Making Survivors Feel Comfortable with Natural Processes
Isha Gupta
August 2024
A traumatic experience such as sexual violence can drastically affect people’s lives. Even if a traumatic experience occurred during childhood, it can still significantly affect people when they become adults and throughout their lifetime.[1] According to the Centers for Disease Control and Prevention, one in four women has experienced completed or attempted rape, and one in three women faced sexual harassment in a public place.[2] Sexual violence is not just an issue that affects women, given that men and LGBTQIA+ individuals also face the threat of sexual violence.[2] Nevertheless, natural biological processes of the female body, namely, menstruation, pregnancy, childbirth, and breastfeeding could bring unique challenges and opportunities for female survivors of sexual violence.
Menstruation
Sexual violence can affect the menstrual cycle. Survivors’ menstrual cycles can become irregular and they may miss their periods.[3] Also, there can be increased premenstrual symptoms, along with more pain and heavier bleeding during menstruation.[3, 4] Periods can be a difficult time, especially for survivors who may find the bleeding and cramps trigger thoughts of the sexual violence they faced.[5] More specifically, some survivors who once used internal menstrual products, like tampons to manage monthly bleeding, find it challenging to continue using internal menstrual products since they can trigger flashbacks of the tremendously traumatic experience.[5] Periods can be a more sensitive time for survivors, especially if they have low self-esteem, negative body image, and guilty feelings following the traumatic experience.[5] There are a variety of strategies to make this monthly occurrence more comfortable and support survivors’ health and wellness during menstruation. For instance, survivors could consider using less invasive menstrual products like pads and period pants, while they are still healing from trauma.[5] Survivors are recommended to be aware of, accept, and acknowledge their emotions honestly during monthly periods.[5] Survivors are encouraged to practice more self-care and relaxation activities during menstruation, such as wearing comfortable clothes, watching a movie, listening to music, drinking a favorite tea, and eating chocolate if desired.[5, 6] Moreover, survivors should try to track their menstrual cycle so they feel more prepared.[6] Loved ones of survivors could try to support them during menstruation by bringing pads and comfort food, and just being there to talk.[6] Similar care, relaxation, and support strategies could be considered for survivors experiencing postpartum bleeding.
Pregnancy and Childbirth
Sexual violence is associated with an increased risk of pregnancy-related concerns such as pelvic pain, pre-term birth, and low birth weight.[7] Nonetheless, pregnancy and childbirth can promote resilience, empowerment, and healing among survivors if they have a positive and supportive birthing experience.[7] One of the first and most important steps to fostering positive birthing experiences for survivors is to effectively educate healthcare workers on sexual trauma and how it affects patient health and well-being, especially during a vulnerable and critical period like childbirth.[7] Pregnancy and childbirth can be stressful for survivors of sexual violence especially due to the association of certain feelings with traumatic memories.[7] For example, among some survivors, pelvic pain and fetal movement could trigger stressful memories of their traumatic experiences.[7] Also, some survivors share how they felt that their healthcare provider dismissed and invalidated their concerns about discomfort and trauma during childbirth, especially during vaginal examinations and procedures, where survivors felt ignored and like they had no control over their bodies.[8, 9]It is essential for survivors and their medical providers to establish and maintain trust. Based on research conducted, many survivors feel it is important for their healthcare team to be aware that they have sexual trauma, however, oftentimes they are not asked about it.[9]Interestingly, there is no one standard birthing method that all survivors prefer; some survivors feel more comfortable with Cesarean sections (C-sections) and some with vaginal deliveries. For instance, some survivors prefer C-sections to prevent possible vaginal tearing and avoid vaginal examinations.[9] On the other hand, some survivors prefer vaginal deliveries since they feel more in control of their bodies, are uncomfortable with the idea of surgery, and avoid taking numerous medications.[9] Trauma-informed medical care practices can help survivors feel more comfortable during pregnancy and childbirth, which can safeguard both their health and their baby’s health. Diverse trauma-informed care practices can be utilized, including allowing the survivor to have a support person if possible, allowing the survivor to uncover her body on her own, starting with the least invasive medical procedure if possible, and ensuring the survivor properly understands the process and importance of medical procedures in advance.[7]
Breastfeeding
Some survivors of sexual violence have low self-esteem and negative body image, which can cause hesitancy about breastfeeding, especially in public settings.[10] This, in turn, further contributes to lower levels of self-esteem as they often feel bad and ashamed about not being able to effectively breastfeed their babies.[10] Moreover, in medical settings, survivors can feel retraumatized particularly if healthcare workers touch them without warning or invitation to help initiate the breastfeeding process after childbirth.[10] Furthermore, the over-sexualization of women’s breasts and undermining of their function to nurture new life significantly contribute to survivors’ discomfort and difficulty breastfeeding. For example, some survivors resent and feel ashamed of their breasts as a result of over-sexualization, ridicule, and hurtful comments about their breasts, and may perceive their breasts to be the cause of the traumatic experience.[10] Simultaneously, the ability to breastfeed can be a transformative experience for survivors and empower them on their healing journey. For instance, some survivors find the changes pregnancy and childbirth bring to their breasts wondrous.[10] Their body image can shift from negative to positive, as they become more aware of the power they hold to breastfeed and nurture new life. This, in turn, encourages them to embrace their breasts, and the process of breastfeeding, as healthy, impactful, essential, and auspicious rather than something to be ashamed of.[10] Additionally, access to social support, such as breastfeeding support groups and initiatives to promote breastfeeding, helps facilitate positive and encouraging experiences for survivors.[10] Making survivors feel more comfortable and confident with breastfeeding simultaneously ensures the new generation of infants are able to get the benefits breastfeeding offers.
Interventions to help survivors who have experienced very traumatic experiences of sexual violence and have difficulty coping include antidepressant medications and psychotherapy.[11, 12] Sexual violence is a critical and prevalent societal concern. Managing normal biological processes occurring in the female body could be difficult for survivors recovering from a traumatic experience like sexual violence. Being aware of the unique challenges survivors face, and how to mitigate them, can help create safe, supportive, positive, and healthy environments for survivors, and simultaneously empower them on their healing journeys.
References
[1] Brunton, R., & Dryer, R. (2021, January). Child Sexual Abuse and Pregnancy: A Systematic Review of the Literature. ScienceDirect.
https://www.sciencedirect.com/science/article/abs/pii/S0145213420304579
[2] Centers for Disease Control and Prevention. (2024, January 23). About Sexual Violence. Centers for Disease Control and Prevention.
https://www.cdc.gov/sexual-violence/about/index.html#:~:text=Sexual%20violence%20is%20co mmon%3A,experienced%20completed%20or%20attempted%20rape
[3] Golding J. M. (1996). Sexual assault history and women’s reproductive and sexual health. Psychology of women quarterly, 20, 101–121.
https://doi.org/10.1111/j.1471-6402.1996.tb00667.x
[4] Romito, P., Cedolin, C., Bastiani, F., Beltramini, L., & Saurel-Cubizolles, M. J. (2017, May 31). Sexual harassment and menstrual disorders among Italian university women: A cross-sectional observational study. Sage Journals.
https://journals.sagepub.com/doi/abs/10.1177/1403494817705559?journalCode=sjpc
[5] Somerset and Avon Rape and Sexual Abuse Support. (n.d.). The impact of trauma and menstruation. Somerset and Avon Rape and Sexual Abuse Support. https://www.sarsas.org.uk/the-impact-of-trauma-and-menstruation/
[6] UC Santa Cruz Center for Advocacy, Resources & Empowerment. (2023, October 16). De-mystifying your period after trauma. UCSC CARE.
https://care.ucsc.edu/resources/your-period-after-trauma.pdf
[7] Ward L. G. (2020). Trauma-Informed Perinatal Healthcare for Survivors of Sexual Violence. The Journal of perinatal & neonatal nursing, 34(3), 199–202.
https://doi.org/10.1097/JPN.0000000000000501
[8] Montgomery, E., Pope, C., & Rogers, J. (2015, August 26). The re-enactment of childhood sexual abuse in maternity care: a qualitative study. BioMed Central.
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0626-9
[9] Lissmann, R., Lokot, M., & Marston, C. (2023, November 16). Understanding the lived experience of pregnancy and birth for survivors of rape and sexual assault. BioMed Central. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-06085-4
[10] Wood, K., & Esterik, P. V. (2010, April). Infant feeding experiences of women who were sexually abused in childhood. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860840/
[11] Rothbaum, B. O., Ninan, P. T., & Thomas, L. (1996). Sertraline in the treatment of rape victims with posttraumatic stress disorder. Journal of traumatic stress, 9(4), 865–871. https://doi.org/10.1007/BF02104108
[12] Tull, M. (2023, December 6). Understanding PTSD After Sexual Assault. Verywell Mind. https://www.verywellmind.com/symptoms-of-ptsd-after-a-rape-2797203#toc-treatments-for-ptsd -after-sexual-assault
