Rape as First Sexual Experience Profoundly Affects Young Women

When First Sexual Encounter Was Forced, Medical Problems Follow

F. Perry Wilson, MD, MSCE


September 18, 2019

Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I'm Dr F. Perry Wilson.

This week we're discussing a sensitive topic, so you may want to ensure that younger individuals are not watching. The topic, broadly, is sexual violence — more specifically, forced sexual initiation among women. The data come from this new analysis appearing in JAMA Internal Medicine.[1]

Lead author Laura Hawks of Harvard and her team analyzed data from the National Survey of Family Growth, a CDC-run survey that collects responses about family life, marriage, pregnancy, reproductive health, and other topics from a nationally representative sample. One question on that survey, administered to women who had experienced vaginal intercourse with a man, was as follows: "Would you say that this first vaginal intercourse was voluntary or not voluntary? That is, did you choose to have sex of your own free will or not?"

About 93% of respondents indicated that, yes, their first sexual experience was voluntary. But 6.5% indicated just the opposite. The survey explored that answer further.


About 25% of women reported being coerced through physical harm, 26% through the threat of harm, 56% through verbal pressure, and 46% by being physically restrained; 22% of these women reported being given drugs.

These are disturbing results, but it actually gets worse. The authors then examined how women whose first sexual experience was not voluntary compared with those in whom it was voluntary. Some startling data emerged. The women with forced sexual initiation were younger at the time of sexual initiation: 15 versus 17 years.


The sexual partner (or assailant) was older — 27 years compared with 21, on average. That's a 12-year versus a 4-year age discrepancy — and, I may add, meets the definition for statutory rape in many states.

These early sexual experiences may be life-changing.


The women with forced sexual initiation were more likely to have pelvic inflammatory disease, endometriosis, problems with ovulation or menstruation, drug use, and self-described poor health. These relationships withstood statistical adjustment for age, race, poverty level, and place of birth.

It pains me a bit to say that these results were eye-opening for me, when I suspect that they will not come as a surprise to many women watching this. That speaks, I think, to the stigmatization of sexual experiences and to negative sexual experiences in particular.

"Was your first sexual experience voluntary?" is not part of my standard sexual history. Maybe it should be. The strong association with downstream adverse outcomes makes it a worthwhile question. But more interesting is whether the answer to that question can lead to interventions, like therapy, that may change the course of a life that was impacted so negatively, so profoundly, so early.


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