MONTREAL, Dec. 19, 2017 - For years, scientists and clinicians have been documenting the significant psychological effects on child victims of sexual abuse. But what about the physical impact? Pascale Vézina-Gagnon, a Ph.D. student researcher at the Department of Psychology of Université de Montréal, has examined the issue as part of her doctoral thesis. Her conclusions have just been published in The Journal of Pediatrics.
In her research, Vézina-Gagnon looked at two groups: a cohort of 882 children who had been victims of sexual abuse, and a comparison group of 882 other children from the general population. She found that up to 12 years after being the victim of one or several assaults, girls in the victims' group received 2.1 times more medical diagnoses for urinary health problems and 1.4 times more diagnoses for genital health problems than girls from the general population. In the case of boys, no difference was observed in the number of diagnoses between boys who had been victims of sexual abuse and those from the general population. There was no significant difference in the number of diagnoses between girls and boys for sexually transmitted infections.
"This study has significant clinical implications," said Vézina-Gagnon. "Up until now we knew very little about the effects of sexual abuse on the physical health of young victims, and more specifically on their genitourinary health, which in general is directly affected in cases of sexual abuse. In view of these findings, it is vital to put certain response and prevention protocols in place to limit the chronicization of these health problems into adulthood."
Study based on government data
The study was conducted under the supervision of UdeM psychology professor Isabelle Daigneault, a specialist in child sexual abuse. It also involved Dr. Jean-Yves Frappier, a pediatric professor at UdeM and specialist in sexual abuse at CHU Sainte-Justine, and Sophie Bergeron, a psychology professor and specialist in the treatment of gynecological pain.
The research team used medical administrative data from the Régie de l'assurance maladie du Québec (Quebec Health Insurance Board) and the Ministère de la Santé et des Services sociaux (Quebec Department of Health and Social Services) to compare diagnoses of sexually transmitted infections, genital problems and urinary problems in two groups: 882 child victims of sexual abuse ranging in ages from 1 to 17, with an average age of 11 when sexual abuse was corroborated by the Director of Youth Protection; and 882 children from the general population of the same age and of the same socio-economic status.
The most frequently reported problems were urinary infections and bacterial infections in the kidneys for urinary health problems. Whereas for genital problems, the most frequently diagnoses were penile disorders; inflammation of the cervix, the uterus, the vagina and the vulva; vaginitis; ovarian cysts and menstrual problems.
Although the nature of sexual abuse was not specified in the databases supplied to the researchers, a study of cases of abuse handled by the Director of Youth Protection estimated that 46 per cent of assaults involved molestation, 17 per cent involved penetration or attempted penetration, and 9 per cent involved oral sex.
Why girls and not boys?
One of the main findings of this study is that, in boys who've been sexually abused at least once, diagnoses of genitourinary health problems remain unchanged. "It is also possible that the effects of sexual abuse on boys' physical health emerge as other health issues, such as gastrointestinal disorders or other somatic symptoms," said Vézina-Gagnon. "A recent study has also revealed that boys who have been sexually abused have a higher frequency of more serious health issues requiring hospitalization.
Some surprises with STIs
The study revealed surprising results regarding diagnoses of sexually transmitted infections (STIs). For both girls and boys, there was no difference in the number of diagnoses for STIs between the victims and the comparison group, which contradicts the findings of previous studies. "This could be explained by the relatively young age of participants at the end of the study in 2013," said Vézina-Gagnon.
"Although participants' sexual activity wasn't documented in this study, we can assume that some participants were not yet sexually active or had only recently become sexually active. Also, as STIs are frequently asymptomatic, they will not be recorded in the Régie de l'assurance maladie du Québec database as the main reason for the medical consultation."
A follow-up is coming
"It may come as a surprise that a psychology researcher is interested in physical health rather than mental health, but one of the aspects that challenges me about the effects of sexual abuse is the link between body and mind," the researcher added. "It is from this perspective that I've been studying how some traumatic experiences such as sexual abuse could have more long-term effects on physical health." In upcoming research, Vézina-Gagnon will look at how sexual abuse can affect the incidence of genitourinary health problems in girls, by testing an affective model.
"My hypothesis is that, among girls who have been victim of sexual abuse, those who suffered more from mental health problems will also be those who are most at risk of having urinary and genital health problems in the years following the abuse."