Angela Lore was 17 when a boy she thought was driving her home from a party took her to his college dorm, where he and several friends raped her. Feeling shame that she had been drinking and gotten into his car, Lore kept the experience to herself.
Lore did not forget, however, and neither did her body. Over the years she experienced depression, anxiety, insomnia, high blood pressure, and other conditions. Looking back, she sees all as linked to the abuse. “When I think of what has happened to me, I feel an internal sadness. It’s made a profound impact on my life,” says the 56-year-old former nurse in Mandeville, LA. It was only in 2018—watching the Brett Kavanaugh confirmation hearings—that Lore finally told someone and even contacted the police (they could do little, as the statute of limitations had long passed). Two years later, she suffered a heart attack. Poor health has forced her to stop working and go on disability.
This story is part of our Year of Making Noise, Prevention’s series dedicated to helping you speak up for your health and change your life. We’re taking a close look at health issues that are ignored and overlooked and making sure every person is heard. It’s time to get the health care you deserve.
The health consequences of sexual violence haven’t received much attention, even as more than half of women will experience a physical sexual assault during their lifetimes, according to the CDC. Roughly every 68 seconds, someone is sexually assaulted, says the nonprofit Rape, Abuse & Incest National Network (RAINN). As in Lore’s case, this violence often begins early, and women in the military are particularly vulnerable, with one study finding that sexual assault happens to up to 3% of women during a single deployment.
But sexual violence isn’t always physical: Advocates say any nonconsensual sexual experience is an act of violence, including lewd comments on the street, sexual harassment at work, and unwelcome sexually explicit photos or texts. In all these instances, the psychological aftershocks may continue to haunt the person, says Rebecca Thurston, Ph.D., a professor of psychiatry, psychology, and epidemiology at the University of Pittsburgh. “Internally, it’s not a one-and-done experience.”
It’s the cumulative health toll that Prevention is highlighting this month. Bruises, sexually transmitted infections, and pregnancy, of course, show up right away. But researchers are documenting other effects, both physical and psychological, that can rear up years or decades later. These experiences “can leave footprints of the trauma in our brains and in our bodies, even in women who outwardly appear to be fine,” says Thurston.
The link between sexual violence and disease
A surprisingly wide range of medical conditions are being shown to be linked to sexual violence. Many may not appear until years after the events. Cancer is one such condition. “A history of abuse may increase a woman’s risk of and susceptibility to cancer,” a review article by researchers at the University of Wisconsin concludes. Cervical cancer is the most prevalent type linked to abuse, and some studies find more breast cancer in survivors (other research does not support this finding). One possible mechanism: heightened immune and inflammatory factors brought on by chronic stress that have been tied to cancer growth, the researchers note.
Heart disease is also increasingly being linked to sexual violence. When Thurston and her colleagues examined levels of plaque in the carotid artery, which carries blood to the brain, they found that women with a history of sexual assault were four times as likely to have signs of blockage. Later, they reviewed 41 studies involving nearly 2 million adults and discovered that cardiovascular disease risk was higher in midlife women with sexual violence in their pasts.
And a history of sexual violence appears to affect other contributors to heart disease, other researchers have documented. Allison Gaffey, Ph.D., an instructor in cardiovascular medicine at the Yale School of Medicine, examined the health records of over 1 million veterans who experienced sexual assault and harassment during their military service (these were mostly women). She discovered that they had a 30% greater risk than others of developing high blood pressure. Gaffey suggested that such sexual violence could increase sympathetic nervous system activity (fight-or-flight), which can damage arteries over time.
Blood vessels in the brain can be affected too. A study of 145 seemingly healthy midlife women presented in 2021 at the North American Menopause Society’s annual meeting concluded that a history of trauma, including sexual assault, substantially increased “white matter hyperintensities,” a marker of small vessel disease that can precede stroke or dementia.
Then there are the physical issues that result from psychological stresses, such as insomnia and gastrointestinal problems, as well as the unhealthy coping mechanisms some survivors employ: Survivors are more likely to smoke, abuse alcohol, use drugs, and engage in risky sexual activity, the CDC says. Researchers at the University of North Carolina found that eating disorders, especially binge eating and purging, were more common in them as well. “A lot of these activities are a way of avoiding emotions, but over time they can become problems themselves,” says Karestan Koenen, Ph.D., a professor of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health.
The psychological fallout of sexual trauma
“In the same way 9/11 was terrorism that used an airplane, rape is an act of aggression where sex is the weapon,” says Barbara Rothbaum, Ph.D., a professor of psychiatry and behavioral sciences at Emory University School of Medicine. It’s no surprise, then, that many survivors develop post-traumatic stress disorder, or PTSD, says Rothbaum, coauthor of the book PTSD: What Everyone Needs to Know. Symptoms of PTSD generally fall into three main categories: reliving the event, such as with nightmares and heart palpitations; avoiding activities that could trigger unwanted sensations; and being in a constantly high state of arousal, which can make it hard to concentrate or relax. Rothbaum metaphorically describes the experience of PTSD as going from having an animal (and human) predator’s front-facing eyes to developing the side-facing ones common to prey that keep them alert to danger. Panic attacks, anxiety, depression, and/or suicidal thoughts are other signs of this condition.
The brain does not make a distinction between physical and psychological attacks. “In our research, we’ve found that the effects of sexual harassment are similar to those of assault,” Koenen says. Still, some women are especially prone to developing PTSD, Koenen notes, including those who were attacked more than once or in an especially brutal way and those who are treated poorly afterward by law enforcement, medical professionals, and/or family members and friends, which compounds the trauma. Women who are blamed, even obliquely, for how they dressed or where they went are much more likely to suffer, she says.
For survivor Amy Malin, a 45-year-old cofounder of an entertainment marketing company in Los Angeles, the “invisible wounds” of PTSD remained for decades after she was repeatedly assaulted and physically abused from her late teens through her 20s. Malin took many years to process her trauma, as it forced her to relive those dark times. “To the outside world I was this successful person in the entertainment industry, but my personal life was filled with despair, depression, and anxiety nearly every day,” she says.
How treatment makes a difference
Malin began to heal after her 30th birthday, when she felt an impulse to stand in front of her mirror and repeat “I am love, I am worthy, I am enough” many times, until it felt true. Gradually, she broke free from society’s toxic culture of shaming and blaming survivors and began to show herself the love, compassion, and grace she deserved. Though Malin still sometimes finds herself triggered, this occurs much less frequently than before, and now she is equipped with the tools to manage a PTSD episode, she says.
Until recent movements like #MeToo, sharing stories of sexual violence was considered taboo, but talking about their experience may be one way for women who have been sexually violated to reduce the odds that physical or psychological problems will develop, Rothbaum says. That’s why it’s important to open up to sympathetic friends or a therapist, especially one with experience treating trauma, both because they will use more targeted techniques and because they understand what does not work. For example, antianxiety benzodiazepines can worsen PTSD, possibly because they numb the emotions that need to be processed, but a medical professional who doesn’t know that might prescribe them, Koenen says.
Exposure therapy has proven to be an effective treatment for PTSD from sexual violence. “This helps people confront what they are frightened of, but in a therapeutic and safe manner,” Rothbaum explains. One type, known as imaginal exposure, has the client recount the experience in detail to the therapist, then repeat it several more times, a retelling that is recorded so the person can listen again at home. Some worry that telling their story will be distressful, but Rothbaum says the distress is already there. “It’s avoiding it that makes it fester,” she says. Another kind asks the person to take baby steps toward what she’s been avoiding, such as going to a place that reminds her of what happened when it’s completely safe. “We do it gradually, so the body and brain learn not to be constantly guarding against another assault,” Rothbaum says. Other useful trauma-based therapies include eye movement desensitization and reprocessing (EMDR) and cognitive processing therapy (CPT).
For Malin, a key element in her healing has been the hot yoga class she attends several times a week, which both calms her and releases hidden memories and emotions. While doing certain poses, especially hip openers, “I’ll be on my mat sobbing while I clear out past trauma. It feels amazing,” Malin says. A study by Emory University found that trauma-sensitive yoga enabled survivors of military sexual violence to improve more quickly than those doing talk therapy. Another therapy that has helped Malin is sound baths, which immerse participants in certain resonances believed to facilitate relaxation and therefore cellular healing.
Helping others, however, has been one of the most pivotal parts of Malin’s healing. “Sharing my experiences and creating a safe space for other survivors to open up lets everyone know we are not alone in our suffering. My goal in my advocacy work is to share a message of hope,” she says.
Because of the risk of long-term health effects, survivors of sexual violence should seek out physicians or other health care providers with whom they feel comfortable talking about their history, Gaffey says. That way the health care team can watch for early signs of hypertension, heart disease, and other conditions more prevalent in survivors. Similarly, doctors should routinely take sexual violence history into account when they calculate the risk of such conditions as dementia, Thurston says.
What’s especially healing, survivors and experts say, is knowing that it’s possible to put the past where it belongs. “Even if this horrible thing has happened, treatments work,” Rothbaum says. “Humans are a very resilient species.”
How you can help
Here’s what you can do to raise awareness and help prevent sexual violence.
- Work your network: Download and repost videos and graphics on your social media networks to inspire your circle to join the fight. Kid- and teen-friendly comics that deal with issues of consent and discuss child abuse are also available from RAINN.
- Call your congressperson: The National Alliance to End Sexual Violence is asking for more funding for the Rape Prevention & Education program, which has been helping community-based groups hold programs for teens and support rape crisis organizations, among other actions.
- Volunteer to help: RAINN, the largest sexual violence prevention organization in the U.S., has lots of opportunities to get involved.
Meryl is an award-winning journalist and author whose latest mindfulness/yoga novel, Warrior Won, was awarded an Independent Publisher Book Award (IPPY).
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