Experiencing the Aftershocks: The Physical Effects of Sexual Trauma

Thanks for being here, reader: I’m Caitlyn, a pelvic health physical therapist and health writer. The topic of this article—the physical effects of sexual⁠ trauma⁠ —is often overlooked or minimized, making it all the more important to understand and discuss. If you have experienced sexual trauma of any kind, this article is meant for you.

Sexual trauma impacts the mind and body in unique ways, and it can leave footprints in the form of physical, mental, and emotional impacts. As a clinician working with survivors of sexual trauma, I frequently encounter these footprints in my clients’ bodies.

In this first of a four-article series, I’ll share more about the physical patterns that I and others observe, and we’ll discuss what the research shows about some of the long-term effects of sexual trauma. Later in the series, we’ll cover some treatments available to address the physical impacts of trauma. We’ll finish by reviewing strategies for talking about a history of sexual trauma with current and future sexual partners.

Please note that this article series is not a substitute for medical and mental health advice. I am not a mental health professional, and as such, we won’t be delving deeply into the mental and emotional impacts of sexual trauma. However, mental health care with a trauma-informed counselor or support group can be an integral part of the trauma recovery journey.

Trauma: More Than a Catchphrase

There’s a lot of talk about trauma in the zeitgeist these days: it might even feel like everywhere you look—on social media, TV, the internet—someone is talking about their trauma or the trauma that others have experienced. This is mostly a positive cultural pattern: it helps destigmatize discussions about trauma and bring survivors into the light, making space for them to speak out⁠ and tell their stories if they so choose.

Unfortunately, the increasing awareness of trauma and recovery can also lead to negative backlash against survivors: trolls and the misinformed may trivialize or even deny the effects of trauma, silencing and harming survivors. This article series aims to do the opposite by shedding light on some of the less recognized effects of trauma.

The American Psychological Association defines trauma as “an emotional response to a terrible event like an accident, rape⁠ , or natural disaster.” In this definition, trauma isn’t the terrible event itself, but rather one’s reaction to it.  But this kind of simple definition doesn’t fully capture the complex responses that people may have to traumatic events. Trauma can cause intense emotions, whether or not the survivor expresses them outwardly, and these emotions may impact survivors for months and years after the event(s). However, other aftereffects of trauma can be just as impactful. Let’s consider some of these effects in the following sections.

The Body Keeps the Score

In my work as a physical therapist, I’m often quite focused on the physical body and symptoms like physical pain or muscle weakness. However, it would be counterproductive to treat physical ailments without considering my client’s mental and emotional state: it would be like trying to bake a cake without an oven.

The body impacts the mind and the mind impacts the body. If we aren’t considering all aspects of a person’s physical, mental, and emotional health when treating a problem, we’re missing the boat. Dr. Bessel Van Der Kolk discusses these complex interactions in great detail in his book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. For another perspective informed by progressive feminist thought, check out Dr. Judith Herman’s Trauma and Recovery.

Pelvic PTs and other pelvic health professionals often encounter trauma survivors with physical effects that have stumped these patients and their providers for years. They’ve often undergone countless medical tests and extensive imaging, none of which can detect a clear physical cause of their symptoms. They’ve may have tried every pill, supplement, therapy, and medical device under the sun, but they haven’t found relief.

Unfortunately, many of these patients and their providers are unaware that a history of trauma, particularly sexual trauma, can be a key contributor to physical effects throughout the body.

The Physical Footprints of Sexual Trauma

People who have experienced sexual trauma often live with a wide range of impacts from the traumatic event(s): some of these appear during or immediately following the event(s), while others may take months or years to manifest. Let’s break down some common symptoms by category:

  1. Mental and emotional effects
  2. General physical symptoms that may impact multiple body regions
  3. Symptoms specific to the pelvic region
  4. Other long-term health consequences

Mental and Emotional Health Impacts

A deep dive into the psychological, emotional, and spiritual effects of sexual trauma is outside the scope of this article. However, it’s important to understand the extensive influence that the mental and emotional impact of traumatic event(s) can have on the physical body.

The mental and emotional patterns that develop in survivors of sexual trauma can affect co-existing physical symptoms and vice versa. Remember: the body and mind are intimately connected (after all, the mind is part of the body!). If we aren’t examining and treating both aspects—mind and body—we’re missing a critical step.

Generalized Physical Symptoms

Sexual trauma doesn’t always involve physical violence, but when it does, it may result in physical injury. Approximately one-half of all sexual assault survivors experience physical injury of some kind. These injuries may be to the genital region, but more often, they affect other body parts. While these initial physical injuries can heal with time and care, the individual may still experience pain and other symptoms long after these injuries have resolved.

Many people assume that sexual assault⁠ must involve physical force or injury to be considered traumatic. However, many survivors of sexual trauma do not sustain obvious physical injuries during the event(s). Despite this, they may still experience physical effects, including pain, for weeks, months, or years after the incident(s). Sexual trauma that causes the survivors to fear for their life—even if no physical force is used—may result in more profound aftereffects.

Physical effects that stem from sexual trauma can affect many body systems. Studies specifically involving survivors of sexual violence have identified symptoms impacting the heart and lungs, the digestive (GI) tract, the nervous system, the genitals and reproductive organs, and the psychological and emotional systems.

Sexual trauma can also impact overall pain tolerance. Survivors often have a lower pain threshold than people unaffected by sexual trauma. This means that something that wouldn’t typically hurt, like a light squeeze of the hand or gentle whole-body massage, may feel painful to a survivor. This can occur because the survivor’s nervous system is on high alert: it is more attuned to external signals and inputs, and it is more likely to interpret them as potential threats. By converting a “normal” stimulus into a painful one, the survivor’s nervous system⁠ forces them to pay close attention and respond to this potential threat.

These changes in pain processing may also contribute to the development of global chronic pain conditions. Compared to people unaffected by sexual trauma, survivors* have higher rates of pain conditions like chronic headache and fibromyalgia.

*These data, like much of the data on survivors of sexual violence, are based on studies performed in populations of cisgender⁠ women or those presumed to be cis women, correctly or not. Because the reported rate of sexual violence is higher among cisgender women than men, many studies focus primarily on women. We’ll touch on specifics for the queer⁠ population later in this article.

The Pelvis and the Role of Sexual Trauma

So far, we’ve discussed the global effects of sexual trauma and how it can affect a wide variety of body systems simultaneously. Now, let’s consider one specific body region—the pelvis—in more detail, analyzing the impact of sexual trauma on this area.

Quick anatomy⁠ note: the pelvis is the bony structure and the associated muscles and nerves that connect the legs to the torso. The bones of the pelvis are bowl-shaped. This “bowl” contains and protects the bladder, reproductive and sexual organs, and the lower portion of the digestive (GI) tract. The pelvis is also closely related to the hips, the lower back, and the organs and muscles of the abdomen.

Chronic Pelvic Pain

Previously, we learned that chronic pain conditions are more common in survivors of sexual trauma than in those who have not experienced this type of traumatic event. This pattern holds true for chronic pelvic pain (CPP): survivors are more likely to experience persistent pain in the abdomen, pelvis, or both.

This type of pelvic pain is distinct from menstrual cramping, although it can be present at the same time as period⁠ cramps. Importantly, CPP is closely associated with sexual violence in particular: people who have experienced physical or emotional violence that was not sexual in nature are less likely to report CPP than those who have experienced explicitly sexual violence.

Compared to people who have not experienced sexual trauma, survivors are more likely to report pain during a gynecological pelvic exam with a speculum. Adolescents who have experienced sexual trauma are more likely to report genital pain, genital bleeding (when not menstruating), and pain when peeing.

Struggles with Sex

Survivors of sexual trauma often report pain during partnered sexual activities, particularly with intercourse⁠ . Some survivors with vaginas may develop vaginismus, a condition that causes the vaginal muscles to spasm strongly and involuntarily with attempted insertion of anything—a penis⁠ , finger, sex⁠ toy, speculum, etc.—into the vagina⁠ . These muscle spasms can cause sexual activity involving the vagina to be quite tender and painful; unsurprisingly, this often causes people with the condition to avoid or even fear sexual encounters.

Some survivors also engage in sex even when they would prefer not to: some worry that abstaining from sex will make them seem “weird” or “abnormal”, or that they will lose relationships if they avoid sex.

When sex is uncomfortable or unpleasant, it can cause problems with the way our minds and emotions prepare for and process sex – even if we’re with someone we genuinely like and trust, and even if we’re turned on with them! These changes can lead to decreased desire for sex, difficulty becoming or staying aroused, and difficulty achieving orgasm.

Changes in Internal Organ Function

In addition to the physical pain it can cause, sexual trauma may also lead to other symptoms which, while not always painful, can be equally disruptive. These symptoms can affect the function of the organ systems in and around the pelvis.

Survivors who menstruate often experience more irregularity in their cycles, extremely heavy bleeding during their periods, and more period-related pain. Survivors also have higher rates of irritable bowel syndrome (IBS) and other GI disorders than those seen in the general population.

They are also more prone to urinary tract infections (UTIs). The frequency of vaginal infections (yeast infections, STIs, etc.) is higher than average among people who have experienced physical or sexual violence at the hands of an intimate partner⁠ .

Other Health Consequences

By now, it should be clear that sexual trauma can affect all aspects of a survivor’s health and wellbeing. In addition to the mental-emotional, physical, and pelvic-specific impacts that sexual trauma may cause, survivors are often subject to other long-term health risks.

Compared to their peers who are not survivors, adults⁠ who experienced sexual trauma as children or adolescents are more likely to contract STIs later in life. Adolescent survivors with uteruses are at higher risk for early or unintended pregnancies, and if they become pregnant, they are more likely to miss some or all of the recommended prenatal medical care. Teenage survivors with uteruses are also more likely to miss their recommended pap smears to screen for cervical cancer.

While each survivor may experience their own unique blend of post-traumatic effects, it’s evident that any arrangement of trauma-related impacts can negatively impact a survivor’s health. This doesn’t mean that they definitely will, though.

In the next installment of this series, we’ll discuss how survivors and their care team can address the physical effects of sexual trauma to live healthy lives regardless of their trauma history.

A note on queer/LGBTQIA populations

Historically, studies on the impact of intimate partner and sexual violence have overwhelmingly focused on heterosexual and cisgender populations. Fortunately, the tide is turning, and more researchers have turned their attention to studying these issues in queer and trans communities.

Initial reports suggest that the negative impacts of sexual violence and trauma may be even more profound among queer survivors than among straight folks. For example, a national survey performed by the Centers for Disease Control & Prevention (CDC) found that bisexual⁠ women who experienced sexual trauma at the hands of an intimate partner were approximately twice as likely as their heterosexual⁠ peers to report negative impacts on their physical, mental, or emotional health.

Other research indicates that over 50% of transgender people have experienced intimate partner violence, a rate substantially higher than that reported among cisgender individuals (34.2%). These data support the hypotheses that 1) queer folks may be more likely to experience sexual violence/trauma, and 2) queer people may experience more severe health impacts than cis folks as a result of the traumatic event(s).

This highlights the need for ongoing, high-quality research into the impacts of sexual trauma in queer populations. In the remainder of this series, I’ll strive to be as inclusive as possible, even when the research has yet to catch up.

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  • Caitlyn Tivy PT, DPT, OCS

This article -- part two of a four part series on the physical effects of sexual trauma -- focuses on treatment options for pelvic effects that survivors may experience. For survivors struggling with pelvic symptoms, pelvic physical therapy can be an invaluable component of a recovery journey.