When Alison*, now 30, was raped as a college freshman, she recalls feeling numb and emotionally disconnected from her friends and family. “That weekend, I was mostly really worried about getting pregnant or getting an STI,” she tells Teen Vogue. Alison bought Plan B at CVS and requested an emergency appointment with her primary care doctor, who prescribed her antibiotics to decrease the risk of contracting an STI.
Alison’s doctor was supportive and provided her with a list of therapists who specialize in PTSD, as well as support groups in the area. “She told me that a lot of people who are raped end up developing PTSD and sometimes it happens years after the assault… But no one ever told me that I might end up having physical health problems, too.”
When she began experiencing frequent migraines, unexplained body pain, and fatigue at age 23, Alison thought it was completely separate from her PTSD and anxiety. Despite the fact that her history of rape was in her medical records, Alison’s doctors didn’t explore the possible connection of PTSD physical symptoms, either. “They ran a ton of tests and x-rays and couldn’t find anything conclusive, so they gave me a dual diagnosis of fibromyalgia and chronic fatigue syndrome,” she recalls. Her doctor prescribed Lyrica, a medication used to treat nerve pain and Topamax, a medication used to prevent migraines, and recommended acupuncture, yoga, and diet adjustments.
Fibromyalgia — a condition marked by chronic pain, fatigue, memory issues, and other problems that sometimes arise after physical trauma — isn’t uncommon in survivors of sexual violence. A 2005 study published in The Clinical Journal of Pain found that women who had been raped were three times more likely to have fibromyalgia than women who didn’t report experiencing rape. A doctor at the Cleveland Clinic mentioned at a conference in November 2019 that 38% of the 600 patients treated for fibromyalgia reported a history of physical abuse, sexual abuse, or both.
Steve Chee, MD, a California-based practitioner who specializes in treating pain conditions, tells Teen Vogue there’s a correlation between trauma and chronic pain. He explains that trauma can cause the brain structure to change and the body’s nervous system to become wired for stressful or scary situations. “So then diseases that are related to stress can crop up,” Dr. Chee explains, citing migraines, chronic pain, irritable bowel syndrome (IBS), and fibromyalgia as examples. However, he emphasizes that just because a person has one of these illnesses doesn’t automatically mean they have a history of trauma.
“As a doctor, it’s important not to hunt for trauma as this can be traumatizing for the patient,” he says. If there is trauma present, depending on where a patient is in their recovery, a doctor asking questions can feel invasive and lead to patients questioning themselves or feeling reluctant to share. “Physicians that create a safe space for patients to bring forward any concerns or questions can be very therapeutic and healing for any condition,” he tells Teen Vogue.
But when trust is established and patients do share that they’ve been sexually abused, Dr. Chee says he makes certain modifications to their treatment. Because physical symptoms often improve when a patient is doing better emotionally, therapy is recommended in addition to physical treatment.
The combination of physical and mental health treatment was critical for Hannah, now 26. She was sexually and emotionally abused by multiple people during her childhood. Hannah tells Teen Vogue that she began experiencing physical health problems about four years ago, around the time she was able to cut ties with her last abuser. “My body just didn’t feel right,” she says. “I had a lot of IBS symptoms and I was getting random pain throughout the day. I was getting really bad cramps for a year straight.” Hannah also noticed that her feet, arms, and legs frequently “went numb.” When she found a therapist who specializes in complex PTSD (a form of PTSD that’s caused by repetitive trauma), the therapist explained to her that the numbness was a fight or flight response because her body constantly felt the need to protect itself from abuse. “I was doing fight or flight like 100 times a day without realizing it,” Hannah says. “So that’s why I was so tired.”
Now that she’s been in weekly therapy for three years and has begun doing trauma-focused yoga, Hannah says her IBS has mostly cleared up and she doesn’t get as many fight or flight responses during the day. But she continues to have reproductive health problems. She tells Teen Vogue that she frequently gets ovarian cysts and her providers told her it's common in sexual abuse survivors. “They see a correlation but they can’t say it’s causation,” she says. When Hannah decided to get an IUD, her body rejected it. “It smashed and ended up going through my uterus,” she recalls. “I just have so many reproductive health problems and a lot of therapists have told me that it’s probably due to all the trauma that’s happened.”
Reproductive health problems are relatively common in survivors of sexual violence. Alison tells Teen Vogue she had limited sexual experience at the time of her rape — so when she attempted to have consensual sex with a new boyfriend a year later, she didn’t think the excruciating pain was due to the fact that her body associated sex with pain. “It just hurt so much and it didn’t get any better over time,” she recalls. “I thought sex was always a painful thing.” When she had a panic attack during a routine visit to the OB-GYN, the doctor suggested she might have vaginismus, a condition that causes the muscles around the opening of the vagina to involuntarily contract.
Alla Vash-Margita, MD, an OB-GYN at Yale Medicine, says the condition is common in sexual violence survivors, and sometimes it manifests years after the assault. The diagnosis is made after a pelvic exam rules out physical causes like a septate hymen. In patients with vaginismus, “the muscles become very tense and the patient is unable to relax those muscles, even if she’s with a sexual partner who’s kind and gentle,” Dr. Vash-Margita explains. “[As a result], penetration with a penis or a finger becomes difficult and painful.”
The condition can be incredibly frustrating because it occurs even if someone wants to have sex and feels ready to do so. “There’s not much control on the part of the patient,” Dr. Vash-Margita says, emphasizing that the muscles tense up involuntarily and it’s not something a person can necessarily fix on their own — even if they feel emotionally ready to have sex and feel safe and comfortable with their partner.
Just like the other conditions referenced above, vaginismus isn’t always related to sexual abuse, and not everyone with with the condition has been abused. Doctors believe that other causes may include the belief that sex is shameful or wrong, fear that the vagina is too small, and a history of painful UTIs and yeast infections. There is often no known cause at all. Still, while correlation doesn’t mean causation, doctors have found links in some cases between sexual abuse and certain medical conditions. These physical ramifications can be surprising, especially for those experiencing them.
Although many doctors recommend cognitive behavioral therapy to address the underlying psychological cause of vaginismus, physical treatment can be crucial to recovery. For example, gynecologists teach patients to use dilators, which are designed to relax and stretch the muscles so they don’t clench and tense up. Typically they begin with a small sized dilator and then slowly work their way up to larger dilators. Vash-Margita explains that using dilators re-trains the muscles and teaches them to relax. Another treatment that’s frequently recommended for people with vaginismus is pelvic floor physical therapy, which also focuses on re-training the muscles so they don’t contract when penetration occurs.
For sexual violence survivors who experience physical pain and chronic illness, a combination of therapy and medical treatment seems to be a big help in improving symptoms. Stephanie Weaver, now 59, dealt with fibromyalgia, chronic fatigue, and migraines for years. After intensive therapy and going through a forgiveness process with her abuser, she says her fibromyalgia symptoms are now “mild” and she no longer experiences fatigue. Stephanie still gets migraines, which she’s had her whole life. She continues to use yoga and meditation to maintain her physical and mental health.
Alison tells Teen Vogue that her PTSD physical symptoms and anxiety improved after she found the right therapist and psychiatrist. “I still go through emotionally rough patches, though,” she says. “I’ve definitely noticed that I have more energy and less body pain when I’m in a good place emotionally. But I always need more sleep than average.” At one point in her early 20s Alison’s fibromyalgia and chronic fatigue syndrome symptoms were so severe that she had to take a medical leave from work. Today she’s able to maintain a job and a social life. “The fibromyalgia pain is still there, though. It’s not as bad as before; it’s bearable, but it’s also not easy,” she says.
As a writer, Stephanie uses her platform to help other survivors and provide them with the tools to advocate for themselves when doctors are dismissive of their physical symptoms. “It’s really hard to break the silence surrounding sexual abuse,” she says. “It’s easy to feel ashamed, but the shame belongs with the perpetrator and not the survivor.” Her goal is to put out writing that helps other people heal and make the connection of how the abuse may be affecting them physically. “That’s my way of making something positive of this bad experience I had,” she says.
*Indicates the name is a pseudonym.
