The gynecological sequelae of sexual violence in adolescence in the United States: A scoping review

Background

Women who engage in sexual acts against their will are at high risk for sexual and reproductive health complications including sexually transmitted infections (STIs), menstruation disturbance, infertility, abnormal uterine bleeding, reproductive cancers, dyspareunia, vaginismus, and chronic pelvic pain. However, the occurrence of these gynecological sequelae in women who experienced sexual violence during their youth has not been scoped in the literature. To map the breadth of gynecological sequelae, corresponding interventions, and associated symptomatology in childhood and adolescence, the researchers conducted a scoping review.

Objectives

To identify the most common gynecological disease manifestations and symptomatology for patients who have experienced sexual violence in childhood and/or adolescence; to identify existing healthcare interventions indicating promising strategies to mitigate the impact of sexual violence for adolescents; and to provide future recommendations for clinicians and researchers to reduce gaps in care.

Search Strategy

A scoping review methodology was chosen and completed in accordance with the PRISMA-ScR. Embase, CINAHL Complete, Web of Science, and MEDLINE PubMed were searched on October 4, 2023. A medical librarian developed, ran, and recorded the search in accordance with PRISMA extension for searching. The search retrieved 11 253 records. After deduplication 7656 articles were screened at the title and abstract levels, of which 212 underwent full text review for eligibility. Ultimately, 92 articles were included.

Selection Criteria

The following inclusion criteria was used to lead the search and for full-text review: (1) the study focuses on persons with a history of sexual violence prior to adulthood; (2) the study focuses on gynecological interventions from healthcare practitioners; (3) the study is based in the US; (4) the study is published in a peer-reviewed journal; (5) the study was published between 1990 and 2022; and (6) because the patient population resides in the US, the literature is limited to English language.

The exclusion criteria that have been identified are: (1) the study focuses on intimate partner violence and/or spousal abuse; (2) the study was published prior to 1990.

Data Collection and Analysis

Researchers utilized Research Electronic Data Capture (REDCap) for data collection and analysis. Norming, title-abstract review, and full-text review were conducted in that order among reviewers. The data that were extracted include: (a) author, year of publication, and other background information; (b) research approach (quantitative, qualitative, mixed methods, etc.); (c) type of sexual violence reported in the study; (d) type of gynecological symptoms and/or diagnoses reported in the study. Additional qualitative data points might have been added by the researchers throughout the process of data extraction and charting. The primary researcher then used REDCap to analyze the provided charts and statistics.

Main Results

A total of 7656 articles were screened at the title and abstract levels, of which 212 underwent full text review for eligibility. A total of 120 articles were excluded, and 92 articles were included in this review, highlighting the types of sexual violence reported, gynecological intervention, and any gynecological symptoms or diagnoses, with the most prominent being rape, antibiotic therapy, and STIs, respectively.

Conclusions

Further research to determine the benefit of earlier cervical cancer screening in a subset of women who experienced early lifetime sexual abuse may prevent invasive cervical cancer as an adult and would provide insight for improved management of child sex abuse victims. Consideration of early psychiatry involvement, or pelvic floor therapy referral prior to the onset of psychiatric-related gynecological symptoms secondary to sexual trauma may improve quality of life in adulthood. Finally, a protocol for pharmacologic management following sexual abuse could be considered in the acute setting of sexual trauma, including an algorithm to at least offer HIV prophylaxis, human papillomavirus vaccination, hepatitis B vaccination (HBV) and/or immunoglobulin if the perpetrator is a known intravenous drug user or HBV carrier, tetanus vaccination, antibacterial therapy, and pregnancy prophylaxis in the emergency department setting.