Does it shock you to hear that at least 20 per cent of girls and 10 per cent of boys experience some form of childhood sexual abuse (CSA) by the age of 18, and family members constitute one third to one half of the perpetrators against girls and 10 per cent to 20 per cent of the perpetrators against boys.
Many folks have a difficult time believing those statistics. I did. Until I became a counsellor. A significant proportion of my clients have reported being sexually abused. Mostly women, but some men too.
In any type of psychotherapy or counselling I believe it is important to explore traumatic childhood experiences, but in infertility counselling, in particular, questioning my clients about childhood sexual abuse, as well as adult experiences of assault or rape is routine for me. While infertility treatment is difficult for anyone to deal with at the best of times, it can be particularly challenging for anyone who has experienced sexual abuse or any type of sexual interference.
Sexual abuse has severe and long-term consequences for victims. Both males and females who have been sexually abused are at higher risk for personality disorders, anxiety disorders and major affective disorders. In addition, childhood sexual abuse affects adult interpersonal relationships.
A Canadian study found that women who had experienced intrafamilial sexual abuse as children were less likely to have a secure attachment style, and more likely to have a fearful attachment style compared to those who had not. Avoidant/fearful attachment styles are inversely correlated with romantic relationship satisfaction, stability, intimacy and commitment and associated with a greater risk of relationship dissolution.
At the 2012 Canadian Fertility and Andrology Society (CFAS) conference in Ottawa, research was presented that found the number one reason why people are putting off having children until later in life is not career or financial stability, but waiting to find a stable relationship. Individuals who have difficulty forming secure attachments may be less likely to maintain stable relationships.
In my practice I have seen several clients who did not marry and/or attempt to have children until later in life when they had resolved the emotional trauma from sexual abuse, and its impact on their interpersonal relationships. Having waited, these women were now facing age-related infertility.
This situation may make the experience of infertility especially emotionally distressing. Individuals who have been sexually abused often blame themselves and feel significant guilt and shame. If their infertility is due to putting off childbearing, this may only add to their feelings of guilt and shame as they may blame themselves for the infertility, and feel guilt for jeopardizing their partners' opportunity to have a family.
Some abused individuals may feel like they are being punished, and that the infertility is confirmation that they are to blame for the abuse, are damaged, or that this is a sign that they are not suitable to parent. Others may wonder if the infertility is the result of physical trauma caused by the abuser, but may be too ashamed to address their concerns with their partner, and/or health care providers.
Certainly few of the individuals I have counselled have mentioned their sexual trauma experiences to their physicians. Infertility may also trigger emotions, memories, and/or self-referent attributions resulting from childhood sexual abuse, such as powerlessness, which may overwhelm individuals already dealing with the stress and emotional burden of infertility.
Finally, the invasive nature of infertility treatments, which often involve frequent exams of the pelvic region, and clinical evaluation of sexual function and behaviour, can be even more distressing and uncomfortable for individuals who have experienced sexual abuse.
I believe that given the prevalence of CSA and other forms of sexual interference, that screening should be a standard part of routine health care -- not just in fertility clinics -- but also within general front line health care practice.