As you may recall, last week I shared how I have heard a lot of recent buzz about sexual abuse and Endometriosis sharing a causal link (read more here). As promised, I did some digging to figure this out for myself. Curious on my opinion? Read on! But, please remember : it’s only my opinion.
According to The National Center for Victims of Crime, 1 in 5 girls and 1 in 20 boys are a victim of child sexual abuse. In 2012 in the United States alone there were 62,939 reported cases of child sexual abuse. That same year, there were 346,830 reported rapes or sexual assaults of persons who were 12 or older.
There are a some people out there that believe a woman’s history of childhood abuse (sexual abuse, emotional abuse, and neglect) may be associated with their Endometriosis. Some even theorize that if women were abused as children, they’re at greater risk for developing Endometriosis.
If 1 in 5 girls have been abused as children, and 1 in 10 women have Endometriosis, there’s a chance that Endometriosis and sexual abuse are just a numerical coincidence. I created this blog’s cover photo as a demonstration : out of 30 women, six were sexually abused as children (1 in 5; red); and 3 have Endometriosis (1 in 10; yellow); however, there may be some overlap (the two women who are yellow and red). The lucky ones (white) have been untouched by either experience.
But, as we’ll see here, there are theories that sexual abuse may cause Endometriosis growth and symptoms.
Being Taken Seriously
As so many of us know, the medical community may brush our complaints aside. It’s regular period pain. We’re weak. It’s all in our heads. Why such nonchalance still exists is beyond me, especially when it’s a proven physical condition…
Any hint of a theory may be enough to invalidate our illness. Sexual abuse has been theorized by some as a cause of Endometriosis. Although many women with Endo have been abused, there are also many who have never had such an experience. Or others whose sexual abuse came after their Endometriosis symptoms started.
In 2014, radio talk show host Dr. Drew Pinsky took a call. The caller was a male describing the pain and disorders his fiancé had been dealing with, including Endometriosis. Before he could ask his question, Dr. Drew interrupted saying, “These are what we call sort of functional disorders. Everything you mentioned, everything you mentioned, are things that actually aren’t discernibly pathological. They’re sort of — they’re what we call ‘garbage bag disorders,’ when you can’t think of anything else, you go ‘eh, well it’s that.’ So it then makes me question why is she so somatically preoccupied that she’s visiting doctors all the time with pains and urinary symptoms and pelvic symptoms, and then that makes me wonder, was she sexually abused growing up?” The caller responded that she had been sexually abused, and Dr. Drew stated her abuse was the cause of her chronic pelvic pain and hung up. Dismissed. On national radio. DISMISSED. You can hear the entire broadcast here. Luckily, several Endometriosis experts (and EndoSisters) from around the world responded, validating our suffering. If you’d like to read the experts’ responses, click here. The barrage of anger prompted Dr. Drew to later host a show with Dr. Tamer Seckin (co-founder of the Endometriosis Foundation of America) to discuss Endometriosis on his radio show, which can be heard here.
Louise Hay wrote You Can Heal Your Life and it was originally published in 1984. The 2012 edition is available free online here and I gave it a glance. It indexes various illnesses and how they are caused by our own negative experiences and thoughts. She believes that Endometriosis is caused by “insecurity, disappointment, and frustration. Replacing self-love with sugar. Blamers.” The book further suggests that if I do not believe her identified cause, I have to sit down and ask myself, “What could be the thoughts in me that created this?” And her fix? Repeat to myself, “I am willing to release the pattern in my consciousness that has created this condition” and my new thought pattern should be, “I am both powerful and desirable. It’s wonderful to be a woman. I love myself and I am fulfilled.” She also wrote Heal Your Body: The Mental Causes for Physical Illnesses and the Metaphysical Way to Overcome Them (first published in 1976) and supposedly links sexual abuse to many illnesses, including Endometriosis. I have yet to read it; I don’t know that I will be able to. Don’t get me wrong : I’m all about positive affirmation, etc., but this just rubs me the wrong way…
A Gambit of Ailments
There’s a 65-page report that references various studies linking women’s infertility and pelvic issues with their sexual abuse. These issues included prolapsed wombs, miscarriages, Endometriosis, pelvic pain, ovarian cancer, erosion of the cervix, and pelvic inflammatory disorder. It also discussed various psychological disorders and emotional conditions, drug/alcohol/smoking dependency, digestive disorders, respiratory conditions, hormonal imbalances, circulatory issues, urinary conditions, skin conditions, muscle aches and pains…the list goes on and on. Each of the women interviewed, or in the literature they read, had a common link : childhood sexual abuse. All of that being said, were the authors of the report able to pinpoint childhood sexual abuse as a causal link to the women’s physical ailments? No, they were unable to conclude that. But, they did suggest a possible link between the types of illnesses and the age at the time of the sexual abuse. They also suggested that medical professionals ask their patients about any history of sexual abuse during consultations. This report, even for the authors, raised a lot of questions that they’d like to delve into deeper. They also have some phenomenal recommendations to schools and government agencies for preventing and treating childhood sexual abuse.
Dr. Carol Berkowitz wrote a chapter in a book concerning the long term consequences of sexual abuse. She also cited several studies associating sexual abuse with many ailments, including psychological disorders, gastrointestinal disorders, gynecologic complaints, neurological conditions, pain syndromes, eating disorders, and “somatization” disorders (the bodies way of manifesting emotional and mental issues). She doesn’t know if they are actually related to the abuse, but sees no harm in including sexual abuse in a patient history questionnaire.
There are other literary references which state there appear to be a significant number of women with Endometriosis who report a history of sexual abuse, compared to women without Endometriosis. Theories point to a decline in the immune system and “psychoneuroendocrinological regulation processes.” With that being said, however, they have not been able to clarify the why behind these supposed changes.
Chronic Pelvic Pain
Chronic pelvic pain (also referred to as CPP) may have a physical cause (like Endometriosis), or there may be no pinpointable physical cause. Plenty of studies have been conducted regarding CPP.
In 1990, a comparative study was published about women with chronic pelvic pain, chronic non-pelvic pain, and others with no pain. It found that the women with chronic pelvic pain had statistically significantly higher occurrences of childhood physical abuse, but childhood sexual abuse figures were about the same for each group. They found that it is likely sexual abuse doesn’t influence pelvic pain, but any type of abuse may promote chronic pain conditions across the board.
In ’91, a study looked at women who had been abused, but had no physical reason (like Endometriosis) for their chronic pelvic pain. Twenty-seven percent of those patients reported pain after sex, and 27% of those patients also stated they had negative sexual experiences, such as childhood sexual abuse. All of the women in the study underwent at least one year of therapy and reported an improvement in their pelvic pain. This study hoped that doctors would seek a sexual abuse history in patients complaining of pain and point them in the direction of therapy as a possible treatment.
In a study published in 1998, 90 women completed psychological evaluations and questionnaires about their histories. Thirty women suffered from chronic pelvic pain, 30 other women suffered from chronic non-pelvic pain, and the last 30 women didn’t suffer from any pain. Each group of 30 had a number of women who had suffered sexual abuse in their lifetime. The data suggested that women who suffered chronic pelvic pain had a higher history of sexual abuse. Many of those women also suffered from Endometriosis.
Another study in 1998 of women who had endured abuse and complained of CPP led the authors to believe that trauma may cause a change in the way the endocrine glands (hypothalamus, pituitary gland, and adrenal glands) interact. They state “a lack of protective properties of cortisol may be of relevance for the development of bodily disorders in chronically stressed or traumatized individuals.”
A study from 2000 found “there is a significant association between sexual victimization before age 15 and later chronic pelvic pain.”
An interesting study published in 2005 was of three groups of women who suffered a history of abuse : those suffering from chronic pelvic pain who did not have Endometriosis; those suffering from chronic pain with Endometriosis, and women who had no pain. It found that women with CPP (with and without Endometriosis) had higher levels of pain when suppressing their emotions. The authors suggested if patients could better express their emotions and let things go, it may help ease their chronic pain.
A study published in July 2018 collected data from 1989 to 2013 and analyzed the results. They opined that women with a history of childhood physical and/or sexual abuse had a higher risk for Endometriosis. The more severe the abuse, the greater the risk.
Stress & Inflammation
Inflammation is a symptom of Endometriosis – a rather painful one…And many in the medical community have researched to see if abuse has any sort of affect on our inflammatory responses.
Stress may weaken our immune system and trigger inflammation within our bodies. There is even some talk about how there are changes in our brainwaves for women who have endured childhood sexual abuse, and those changes alter our brain’s response to inflammation. Due to these theories, some believe that childhood sexual abuse may make a person more susceptible to autoimmune diseases. And many people believe Endometriosis is an autoimmune disease.
In 2012, a study found that women who had been sexually abused as children had slightly elevated inflammatory markers than women who had not. It concluded that it may have an affect on women in their future risk of physical and psychological disorders.
A 2013 study looked at the way childhood abuse (verbal, physical, sexual) may trigger inflammatory responses, as well as poorer immune systems, in adults. The study found that adults who sustained childhood abuse actually had higher levels of chronic low-grade inflammation when subjected to daily stress than those who were not abused. The author of the study did mention that there were several variables that were not accounted for and further studies were needed, but “[e]arly life stress may set the path for dysregulated inflammatory stress responses across the life span.”
In 2015, a study looked into a relationship between childhood trauma and inflammatory responses. This study acknowledged prior findings that childhood trauma could lead to psychological disorders, as well as chronic physical conditions such as arthritis, cardiovascular disease, and cancer. It found that childhood trauma (physical, verbal, sexual, etc.) contributed to a pro-inflammatory state in adults. These changes may be because the trauma caused a glitch in our immune systems. As they stated, “[there is] strong evidence that childhood traumatic events significantly impact on the inflammatory immune system, with trajectories reaching into adulthood, thus offering a potential molecular pathway by which early trauma confers vulnerability to developing psychiatric and physical disorders later in life.” However, further studies are needed.
My Promised Two Cents
I don’t believe that sexual abuse is a cause of Endometriosis. It may, perhaps, contribute to it’s spread and progression due to stress. It’s been found that stress affects inflammation and the progression of our Endometriosis. It’s been proven in the lab – read more here. Whether or not the stress of enduring childhood sexual abuse, the nightmares and memories, the triggers, and the shame had anything to do with the progression of my disease; I have no idea. BUT I have cut out as much stress in my life as possible and take positive steps to remaining calm and as stress-free as possible. I repeat : there’s no way I believe that because I was molested as a child, I magically developed Endometriosis, but I do believe that the statistics of sexual abuse and women with Endometriosis overlap. I also had a lot more childhood stress than just the sexual molestation : my father was in a horrific car accident when I was three which left him in a wheelchair, my parents divorced when I was six, we moved around a lot, started a new school, endured teasing by classmates, family woes, being a teenager, etc. I will not hold my grandfather responsible for my Endometriosis, nor will I blame my childhood years. And, despite it all, I enjoyed being a kid. I have mostly fond memories growing up.
Again, our disease has no proven cause; simply theories, too many to list. Many are highly supported, others are fiercely discredited. Some say we’re born with it. Some say it’s our periods gone in reverse. Others believe it’s an autoimmune disease. Others say it’s due to toxins. Some believe everyone has it, it just lays dormant in our bodies, triggered awake by something. One day they may pinpoint exactly what the cause is…which may lead them to a cure more quickly. But for now, we can continue to find ways to ease our suffering, lighten our stress load, and support each other.
For any of you who may have been sexually abused (childhood or other), I strongly suggest therapy. I endured counseling as a child, hated it, rolled my eyes, didn’t want to be there, ended up telling her what I thought she wanted to hear. But as an adult, dealing with sex for the first time…I had to take one of those tricks my childhood therapist had taught me – and it worked. All of my triggers growing up, which threw me right back into my grandfather’s lap, have lost their power. He lost his hold over me.
The trick? Imagine your favorite childhood hero (Mighty Mouse, of course), and when your trigger activates and you’re thrown right back into that scenario, your hero sticks his hand up and stops you (or your abuser) from proceeding. In my case, he stopped me from sitting on *that* lap…It took time. But I was able to let go. I was able to enjoy my partner. And could look at physical triggers (leather studded furniture, a gun case, glass grapes, etc.) without freezing, needing to cry, or reliving the nightmare. Imagination : it’s a powerful force… Have your own trick? Share it with us.
Again…this is purely my opinion. And you’re welcome to yours…and I’d LOVE to hear it!
*Updated August 21, 2018*
Adler Graduate School (Thesis, 2007) – Chronic Illness as Trauma: The Case of Endometriosis, an Alderian Perspective
American Journal of Preventative Medicine (Article; Dec. 2012) – Inflammation and Early-Life Abuse in Women
American Nurse Today – Long-Term Health Outcomes of Childhood Sexual Abuse
An International Journal of Obstetrics and Gynaecology (Article; 1998) – A comparative study of women with chronic pelvic pain, chronic nonpelvic pain and those with no history of pain attending general practitioners
End Endo Forever – Top Specialists Speak Out to Dr. Drew on Behalf of Endometriosis Patients Worldwide.
Endometriosis : Science and Practice (Part 10; April 2012) – Associated Disorders
Fertility and Sterility (Abstract; Sept. 2012) – Abuse in Childhood and Risk of Endometriosis
Human Reproduction (Abstract; July 2018) – Early Life Abuse and Risk of Endometriosis
Jezebel – Dr. Drew Insults Women with Endometriosis, Ignites Massive Shitstorm
Journal of Psychosomatic Research (Abstract; April 2005) – Coping with Emotions and Abuse History in Women with Chronic Pelvic Pain
Minnesota Center Against Violence and Abuse – The Health Impacts on Adult Women of Childhood Sexual Violence Before the Age of Twelve (65 pages)
Molecular Psychiatry (Article; June 2015) – Childhood Trauma and Adulthood Inflammation : a Meta-Analysis of Peripheral C-Reactive Protein, Interleukin-6 and Tumour Necrosis Factor-α
Obstetrics & Gynecology (Abstract; Dec. 2000) – Chronic Pelvic Pain and Previous Sexual Assault
Obstetrics & Gynecology (Abstract; July 1990) – History of Physical and Sexual Abuse in Women with Chronic Pelvic Pain (.pdf of full article available in link)
Obstetrics & Gynecology (Abstract; May 1991) – A Randomized Clinical to Compare Two Different Approaches in Women with Chronic Pelvic Pain
Psychosomatic Medicine (Abstract; May/June 1998) – Abuse-Related Posttraumatic Stress Disorder and Alterations of the Hypothalamic-Pituitary-Adrenal Axis in Women with Chronic Pelvic Pain
Posters2View (Poster; unknown)- Adverse Childhood Experiences – A Risk Factor for the Development of Endometriosis?
The National Center for Victims of Crime – Child Sexual Abuse Statistics
Treatment of Child Abuse : Common Ground for Mental Health, Medical, and Legal Practitioners (Chapter 4; April 2005) – The Long Term Medical Consequences of Sexual Abuse
U.S. Department of Justice National Sex Offender Public Website – Raising Awareness about Sexual Abuse; Facts & Statistics
U.S. National Library of Medicine (Article; July 2013) – Childhood Abuse and Inflammatory Responses to Daily Stressors
~ Again, I am a layman. I do not hold any college degrees, nor mastery of knowledge. Please take what I say with a grain of salt. If curious, do your own research 😉 Validate my writings. Or challenge them. And ALWAYS feel free to consult with your physician. Always. Yours ~ Lisa