Studies have shown that women with a history of CSA utilize the healthcare system more often and experience more medical interventions, such as surgery, than non-abused women. 15 16
Pregnancy, labor and birth
- Survivors may associate the feeling of lack of control during pregnancy, labor and birth with memories of past sexual abuse.
- Many studies have documented that the birthing process can remind women of past abuse. 3 27 28 29
- Some women are unable to deliver vaginally without an epidural because the feeling of the baby in the birth canal causes extreme flashbacks.
- Others are terrified of an epidural because they feel immobilized and unable to run away.
- Abnormally strong reactions can occur to almost anything in OB/GYN care and providers need
to have heightened sensitivity to a history of CSA even if the patient does not report it. 77 -
Recognizing survivors during labor
- Little or no prenatal care
- History of multiple STIs
- Scars from self-mutilation
- Extreme sensitivity about body fluids on underpads, sheets, and gowns
- Intense gag reflex
- Refuses taking infant's temperature rectally 35

Breastfeeding
- Breastfeeding requires intimacy, trust, sensitivity, and connectedness between a mother and her baby 26
- Breastfeeding may trigger negative emotions related to past sexual abuse that cause survivors to stop breastfeeding soon after they start or to decide against breastfeeding altogether.
- To some survivors breastfeeding may feel intrusive and become a source of anxiety, disconnection, and trauma. 26
- The hormones that regulate lactation also regulate sexual arousal, which may cause a negative feelings in women with CSA histories. 31 32
-
One study participant described the experience of breastfeeding as "disgusting". She noted that a baby "can't make a choice and I feel like I'm doing a dirty thing to my baby." 30
Pelvic exams and Paps
- For some women specific experiences or words can trigger memories of abuse including saying, "It will not hurt"
- Lying on the exam table
- Pelvic examinations - may see patients pulling back while the speculum is being inserted
- A procedure being done without previous announcement
- The feelings of helplessness and pain 33
- Survivors can have very unpleasant experiences during gynecology exams, including overwhelming emotions, unwanted or intrusive thoughts, having traumatic memories triggered, body memories, and feelings of dissociation. 34
- Other experiences may include feelings of guilt, worthlessness, and impending danger, worry about being vulnerable and violated, and thoughts of being raped and tortured. 34
-
43.5% of female CSA survivors in one study experienced memories of the original abuse during gynecologic exams. 33
Over 50% of the women in another study reported having felt detached from their bodies at some point during a gynecological exam. 34 - Remember that a vaginal exam can feel like a repeat of the abuse 35 33
- These memories can be so strong they cause patients to dissociate, or become emotionally detached. 36 19
- If the patient dissociates they may seem distant, unable to focus, or uninvolved in the present. 2