Trigger warning: This blog addresses sexual abuse.
For over 11 years, I have worked as a therapist focusing on sexual abuse and trauma. From my experience as a therapist, I have learnt that many people feel ashamed to discuss any form of sexual abuse. They often feel negative feelings like guilt, shame or embarrassment. Many survivors of sexual abuse also deal with infertility and, in some extreme cases, sterility. Unfortunately, research on the relationship between sexual trauma and infertility is limited. Much of what I discuss in this post is from working as a therapist.
Who is this blog post for?
If you are reading this blog post, it may be because you’ve experienced sexual abuse or you know someone who has and you want to offer support. My hope is that this blog can start the discussion of how a history of sexual abuse can impact fertility and allow you to feel empowered to address any concerns. Please reach out to The Fruitful Hollow if you want us to expand on any of these ideas, as this blog is meant to provide a brief overview. In this post, I refer to the person who suffered abuse as a “survivor” but I recognize that not all individuals who have experienced abuse identify as a survivor. Use the term that you feel most comfortable with using when describing your experience. If you are supporting someone, remember to use their language. Challenging someone’s language, such as insisting that they are a survivor, can be disempowering.
What is sexual abuse?
First, let’s define sexual abuse. Sexual abuse is any form of contact or behavior that occurs without explicit consent. Not all sexual abuse is in the form of a violent sexual attack. Sexual abuse may include:
Childhood sexual abuse
Military sexual trauma
Rape or attempted rape
Fondling or unwanted sexual touching
Intimate partner violence (IPV)
The use of technology to engage in non-consensual or harassing sexual interactions
Medical sexual trauma/non-consensual treatments
Sexual abuse is common: more than 50% of women report a history of sexual abuse (Centers for Disease Control and Prevention, 2022). Keep in mind, however, that these numbers only represent people who felt comfortable reporting a history of sexual abuse. Many women and men do not feel comfortable disclosing this information, and there are also people that may not realise that what they experienced was sexual abuse.
Connection between sexual abuse and fertility
As previously mentioned, sexual abuse can have a range of consequences on fertility, including the extreme case of making someone sterile. Let us take a moment and pray for those women and their husbands as this is a painful cross to bear.
Physical complications can vary from person to person. There may be physical complications from the sexual abuse which the survivor is aware about, such as bruises or scars. However, there also may be complications that aren’t evident until someone is trying to conceive. For example, studies suggest that fibroids and endometriosis can be caused by sexual abuse (Boynton-Jarrett et al., 2011; Harris et al., 2018). However, because research is limited, it’s hard to know how frequently this occurs. A small study found that women who survived sexual abuse had a higher likelihood of accelerated ovarian follicle loss (Bleil et al., 2012). While it is difficult to generalize these results, it does make me curious about what the results would be in a larger study.
Other ways sexual abuse can impact fertility include:
Minimal interest in having sex
Pelvic pain
Painful intercourse
Mental and emotional challenges
Sexual abuse and trauma can also impact brain structure. One study found that childhood sexual abuse impacted the dopamine and serotonin levels in the brain (Shrivastava et al., 2017). Both dopamine and serotonin are important neurotransmitters that are involved with depression, digestion, and sleep. The abuse may lead to hormonal imbalances.
Mental health challenges
In addition to physical consequences, there may be mental health complications as well. Someone may be insecure about either their body or the act, they may be scared, or not want to have sex at all. Addressing the mental health challenges of sexual abuse is just as important as addressing the physical challenges. Someone may continue to feel anger or resentment towards the abuser. They may feel like their fertility was taken from them as a result of the abuse. Anyone can be triggered or retraumatized by a consensual sexual experience as well. Survivors may feel retraumatized by their spouses, even though they are in a loving and consensual relationship. Being retraumatized can result in the person refraining from or avoiding touch or any sexual act. Individual and couples therapy can be useful in these situations. A trained couples therapist can work with you on what safe touch feels like and how to communicate to your spouse when you are triggered.
Spiritual struggles
Many survivors struggle spiritually after abuse, or after realizing that there have been long-term consequences of the abuse. This is normal, and please know that if you are experiencing this, you are not alone. God is there and there is help available in the community. Accepting that the abuse happened does not mean that you approved it.
Treatment options and building your dream team
Because the impact of sexual abuse differs from person to person, treatment options are going to vary. Below is an overview of how various treatment providers can assist you. This is not meant to be advice or exhaustive. When working with survivors, I recommend that they create their own “support team”. For many, one person or provider may not be able to address all the complexities of being a survivor and managing infertility. Consider who you want to be on your dream team from the list of treatment providers and support people below.
Treatment: doctor
I always suggest that someone see a NaProTechnology specialist. Unfortunately, trained providers are not always accessible. NaPro providers often think holistically and consider the whole person when looking at infertility. A challenge that women face, and especially survivors, is the push by some providers to do treatments that are against Catholic Church teachings, such as IVF. IVF does not address the underlying issues of infertility.
Treatment: dietitian
Some dietitians can recommend foods that help reduce inflammation and address hormonal imbalance. Additionally, dieticians can speak about food’s relationship with neurotransmitters. Many NaPro providers have connections to dietitians, or may even have one in-house that can help.
Treatment: pelvic floor therapist
Pelvic floor therapists are underrated, in my opinion. PFTs can help with a variety of issues, including sexual function. I often refer clients to see PFTs that are trained to work with survivors and can help with a variety of issues including inflammation and pelvic pain. They can give exercises and stretches, and also work with survivors around their concerns about having sex.
Treatment: acupuncturist
One of the many benefits of acupuncture is addressing inflammation in your body. Some may also find acupuncture relaxing, which ultimately impacts stress hormone levels and mental health. It’s most helpful to find an acupuncturist that specializes in women’s health concerns.
Treatment: mental health therapist
I am a strong advocate for finding a great therapist who can help navigate challenges related to past sexual abuse. A therapist can help someone work on the skills to tell their provider about their past abuse without getting retraumatized. A therapist can also help address other mental health challenges, and some therapists also specialize in couples therapy and intimacy. There are websites like CatholicTherapists.com that can connect you to someone Catholic. Postpartum Support International also has an online directory of therapists who specialize in infertility and loss.
Support: spiritual director
As mentioned earlier, survivors may feel spiritually challenged. Good spiritual directors can also be hard to come by, but I highly recommend looking. In my personal journey with infertility, I often lost sight of God’s plan for me.
Support: Mary and the saints
During my infertility treatments, I prayed for Mary to watch over my doctors and over me. You could pick a list of saints that you have on “speed dial”. The saints you choose can be anyone. For example, one of my go-to saints is St. Pope John Paul II. I’ve always sought his intercession because I have a special connection to him. During my journey, I’ve also turned to St. Maria Goretti, St. Gianna Molla, St. Gerald Majella and Venerable Fulton Sheen.
Support: your spouse
Your spouse will often be your person during this process whom you lean on. Sit down with your spouse and talk to them about what you're feeling and experiencing. Remember, they need support also. I recommend spouses also seek support from the providers mentioned above. While this blog primarily focuses on women and fertility, preliminary research has shown that there is a relationship between sexual trauma and male infertility as well (Berger et al., 2016). Although it can be a challenging conversation, open up to your spouse about these past experiences to get them the help that they may need too.
Other supports
This can include your mother or best friends. Whoever it is, it is important that it is someone that you trust and that will always lead you back to God and your Catholic faith. Your dream team can include anyone that you would like. The most important part is that your team is grounded in your faith. While it may take additional work to coordinate, you can arrange for the providers to meet with one another. I recognize that this may be a privilege to have access to these various types of treatment providers. For those in the USA, I’m grateful MyCatholicDoctor has access to many of these providers. MyCatholicDoctor has made a substantial effort to provide holistic care and has included many fertility providers in their network.
Conclusion
Living through sexual abuse is challenging. Sometimes, right when you think you’ve healed, you experience another challenge as a result of the abuse. Please know that you are not alone and that help is available. We are praying for you always.
References
Berger, M. H., Messore, M., Pastuszak, A. W., & Ramasamy, R. (2016). Association Between Infertility and Sexual Dysfunction in Men and Women. Sexual medicine reviews, 4(4), 353–365. https://doi.org/10.1016/j.sxmr.2016.05.002
Bleil, M. E., Adler, N. E., Pasch, L. A., Gregorich, S. E., Rosen, M. P., & Cedars, M. I. (2012). Abuse in childhood is related to accelerated ovarian follicle loss at midlife. Fertility and Sterility, 98(3). https://doi.org/10.1016/j.fertnstert.2012.07.158
Boynton-Jarrett, R., Rich-Edwards, J. W., Jun, H. J., Hibert, E. N., & Wright, R. J. (2011). Abuse in childhood and risk of uterine leiomyoma: the role of emotional support in biologic resilience. Epidemiology (Cambridge, Mass.), 22(1), 6–14. https://doi.org/10.1097/EDE.0b013e3181ffb172
Centers for Disease Control and Prevention. (2022, June 22). Fast facts: Preventing sexual violence |violence prevention|injury Center|CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/sexualviolence/fastfact.html
Harris, H. R., Wieser, F., Vitonis, A. F., Rich-Edwards, J., Boynton-Jarrett, R., Bertone-Johnson, E. R., & Missmer, S. A. (2018, July 17). Early life abuse and risk of endometriosis. OUP Academic. https://doi.org/10.1093/humrep/dey248
Shrivastava, A. K., Karia, S. B., Sonavane, S. S., & De Sousa, A. A. (2017). Child sexual abuse and the development of psychiatric disorders: a neurobiological trajectory of pathogenesis. Industrial psychiatry journal, 26(1), 4–12. https://doi.org/10.4103/ipj.ipj_38_15
Trickett, P. K., Noll, J. G., & Putnam, F. W. (2011). The impact of sexual abuse on female development: lessons from a multigenerational, longitudinal research study. Development and psychopathology, 23(2), 453–476. https://doi.org/10.1017/S0954579411000174