**2. Definition of sexual abuse**

Sexual abuse is a traumatic experience involving an involuntary sexual contact between the abuser and the victim, with the intention of sexually arousing the perpetrator who transgresses all limits of human dignity [1]. The actions are not limited to a forced sexual intercourse but include a wide range of sexual behaviours, most commonly the following: exposing one's genitals, observing a child, using pornography, groping, masturbating in front of the victim or forcing the victim to masturbate while the offender watches, fellatio, cunnilingus, digital or object penetration of the anus or vagina, sodomy, etc. [2].

Clinical practice has shown that it is very difficult to predict what consequences a victim will experience. This is because they depend on several factors: the age and sex of the abused, the seriousness of the abuse, the relation between the victim and the offender (whether the offender is a family member or not, a known person, an unknown person, etc.), whether the child told anyone about the abuse and, if they did, what the response was and the duration of the abuse [3-6].

Many abused individuals are too focused on survival to notice how the abuse has effected them. Even worse, most do not even think that the effects and problems they experience could be related to sexual abuse. They are ashamed of what they did to survive, even though, in the given situation full of pain, that was the best possible solution. The most common kinds of behaviour that the abused adopt to survive are: derogation, rationalization, denial, forgetting and running away from reality (split, dissociation), constant control, hypervigilance, perfec‐ tionism, freezing, absentmindedness, busyness, escape, humour, lying and stealing, religious fanaticism, drug and alcohol abuse, overeating, engaging in unhealthy and risky sexuality, obsessive masturbating, etc. [7].

### **3. The consequences of sexual abuse**

pushing, when the woman in labour needs to co-operate most with the medical staff, her body or psyche can react by freezing, panicking or taking complete control. She is also more prone

These feelings and experiences are also often present *in motherhood*. Compared to a mother who has not been sexually abused, a mother with a history of sexual abuse experiences more

We conclude this paper by expressing our hope that one can work through the trauma of sexual abuse and start living a full life. Clinical experiences have shown that a woman who resolves her trauma is much more relaxed and happy during pregnancy. She is calmer during childbirth and is a more compassionate mother, compared to a woman who does not resolve her trauma. After all, if the little girl survived the trauma when it happened, she can now survive as a

Sexual abuse is a traumatic experience involving an involuntary sexual contact between the abuser and the victim, with the intention of sexually arousing the perpetrator who transgresses all limits of human dignity [1]. The actions are not limited to a forced sexual intercourse but include a wide range of sexual behaviours, most commonly the following: exposing one's genitals, observing a child, using pornography, groping, masturbating in front of the victim or forcing the victim to masturbate while the offender watches, fellatio, cunnilingus, digital or

Clinical practice has shown that it is very difficult to predict what consequences a victim will experience. This is because they depend on several factors: the age and sex of the abused, the seriousness of the abuse, the relation between the victim and the offender (whether the offender is a family member or not, a known person, an unknown person, etc.), whether the child told anyone about the abuse and, if they did, what the response was and the duration of

Many abused individuals are too focused on survival to notice how the abuse has effected them. Even worse, most do not even think that the effects and problems they experience could be related to sexual abuse. They are ashamed of what they did to survive, even though, in the given situation full of pain, that was the best possible solution. The most common kinds of behaviour that the abused adopt to survive are: derogation, rationalization, denial, forgetting and running away from reality (split, dissociation), constant control, hypervigilance, perfec‐ tionism, freezing, absentmindedness, busyness, escape, humour, lying and stealing, religious fanaticism, drug and alcohol abuse, overeating, engaging in unhealthy and risky sexuality,

to a caesarean section and other complications.

118 Sexology in Midwifery

**2. Definition of sexual abuse**

the abuse [3-6].

obsessive masturbating, etc. [7].

feelings of guilt, troubles with breastfeeding and various fears.

object penetration of the anus or vagina, sodomy, etc. [2].

grown woman - the abuse is **no longer** happening, it is only awakening.

In general, it is difficult to say how sexual abuse impacts an abused person. This is because sexual abuse effects everything: self-confidence, sexuality, intimate relationships, parenthood, work, mental health, body, etc. Additionally, some consequences may be visible immediately, whilst others only come to light years after. They awaken in various situations reminiscent of the abuse. Recent studies have shown that they can even come to an intergenerational transmission of trauma. This means that the effects manifest in future generations, in children born after the trauma had already taken place (e.g., war veterans and their children and grandchildren) [8]. Sexual abuse has an impact on both the physical and the psychical area of human action, which strongly marks and changes a person's life. In most cases, the effects are long-term, extremely radical and harmful. More rarely, the effects can be short-term [7-10].

*Short-term consequences:* unwanted pregnancy, higher risk of sexually transmitted diseases, infertility, various gynaecological inflammations and pains in the lower abdomen, infections of the urinary bladder, abrasions and laceration on various parts of the body, bruises and redness, more frequent chronic somatic diseases, a negative attitude towards one's body, chronic fatigue and exhaustion, sleeping disorders, eating disorders, very painful menstrua‐ tion, fear, apprehension and anxiety, troubles concentrating and thinking, emotional irritabil‐ ity and hypersensitivity, hate and aggression, promiscuous behaviour, etc.

*Long-term consequences:* many of the above also belong among the long-term consequences but the effects that most often come to light after many years, on the other hand, can sometimes appear soon after the abuse. The most frequent among them are: post-traumatic stress disorder, social phobias, fear and anxiety, guilt and shame, substance abuse and eating disorders, running away from home, depression, suicide, panic attacks, excessive distrust, troubles with interpersonal relationships, partner relations, infidelity and physical violence, sexual dys‐ functions and other problems with sexuality, personality disorders and dissociations, likeli‐ hood of re-victimization, low self-esteem, sexualized behaviour in children, regression in behaviour, self-harming, etc.

### **4. The trauma of sexual abuse, body and health issues**

Sexual abuse first occurs at a physical level. This is precisely why many victims of sexual abuse blame their bodies for having responded; for being attractive, small, vulnerable and susceptible to arousal and pleasure. They accuse themselves for even having bodily sensations. Thus, in some respects, relaxation can pose a subconscious risk of something bad happening. This is why victims feel it is safer to be alert and awake - a sexually abused child can never really relax. Many victims of sexual abuse experience their bodies as a burden and a nuisance. They do take it into account because, precisely when it should have defended itself, it ran away and betrayed them. Part of not paying heed to their bodily needs is not hearing the body. This also applies when people are ill; they hold in their urine because they want to finish a small task, they do not rest when it is high time for them to take a break, they go to extremes with eating and performing physical activities, they harm themselves, develop various forms of addiction, etc. [7].

It is often the case that medical examinations and tests do not explain the symptoms of a patient who has experienced a trauma. This does not mean that the patient does not suffer physical pain, only that the cause of the pain is psychosomatic. A traumatic experience effects not only the structure and functioning of the brain, but also the stability of one's psyche, one's thought processes and the health of one's body. In extreme cases, traumas can contribute substantially to psychiatric disorders [11]. Most of these patients seem demanding, afraid, uncertain and sometimes do not trust even those closest to them who ensure them that they are perfectly fine. Many suffer due to various medical symptoms, most often digestion problems, chronic fatigue and sleeping disorders. Scaer [11], who has worked as a doctor for many years and encountered various patients (those also injured in accidents or otherwise traumatized), believes that the various physical syndromes (pains) in traumatized people are more often a consequence of a certain experience, rather than a proven organ injury. *For example, stomach pain may be the result of a psychic distress experienced by a sexually abused person, rather than organ damage or food poisoning.* The trauma of sexual abuse can also impact neurological and hormonal (endocrinological) changes, the immune system, etc. A person's emotional state effects their physical wellbeing and health. There is an increasing number of scholars [11-13] who empha‐ size that the mind, brain and body are related. The brain operates and responds on the basis of stimuli that come from outside and inside the body. It compares present experiences with past ones. The body then responds to the brain's orders and changes, according to the stimuli and messages it receives through the brain. In view of all the stored memories, the mind then directs the body's behaviour and influences the content of the memories to be stored.

The above suggests that the atmosphere and emotional and physical states during the trauma are very closely connected to the operation and functioning of the brain. This then effects bodily changes, which also include diseases and one's health condition.

Studies in the field of health care and medicine [14] have generally shown that people who have been sexually abused in the past have more health issues, report more somatic symptoms and pains than people who are not victims of sexual abuse. They also report a greater degree of chronic diseases. The most common and most general are: gastrological diseases, stomach diseases (ulcer), respiratory disorders (e.g., asthma, bronchitis, emphysema), heart problems, hypertension, arthritis, diabetes and gynaecological problems. Gynaecological problems are most often related to the loss of the menstrual cycle or excessive bleeding, sexual dysfunctions, frequent pains in the lower abdomen (even when not during menstruation), frequent inflam‐ mation of genitalia and pains during sexual intercourse.

Golding [15] interviewed a group of women who were seeking help due to severe PMS. She found that 95% of the women reported that they had experienced at least one attempt of sexual abuse or were sexually abused. Furthermore, 81% of these women were raped.

Additionally, other studies [11,13] report chronic inflammation of the bladder and frequent and painful urinating - which only intensify during menstruation. Such studies estimate that 90% of women with a history of sexual abuse experience these problems.

It is precisely the above health issues that can lead to sexually abused women turning to pills and other medical devices.

take a break, they go to extremes with eating and performing physical activities, they harm

It is often the case that medical examinations and tests do not explain the symptoms of a patient who has experienced a trauma. This does not mean that the patient does not suffer physical pain, only that the cause of the pain is psychosomatic. A traumatic experience effects not only the structure and functioning of the brain, but also the stability of one's psyche, one's thought processes and the health of one's body. In extreme cases, traumas can contribute substantially to psychiatric disorders [11]. Most of these patients seem demanding, afraid, uncertain and sometimes do not trust even those closest to them who ensure them that they are perfectly fine. Many suffer due to various medical symptoms, most often digestion problems, chronic fatigue and sleeping disorders. Scaer [11], who has worked as a doctor for many years and encountered various patients (those also injured in accidents or otherwise traumatized), believes that the various physical syndromes (pains) in traumatized people are more often a consequence of a certain experience, rather than a proven organ injury. *For example, stomach pain may be the result of a psychic distress experienced by a sexually abused person, rather than organ damage or food poisoning.* The trauma of sexual abuse can also impact neurological and hormonal (endocrinological) changes, the immune system, etc. A person's emotional state effects their physical wellbeing and health. There is an increasing number of scholars [11-13] who empha‐ size that the mind, brain and body are related. The brain operates and responds on the basis of stimuli that come from outside and inside the body. It compares present experiences with past ones. The body then responds to the brain's orders and changes, according to the stimuli and messages it receives through the brain. In view of all the stored memories, the mind then

directs the body's behaviour and influences the content of the memories to be stored.

changes, which also include diseases and one's health condition.

mation of genitalia and pains during sexual intercourse.

The above suggests that the atmosphere and emotional and physical states during the trauma are very closely connected to the operation and functioning of the brain. This then effects bodily

Studies in the field of health care and medicine [14] have generally shown that people who have been sexually abused in the past have more health issues, report more somatic symptoms and pains than people who are not victims of sexual abuse. They also report a greater degree of chronic diseases. The most common and most general are: gastrological diseases, stomach diseases (ulcer), respiratory disorders (e.g., asthma, bronchitis, emphysema), heart problems, hypertension, arthritis, diabetes and gynaecological problems. Gynaecological problems are most often related to the loss of the menstrual cycle or excessive bleeding, sexual dysfunctions, frequent pains in the lower abdomen (even when not during menstruation), frequent inflam‐

Golding [15] interviewed a group of women who were seeking help due to severe PMS. She found that 95% of the women reported that they had experienced at least one attempt of sexual

Additionally, other studies [11,13] report chronic inflammation of the bladder and frequent and painful urinating - which only intensify during menstruation. Such studies estimate that

abuse or were sexually abused. Furthermore, 81% of these women were raped.

90% of women with a history of sexual abuse experience these problems.

themselves, develop various forms of addiction, etc. [7].

120 Sexology in Midwifery

In general, the trauma of sexual abuse can have a direct impact on the health of an abused person. This is because the victim could have been exposed to infection or even infected with an STD during the abuse itself. The abuse can also indirectly harm the victim's health. This is because abuse increases the probability of the abused person getting involved in abusive relationships. In this regard, relational family therapy explores the subconscious attractiveness of abuse or the loyalty to feelings reminiscent of abuse (disgust, shame, disdain, fear, etc.). The psyche subconsciously seeks such an atmosphere, with the hope that these effects will be resolved and that something new – non-abusive – will happen [16]. Studies have shown that people who have been raped are much more inclined to experience physical violence from a partner in a relationship, compared to people who have no history of rape [17]. It is this physical violence that increases the chances of those victims suffering more serious injuries.

Some scholars [18] have found that victims of sexual abuse can quickly begin to perceive their bodies as dysfunctional. This can lead to psychosomatic problems. Some victims also become preoccupied with every bodily change. Furthermore, upon every - even the slightest - sign of illness, they suffer real horrors as if they were seriously ill. The consequences of such psychical distresses and experiences are manifested physically, in organs. In other words, the psychical pain is transferred to the victim's body and her body tells her that there is something she can no longer endure.

All these physical signs are psychosomatic and can manifest in: headaches (only as tensions or migraines), sleeping disorders, appetite disorders, stomach problems, gynaecological issues (chronic pains in the lower abdomen, dyspareunia, vaginismus, non-specific vaginitis, menopausal disorders, etc.), asthmatic and heart problems, muscular tension, fainting fits, vertigo, fatigue, etc.

The same scholars explain psychosomatic problems that are consequences of sexual abuse with a chronically stimulated autonomic nervous system. This nervous system increases the release of hormones (epinephrine and cortisol). It is this constant releasing that has long-term effects on the body.

Sometimes, the psychosomatic problems in a certain part of the body injured during abuse appear much later, even after several years, e.g., pains in the jaw if the person had been raped orally. Additionally, problems may emerge that are more difficult to notice such as a weak immune system, susceptibility to colds and flu, chronic fatigue and exhaustion, etc. [7].

All the mentioned studies show that the trauma of sexual abuse is related to a higher degree of health problems. Such problems can also have an effect on pregnancy, which we will consider next.
