Sexual Abuse, Assault Leads to Heart, Brain Health Risks| Everyday Health

It’s long been clear that sexual violence can have psychological consequences for survivors, in the form of post-traumatic stress disorder (PTSD) and an increased risk of drug and alcohol abuse, among others.

Now, two new studies show there can be long-term physical health effects as well. Both heart disease and brain small-vessel damage may occur years after the violence happened, researchers found. Both study abstracts were presented at the annual meeting of the North American Menopause Society (NAMS) on September 24, 2021.

“Until ours, no study attempted to link sexual assault to physical health such as cardiovascular disease, stroke, and risk of dementia,” says Rebecca C. Thurston, PhD, professor of psychiatry, psychology, and epidemiology at the University of Pittsburgh and a coauthor of the two studies.

Sexual Violence Is a Major Problem, and a Too Common Problem

More than one-third of women and one-quarter of men in the United States experience some form of sexual violence in their lifetime, according to the Centers for Disease Control and Prevention (CDC). Such violence includes one-time or ongoing sexual assault or sexual abuse, intimate partner violence, and significant sexual harassment.

Completed or attempted rape strikes 1 in 5 American women and 1 in 38 men, the CDC reports. Such violence can happen early, with 1 in 8 female rape victims under the age of 10 and 1 in 3 between 11 and 17.

These numbers are likely an underestimate. Victims are often embarrassed or afraid to talk about this violence, and some keep quiet because they are threatened with further harm if they do speak out, according to the CDC.

Midlife Female Survivors Have Markers of Brain Disease

In one of the studies presented at the NAMS conference, 145 midlife women (with a mean age of 59) with no medical evidence of stroke, dementia, or other signs of blood vessel problems were asked about their history of trauma. Blood pressure, body mass index, and other indicators were measured.

Then the women’s brains were imaged for white matter hyperintensities (WMH). WMH are markers of brain small-vessel disease, and may be detected decades before the onset of a stroke, dementia, and other disorders. The more WMH, the more possibility for later problems.

Some 68 percent of the women in the study reported that they had experienced at least one trauma, with sexual assault, at 23 percent, the most common.

Women with this trauma exposure, especially for sexual assault, were found to have substantially increased WMH volume compared with the women without. These results held even when researchers adjusted for other issues that might affect WMH volume, such as having PTSD or depression.

Sexual Violence Raises Cardiovascular Disease Risk Too

In the second study, scientists searched through databases of existing scientific research for those mentioning sexual violence and also cardiovascular disease. Some 41 studies covering nearly two million adults (three-quarters of them women) were ultimately evaluated.

The researchers found that sexual violence was correlated with increased incidence of cardiovascular disease in midlife. The timing of the violence played a role, with larger effects seen for those whose sexual violence occurred in childhood.

Implications for Women and Their Doctors

The WMH finding “suggests that sexual assault may place women at risk for poor brain health later in life and that women who have an assault history warrant increased vigilance to reduce stroke and dementia risk,” says Dr. Thurston, the lead author of this study. Doctors should factor sexual assault history when considering a woman’s stroke or dementia risk by asking about this history, but they must also understand that “patients may take some time and trust before disclosing this history,” she says.

Based on the heart-disease results, it’s evident that informing cardiologists of trauma history can help a doctor better monitor cardiovascular health, says Allison E. Gaffey, PhD, a research associate in cardiovascular behavioral medicine at the Yale School of Medicine in New Haven, Connecticut, who was not involved with this research.

“Cardiologists understand that a woman's risk of heart and vascular diseases arises from both traditional and nontraditional factors,” Dr. Gaffey says. Sharing trauma history “may help the provider to better understand a woman's risk.”

Such disclosure can also enable a woman to receive more trauma-sensitive care during physical exams, as well as getting any desired referrals for mental health or other services if they do, she says.

Know That Help for Trauma Survivors Is Available

It’s clear that women with a history of sexual assault should not underestimate the “footprints” the trauma can leave on their brain and body, Thurston says.

“If you have experienced a sexual assault, and you feel comfortable sharing that with your healthcare provider, please do so. It really matters for your health,” she says.

Because of the increased risk to a woman’s heart and blood vessels, it’s especially important that women with a history of sexual violence pay attention to other risk factors for these conditions, such as high blood pressure, blood sugar, and cholesterol, and work with their doctor to keep them under control, Thurston says.