violence and adult sexual assault, with over 30% of women
who reported a completed rape as a child also experiencing rape as
an adult.4 The American Medical Association estimates that one in
five adult survivors of childhood sexual abuse suffers from severe,
lifelong psychological problems.5
Too often, these presenting symptoms are not connected to their
root cause – a history of childhood sexual abuse – and these patients
are not receiving the specialized services they need.6
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CSA as Major Women’s and Men’s
Health Issue
The impact of CSA on women’s health warrants specific highlight.
As girls are more likely than boys to be sexually abused by a family
member,7 they are less likely to report the abuse and more likely
to be encased in family loyalty, secrecy and denial, referred to as
“entrapment” and “forced silence,” preventing them from accessing
healing services as a girl or woman, for fear of what may happen to
the offending family member.8 These specific familial and cultural
conditions surrounding CSA and incest for girls, then, puts them in
particularly vulnerable positions to both experience abuse and to be
denied appropriate healing well into their adulthood.
Moreover, because an experience of CSA in childhood has direct
implication for an adolescent girl or woman to be revictimized through
intimate partner violence (IPV) and adult sexual assault, resulting in
unplanned pregnancies, increased exposure to STD’s, cervical cancer,
and domestic violence, it is particularly vital that girls and women
understand the ways their lives and reproductive health may be
negatively impacted by CSA and that their healthcare providers and
potential counselors understand this connection, as well.9
Certainly, the need to screen for, identify and treat CSA trauma
due to its high occurrence for girls and women, then, makes CSA
a major women’s health issue. To be sure, however, CSA is also an
equally significant men’s health issue. Indeed, men are impacted in
ways similar to women, while they may experience challenges and
face barriers in seeking help that are specific to their gender.
The statistics on the number of boys who experience CSA (1 in 6)
are only slightly lower than that of girls (1 in 4). In both cases, due
to the challenges associated with disclosing CSA, many leaders in
the field believe the statistics could be much higher. Because of the
restrictive stereotypes surrounding masculinity in our culture, men
often face extensive barriers in recognizing the impact of CSA trauma
on their lives and seeking help.