Infertility Linked to Sexual Abuse

Fran Lowry

October 17, 2018

Many women who have served in the Armed Forces in the United States have experienced sexual assault, and those victims of assault are more likely to be infertile, a cross-sectional study of infertility in veterans shows.

"Recent studies have suggested that fertility status can serve as a window to overall health and that people who show up with infertility may, later on, be at increased risk to develop other things like cancer and heart disease," said Abigail Mancuso, MD, from the University of Iowa in Iowa City.

"We wanted to know if serving in a military area or war zone, having some radiation exposure, or being around a serious accident or explosion could lead to infertility or health problems," she told Medscape Medical News.

The researchers also looked at the issue of sexual assault in women veterans as one of the things that might lead to infertility, Mancuso said at the American Society for Reproductive Medicine 2018 Scientific Congress in Denver.

The theory is that the resulting chronic stress of the sexual assault perhaps leads to infertility and chronic health problems.

"Women veterans have quite a high rate of lifetime sexual assault, and that was a big focus of the database we used in our study," she explained. "The theory is that the resulting chronic stress of the sexual assault perhaps leads to infertility and chronic health problems."

Mancuso and her colleagues conducted computer-assisted telephone surveys of 966 women 21 to 52 years of age who were enrolled in the Veterans Administration healthcare system.

About one-third of the women had served in the post-Vietnam era (1978 to 1990), one-third in the Persian Gulf era (1990 to 1998), and one-third in Operation Enduring Freedom and Iraqi Freedom (1998 to 2010).

Infertility — defined as having tried unsuccessfully to have a baby — was reported by 179 (18.5%) of the women surveyed.

The women who reported infertility were significantly older than the women who did not (mean age, 40 vs 38 years; P = .003), were more likely to have been smokers, and were less likely to be white.

The women who reported infertility were also more likely to report sexual assault that included vaginal penetration than women who were not infertile (60% of 107 women vs 45% of 368 women; P < .001).

Rates of fibromyalgia were higher in the infertile group than in the fertile group (18% vs 8%; P < .001), as were rates of cancer (14% vs 8%) and chronic pain (65% vs 54%, P = .009).

"Sixty percent of the infertile women had been sexually assaulted with vaginal penetration. That is very disturbing," Mancuso said.

"My hope is that our study will increase awareness of what our female veterans go through and that this increased awareness will lead to changes to protect these women, who are serving our country," she added.

Patients who present with infertility may warrant additional counseling and screening regarding chronic health issues.

The high rate of sexual assault revealed in this study is very disturbing, said Elizabeth Ginsburg, MD, from the in vitro fertilization program at the Brigham and Women's Hospital in Boston.

"It's horrifying," she told Medscape Medical News. "I'm assuming that the infertility may be related to chronic pelvic pain, because women who have been sexually assaulted are much more likely to get chronic pelvic pain. Whether that is because of the emotional trauma, I don't know, but it's horrifying."

"You would hope that the military knows this and is doing something about it. And that there will be more women in positions of authority to eventually do something about this," she said.

Ginsburg said she agrees with the conclusions of Mancuso's team.

"Patients who present with infertility may warrant additional counseling and screening regarding chronic health issues," she added.

This study was funded by the Department of Veterans Affairs, Health Services Research and Development: NRI 04-194-1. Mancuso and Ginsburg have disclosed no relevant financial relationships.

American Society for Reproductive Medicine (ASRM) 2018 Scientific Congress: Abstract 0-9. Presented October 8, 2018.

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