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Sexual Studies: Pain After Sexual Assault is Common…and Commonly Untreated

January 26, 2013

sex_assault_1Every Saturday, The CSPH highlights news or recent research in the field of human sexuality. This week we’re looking at the severity, distribution, and treatment of pain in sexual assault (SA) survivors.  A recent study in The Journal of Pain found that, although more than half of SA survivors experience severe pain immediately after assault and up to one week later, less than a third were being treated. This is the first study to follow the pain experience of SA survivors starting within 48 hours of the assault itself.
Eighty-three women were recruited from ten centers with a Sexual Assault Nurse Examiner (SANE) throughout the mid-Atlantic (MD, VA, NC, and SC), with the majority of the women as white, lower-middle class, less than 30 years old, and having some post-graduate education.  Given that recruitment centers ranged from inner-city Baltimore to rural Appalachia, these sample characteristics were the most disappointing part of a study that had the opportunity to really delve into the experiences of SA survivors living in vastly different conditions.  The exclusion criteria—including being pregnant, living with the assailant, and not having a telephone or living within driving distance of the center—likely played a role in this and seem pretty unreasonable since, as the authors even point out, the majority of SA survivors never seek treatment and thus any hospital-based study is already biased in terms of its participants.
All the survivors sought care within 48 hours of the SA that most commonly involved being unconscious during penile-vaginal penetration by someone who was not a stranger.  Levels of pain experienced by the women were assessed at the time they presented for treatment on a 1-10 scale for each of eight different body regions: head and face, neck, breast, arms, abdomen, back, genital and pelvic, and legs. The same was done via phone one week later with the addition of an evaluation of Acute Stress Disorder (ASD) symptoms, e.g. irritability, trouble sleeping, etc.  All other details regarding the SA and the patient were obtained from hospital records.
Most of the women experienced severe pain (≥ 7 out of 10) in one or more body parts both initially and one week later.  Though the severity of this pain did decrease between the two time points, its distribution tended to increase, with more women reporting pain in four or more areas at follow-up than at initial assessment.  The most common regions of pain reported at both times were the genital region, head/neck, back, and abdomen.  Interestingly, many women also reported pain, and sometimes the highest levels of it, in areas not affected by the SA.  For example, women commonly reported pain in the breast, abdominal, and back regions despite a lack of identifiable physical injuries (from SANE history and physical examination) in those areas.
Despite the ubiquitousness of this pain experience though, less than one quarter of the women who reported severe pain were given pain medication or instructions for non-medication pain treatment (e.g. a heating pad) when they initially presented for care.  Similarly, less than one third reported having received either by follow-up.  This result is incredibly alarming even given the study’s limitations, and it is something that the healthcare field needs to address, potentially through better training of SANEs and their staff, as suggested by the authors.  Additionally, the standard of care for treating survivors should be reassessed and reformatted.  In short, it is unacceptable that survivors are not receiving the care they need for something as easily treated as pain.  By not providing this basic solution, healthcare providers are doing a disservice to survivors rather than helping them.
McLean, S. A., Soward, A. C., Ballina, L. E., Rossi, C., Rotolo, S., Wheeler, R., . . . Liberzon, I. (2012). Acute Severe Pain Is a Common Consequence of Sexual Assault. The Journal of Pain, 13, 736-741.

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