Women who were pressured or physically forced into an unwanted first sexual intercourse were found to have increased rates of adverse reproductive, gynecologic, general health, and functional outcomes, according to study results published in JAMA Internal Medicine.

Investigators conducted a cross-sectional analysis to determine the frequency of involuntary sexual initiation among US women and if these encounters would subsequently affect reproductive, gynecologic, and general health outcomes.

The primary outcomes measured were the prevalence of forced sexual initiation, the age of the woman and her partner at primary sexual intercourse, and the odds ratios for unwanted pregnancy or abortion, development of pelvic pain, and other reproductive and general health events.

The authors collected data from 13,310 women aged 18 to 44 years who completed the National Survey of Family Growth, conducted by the Centers for Disease Control and Prevention. Following adjustments, 6.5% of respondents reported that they had experienced unwanted sexual initiation, which translates to 3,351,733 US women in this age group.

Results suggested that women who experienced unwanted primary intercourse were on average 2 years younger than women with voluntary sexual initiation (15.6 years vs 17.4 years, respectively). The average age gap between women included in the study and their sexual partners was 6 years.

Of women who reported forced sexual initiation, 74.7% were younger than 18 years at the time compared with 60.5% of women who experienced voluntary sexual initiation; 6.8% of women subjected to forced sexual initiation and 0.1% of women with voluntary sexual initiation were younger than 10 years at the time.

Of the women who reported forced sexual initiation, 50% claimed they were coerced by a partner who was larger or older; 54% reported experiencing verbal pressure and 46.3% were physically forced. Women who were forced into their first sexual intercourse also reported being given a drug (22.0%) or experiencing a physical threat (26.5%) or physical harm (25.1%).

Compared with women who had voluntary experiences, women who were forced into sexual initiation were more likely to have had an unwanted first pregnancy (adjusted odds ratio [aOR], 1.9), an abortion (aOR, 1.5), or to not have used birth control in their lifetime (aOR, 2.6).

According to study results, women who were subjected to forced sexual initiation were more likely to experience pelvic inflammatory disease, endometriosis, and ovulation or menstruation-related problems. They were also more likely to have not undergone cervical cancer screening or HIV testing.

Illicit drug use (aOR, 3.6), fair or poor health (aOR, 2.0), and difficulty completing tasks owing to a physical or mental health condition (aOR, 2.8) were more frequently reported among survivors of forced sexual initiation.

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“A substantial proportion of American women may experience forced sexual initiation, and the individual and public health implications of this exposure are far reaching,” the investigators noted. “Although additional research is needed, physicians should incorporate trauma informed measures into their practices while advocating for the reduction of structural causes of sexual violence.”


Hawks L, Woolhandler S, Himmelstein DU, Bor DH, Gaffney A, McCormick D. Association between forced sexual initiation and health outcomes among US women [published online September 16, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.3500