**8. Types of health issues**

Gastrointestinal symptomatology and disorders have been correlated with childhood sexual abuse. Gastrointestinal disorders include irritable bowel syndrome which is known to affect as many as 10%-20% of adults living in the United States (Hymowitz, 2011). Heim (2002), Drossman (1998), and Levy (2005) have discussed the relationship of genetic and environmental factors, joining with life stressors that influence physiological factors such as the Central Nervous System (CNS), and the Enteric Nervous System (ENS) (Hymowitz,

The survivor may not have had good health care models to emulate or his or her health care needs may have been neglected and minimized. Cycles of negative emotions, stress, pain and self-defeating beliefs may perpetuate physical problems. Years of avoidant behavior regarding health issues may have passed before the CSA survivor reaches the health care

In an effort to self-soothe, the CSA survivor may have tried to self-medicate using a variety of maladaptive behaviors and methods. No one would doubt that the prevalence of addiction difficulties with substances such as drugs and alcohol in the United States is of epidemic proportion. Eating disorders, closely correlated with sexual abuse, is a mental health difficulty with severe physical consequences. Unprotected sex, sexually risky behaviors, and prostitution have their etiology in sexual abuse trauma (Tarakeshwar, Fox, Ferro, Khawaja, Kochman, Sikkema, 2005). Self-injurious behavior such as skin carving has long been thought to alleviate some of the internal stress experienced by CSA

Before reviewing the medical issues of CSA survivors one must consider the often mistaken assumption that the somatic complaints of the survivor have no physical etiology, and therefore they are often overlooked and/or misdiagnosed. This phenomenon occurs both

Psycho-physiological changes coupled with psychological changes create multi-systemic problems common to CSA survivors. The American Medical Association 1992 addresses these

Psychological distress also contributes to the CSA survivor having an impaired view of their

Gastrointestinal symptomatology and disorders have been correlated with childhood sexual abuse. Gastrointestinal disorders include irritable bowel syndrome which is known to affect as many as 10%-20% of adults living in the United States (Hymowitz, 2011). Heim (2002), Drossman (1998), and Levy (2005) have discussed the relationship of genetic and environmental factors, joining with life stressors that influence physiological factors such as the Central Nervous System (CNS), and the Enteric Nervous System (ENS) (Hymowitz,

The event has such physiological and psychological intensity that it overrides and impairs the individual's neurophysiological mechanisms of adaptation. The resulting damage is not merely emotional. The person's biological capacity to tolerate and regulate internal and external stimulation can be altered. These changes, in turn, compromise the person's ability to organize perceptual stimuli and cognitive information, making them susceptible to a range of somatic illnesses and a spectrum of

with the health and mental health care professional as well as the CSA survivor.

professional, thus warranting more intensive and costly treatment.

**6. Health risk behaviors** 

survivors.

**7. Medical issues** 

changes when they state,

**8. Types of health issues** 

anxiety and depressive disorders (p 35).

health either through somatization and/or dissociation.

2011). All of these factors modulate functional aspects of the gastrointestinal system and later, symptoms. While IBS is influenced by several factors such as genetics, environment, and family environment, childhood sexual abuse is a contributing factor.

Gynecological problems such as difficult menses and pain when having sexual intercourse, sexual performance, as well as promiscuity, may also contribute to poor reproductive health outcomes.

CSA survivors may also suffer from Immune System Dysfunction, musculoskeletal difficulties, respiratory ailments such as Asthma, and rheumatic disorders. CSA survivors can also experience what is called Medically Unexplained Symptoms (MUS) such as fibromyalgia (Roelofs & Spinhoeven (2009). Other types of difficulties include urinary tract infections, migraine headaches, chronic pelvic pain and pain intolerance or sensitivity.

Addictive behaviors that lead to poor health outcomes are also associated with childhood sexual abuse such as eating disorders (anorexia, bulimia, and obesity), substance abuse (alcohol and/or drugs), and cigarette smoking. Table 1 lists the most common medical conditions for CSA survivors.

 Autoimmune Diseases Cardiovascular Disease Pain Perception and Chronic Pain Compromised Reproductive Health Gynecological Issues Diabetes Eating Disorders (Anorexia, Obesity, Bulimia) Gastrointestinal Disorders (Irritable Bowel Syndrome) Immune System Dysfunction Musculoskeletal difficulties Respiratory Ailments (Asthma) Medically Unexplained Symptoms (MUS) e.g., fibromyalgia Rheumatic Disorders

Table 1. Common Medical Difficulties Reported By CSA Survivors
