Sexual trauma is a global public health issue

 Sexual trauma is a global public health issue
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A recent study published in one of the premiere journals from the American Medical Association indicates that 6.5 percent of women in the United States experience their first sexual intercourse through physical force or coercion. 

Using a population-based sample of over 13,000 American women between the ages of 18 and 44, and appropriate statistical weighting, researchers say this means that more than 3.3 million reproductive-age women nationwide experienced forced intercourse as their sexual initiation. That number is jaw-dropping. 

As a trauma psychologist, this to me further highlights the imperative for public health measures and sociocultural changes to prevent sexual violence.


Until recently, a lot of the research on forced sexual initiation was conducted outside the U.S., in countries like Nigeria, Ethiopia, and South Africa. This new investigation, however, definitively shows that forced sexual initiation happens here as well. 

In addition, this study documents that those who experience their first sexual encounter as forced have serious, subsequent negative health consequences, including reproductive and gynecologic issues. These women are more likely to develop painful pelvic conditions, such as inflammatory diseases or endometriosis, experience unwanted first pregnancies or abortions, and have problems with ovulation or menstruation.

Coerced/forced sexual initiation in women has also been associated with higher rates of HIV, sexually-transmitted diseases, and intercourse with multiple and high-risk sex partners. It should also be no secret after the #MeToo movement that sexual violence — sexual harassment, non-penetrative sexual assault and rape —  is highly linked to serious mental health outcomes. This includes, but is not limited to, post-traumatic stress disorder, depression, substance abuse, eating disorders, and suicidal thoughts and behaviors.

It’s not alarmist to say that forced sexual initiation and other forms of sexual violence can affect girls and women for the rest of their lives. It affects how they see themselves and how they expect others to treat them in relationships. 

Dr. Nicole Nugent, an internationally-recognized child clinical psychologist and an associate professor at Brown University and Hasbro Children’s Hospital, has worked with this population for many years. 

She said, “It breaks your heart to hear their stories. Girls who have been sexually violated say things like, ‘I’m dirty, or no one will ever want to date or marry me.’ I’ve seen many of these girls pick unhealthy dating partners in their futures, because they believe they are not deserving of being with a good and kind person.”

Dr. Nugent further explained, “Some of these girls have a very hard time believing that forced sexual initiation was rape. They say things like, ‘I didn’t want to lose my virginity that way.’ It’s not uncommon that their perceptions about this traumatic experience become twisted in their mind.” Sexual violence is something that is hard to digest in the psyche. Its effects linger. For example, the moment someone touches them, even in a loving way, they shut down and freeze. Often times, these trauma responses make it much more difficult for women to engage in safe sex negotiations with future partners. Sadly, not having these skills or not believing the skills should be put in place, almost sets women up for re-victimization.

Clearly, we need to improve the physical and mental health care of women and men who’ve been sexually assaulted in this country. But, we also desperately need public health policies and programs aimed at reducing forced sexual initiation and other forms of sexual violence across the lifespan.

The Center for Disease Control and Prevention has been strongly promoting the dissemination of programs that address sexual culture and violence prevention skills. It’d be prudent for our country’s health systems to invest in developing and implementing evidence-informed prevention approaches. 

We need programs, policies, and practices that promote social norms that protect against violence, like bystander approaches. These involve people being taught to recognize behavior that puts others at risk for sexual violence, and then how to take appropriate steps to safely and effectively intervene. 


I wish it was as easy as waving a magic wand to make the world a better place. One of the most difficult problems that I wish could quickly and easily be solved would be to positively shape relationship skills. What if we all received some really key social and emotional skills focused on empathy, conflict management, and communication at an appropriate age. 

What if all of us gained a firm understanding on what makes for healthy dating and marital relationships, including sharing power and respecting one another’s boundaries. Wouldn’t it be amazing if we were all taught the basics of healthy sexuality, and that it’s normal/acceptable for women to initiate and decline sexual intercourse.

This recent study illuminating the rates and some of the effects of forced sexual initiation in American women adds to the decades of research on sexual violence. Too many women and men, across cultures and societies, encounter sexual violence. 

It’s a global public health issue that increases people’s vulnerability to a host of physical, psychological and social difficulties. We must do something to implement best practice interventions and policies to prevent and address this widespread problem.

Joan Cook is a psychologist and associate professor at Yale University who researches traumatic stress and clinically treats combat veterans, interpersonal violence survivors and people who escaped the former World Trade Center towers on 9/11.