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 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