Sexual violence is a serious public health problem with devastating health-related consequences. In this article, the authors review the prevalence, characteristics, vulnerability factors for, and impacts of sexual violence victimization for women. Some key factors are reviewed that have been shown to increase vulnerability for victimization, including certain demographic characteristics, previous victimization, and use of drugs or alcohol. The impacts of rape and other sexual violence are described, including physical and sexual health; psychological, social, and societal impacts; as well as impact on risky health behaviors. The authors conclude with a discussion of the public health approach to sexual violence, primary prevention, the relevance of sexual violence research for health care practitioners, and recommendations for health care practice.
GoldingJM. Sexual assault history and medical care seeking: the roles of symptom prevalence and illness behavior. Psychol Health. 1999;14:949-957.
2.
BasileKC. Sexual violence in the lives of girls and women. In: Kendall-TackettK. ed. Handbook of Women, Stress, and Trauma. New York, NY: Brunner-Routledge; 2005: 101-122.
3.
CampbellRTownsendSM. Defining the scope of sexual violence against women. In: RenzettiCMEdlesonJLBergenRK. eds. Sourcebook on Violence Against Women. 2nd ed.Thousand Oaks, CA: Sage; 2010:95-110.
4.
BasileKCSaltzmanLE. Sexual Violence Surveillance: Uniform Definitions and Recommended Data Elements, Version 1.0. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2002.
5.
BasileKC. Prevalence of wife rape and other intimate partner sexual coercion in a nationally representative sample of women. Violence Vict. 2002;17:511-524.
6.
Struckman-JohnsonCStruckman-JohnsonDAndersonPB. Tactics of sexual coercion: when men and women won’t take no for an answer. J Sex Res. 2003;40:76-86.
7.
KrugEGDahlbergLLMercyJAZwiABLozanoR. eds. World Report on Violence and Health. Geneva, Switzerland: World Health Organization; 2002.
8.
BasileKCChenJBlackMCSaltzmanLE. Prevalence and characteristics of sexual violence victimization among U.S. adults 2001-2003. Violence Vict. 2007;22:437-448.
9.
FinkelhorDYlloK. License to Rape: Sexual Abuse of Wives. New York, NY: Free Press; 1985.
10.
RussellDEH. Rape in Marriage. Bloomington: Indiana University Press; 1990.
11.
BrenerCDMcMahonPMWarrenCWDouglasKA. Forced sexual intercourse and associated health-risk behaviors among female college students in the United States. J Consult Clin Psychol. 1999;67:252-259.
12.
TjadenPThoennesN. Full Report of Prevalence, Incidence, and Consequences of Violence Against Women: Findings From the National Violence Against Women Survey. Washington, DC: US Department of Justice, National Institute of Justice; 2000.
13.
KilpatrickDGEdmundsCNSeymourAK. Rape in America: A Report to the Nation. Arlington, VA: National Victim Center & Medical University of South Carolina; 1992.
14.
LeebRLewisTZolotorAJ. Physical and mental health consequences of child abuse and neglect: a review. Am J Lifestyle Med. In press.
15.
BergenR. Wife Rape: Understanding the Response of Survivors and Service Providers. Thousand Oaks, CA: Sage; 1996.
16.
CulbertsonKDehleC. Impact of sexual assault as a function of perpetrator type. J Interpers Violence. 2001;16:992-1007.
17.
JohnsonH. The cessation of assaults on wives. J Comp Fam Stud. 2003;34:75-91.
18.
DeKeseredyWSchwartzMHallM. Separation/divorce sexual assault: The contribution of male peer support. Fem Criminol. 2006;1:228-250.
19.
MakerAHKemmelmeierMPetersonC. Child sexual abuse, peer sexual abuse, and sexual assault in adulthood: a multi-risk model of revictimization. J Trauma Stress. 2001;14:351-368.
20.
MerrillLLNewellCEThomsenCJ. Childhood abuse and sexual revictimization in a female Navy recruit sample. J Trauma Stress. 1999;12:211-225.
21.
WestCMWilliamsLMSiegelJA. Adult sexual revictimization among black women sexually abused in childhood: a prospective examination of serious consequences of abuse. Child Maltreat. 2000;5:49-57.
22.
DesaiSAriasIThompsonMPBasileKC. Childhood victimization and subsequent adult revictimization assessed in a nationally representative sample of women and men. Violence Vict. 2002;17:639-653.
23.
BlackDAHeymanRESlepAMS. Risk factors for male-to-female partner sexual abuse. Aggress Violent Behav. 2001;6:269-280.
24.
SiegelJAWilliamsLM. Risk factors for sexual victimization of women: results from a prospective study. Violence Against Women. 2003;9:902-930.
25.
FollingstadDRBrennanAFHauseESPolekDSRutledgeLL. Factors moderating physical and psychological symptoms of battered women. J Fam Violence. 1991;6:81-95.
26.
TestaM. The role of substance use in male-to-female physical and sexual violence: a brief review and recommendations for future research. J Interpers Violence. 2004;19:1494-1505.
27.
KossMPGoodmanLABrowneAFitzgeraldLFKeitaGPRussoNF. No Safe Haven: Male Violence Against Women at Home, at Work, and in the Community. Washington, DC: American Psychological Association; 1994.
28.
AbbeyAZawackiTBuckPOClintonAMMcAuslanP. Alcohol and sexual assault. Alcohol Res Health. 2001;25:43-51.
29.
CrowellNABurgessAW, eds. Understanding Violence Against Women. Washington, DC: National Academy Press; 1996.
30.
UllmanSE. A critical review of field studies on the link of alcohol and adult sexual assault in women. Aggress Violent Behav. 2003;8:471-486.
31.
AbbeyAClintonAMMcAuslanPZawackiTBuckPO. Alcohol-involved rapes: are they more violent?Psychol Women Q. 2002;26:99-109.
32.
BrecklinLRUllmanSE. The roles of victim and offender substance use in sexual assault outcomes. J Interpers Violence. 2010;25:1503-1522.
33.
BeynonCMMcVeighCMcVeighJLeaveyCBellisMA. The involvement of drugs and alcohol in drug-facilitated sexual assault: a systematic review of the evidence. Trauma Violence Abuse. 2008;9:178-188.
34.
KilpatrickDGAciernoRResnickHSSaundersBEBestCL. A 2-year longitudinal analysis of the relationships between violent assault and substance use in women. J Consult Clin Psychol. 1997;65:834-847.
35.
Association of Chief Police Officers. Operation MATISSE: Investigating Drug Facilitated Sexual Assault. London, England: Association of Chief Police Officers; 2006.
36.
Scott-HamMBurtonFC. Toxicological findings in cases of alleged drug-facilitated sexual assault in the United Kingdom over a 3-year period. J Clin Forensic Med. 2005;12:175-186.
37.
SchwartzRHMilteerRLeBeauMA. Drug-facilitated sexual assault (“date rape”). South Med J. 2000;93:558-561.
38.
SpillerHARogersJSawyerTS. Drug facilitated sexual assault using an over-the-counter ocular solution containing tetrahydrozoline (Visine). Leg Med (Tokyo). 2007;9:192-195.
39.
McGregorMJLipowskaMShahSDu MontJDi SiatoC. An exploratory analysis of suspected drug-facilitated sexual assault seen in a hospital emergency department. Women Health. 2003;37:71-80.
40.
McCauleyJLConoscentiLMRuggieroKJResnickHSSaundersBEKilpatrickDG. Prevalence and correlates of drug/alcohol-facilitated and incapacitated sexual assault in a nationally representative sample of adolescent girls. J Clin Child Adolesc Psychol. 2009;38:295-300.
41.
KrebsCPLindquistCHWarnerTDFisherBSMartinSL. College women’s experiences with physically forced, alcohol-or other drug-enabled, and drug-facilitated sexual assault before and since entering college. J Am Coll Health. 2009;57:639-647.
42.
MuramDMillerKCutlerA. Sexual assault of the elderly victim. J Interpers Violence. 1992;7:70-76.
43.
SommersMS. Defining patterns of genital injury from sexual assault: a review. Trauma Violence Abuse. 2007;8:270-280.
44.
KossMPHesletL. Somatic consequences of violence against women. Arch Fam Med. 1992;1:53-59.
45.
WingoodGMDiClementeRJ. Child sexual abuse, HIV sexual risk, and gender relations of African-American women. Am J Prev Med. 1997;13:380-384.
46.
IrwinKLEdlinBRWongL. Urban rape survivors: characteristics and prevalence of human immunodeficiency virus and other sexually transmitted infections. Obstet Gynecol. 1995;85:330-336.
47.
MurphySM. Rape, sexually transmitted diseases, and human immunodeficiency virus infection. Int J STD AIDS. 1990;1:79-82.
48.
HolmesMResnickHKilpatrickDBestC. Rape related pregnancy: estimates and descriptive characteristics from a national sample of women. Am J Obstet Gynecol. 1996;175:320-325.
49.
McFarlaneJMalechaAWatsonK. Intimate partner sexual assault against women: frequency, health consequences, and treatment outcomes. Obstet Gynecol. 2005;105:99-108.
50.
HeitkemperMJarrettMTaylorPWalkerELandenburgerKBondEF. Effect of sexual and physical abuse on symptom experiences in women with irritable bowel syndrome. Nurs Res. 2001;50:15-23.
51.
KossMPHeiseLRussoNF. The global health burden of rape. In: O’TooleLLSchiffmanJR. eds. Gender Violence: Interdisciplinary Perspectives. New York, NY: New York University Press; 1997:223-241.
52.
Harrop-GriffithsJKatonWWalkerEHolmLRussoJHickokL. The association between chronic pelvic pain, psychiatric diagnoses, and childhood sexual abuse. Obstet Gynecol. 1988;71:589-594.
53.
MarkHBitzkerKKiappBFRauchfussM. Gynaecological symptoms associated with physical and sexual violence. J Psychosom Obstet Gynaecol. 2008;29:164-172.
54.
GoldingJM. Sexual assault history and women’s reproductive and sexual health. Psychol Women Q. 1996;20:101-121.
55.
GoldingJMWilsnackSCLearmanLA.Prevalence of sexual assault history among women with common gynecologic symptoms. Am J Obstet Gynecol. 1998;179:1013-1019.
56.
GoldingJMTaylorDL. Sexual assault history and premenstrual distress in two general population samples. J Womens Health. 1996;5:143-152.
57.
Janoff-BulmanR. Shattered Assumptions: Toward a New Psychology of Trauma. New York, NY: Free Press; 1992.
58.
FrazierPConlonAGlaserT. Positive and negative life changes following sexual assault. J Consult Clin Psychol. 2001;69:1048-1055.
59.
HermanJL. Trauma and Recovery. New York, NY: Basic Books; 1992.
60.
LittletonHGrills-TaquechelAAxsomD.Impaired and incapacitated rape victims: assault characteristics and post-assault experiences. Violence Vict. 2009;24:439-457.
61.
ElklitAChristiansenDM. ASD and PTSD in rape victims. J Interpers Violence. 2010;25:1470-1488.
62.
KossMPFigueredoAJ. Change in cognitive mediators of rape’s impact on psychosocial health across 2 years of recovery. J Consult Clin Psychol. 2004;72:1063-1072.
63.
YuanNPKossMPStoneM. The psychological consequences of sexual trauma. VAWnet, a project of the National Resource Center on Domestic Violence/Pennsylvania Coalition Against Domestic Violence. http://www.vawnet.org. March2006. Accessed October 6, 2010.
64.
BeckerJVSkinnerLJAbelGGCichonJ. Level of postassault sexual functioning in rape and incest victims. Arch Sex Behav. 1986;15:37-49.
65.
ResnickHMonnierJSealsB. Rape-related HIV risk concerns among recent rape victims. J Interpers Violence. 2002;17:746-759.
66.
SarkarNNSarkarR. Sexual assault on woman: its impact on her life and living in society. Sex Relationship Ther. 2005;20:407-419.
67.
BurnamMASteinJAGoldingJM. Sexual assault and mental disorders in a community population. J Consult Clin Psychol. 1988;56:843-850.
68.
ChenLPMuradMHParasML. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc. 2010;85:618-629.
69.
RothbaumBOFoaEBRiggsDSMurdockTWalshW. A prospective examination of post-traumatic stress disorder in rape victims. J Trauma Stress. 1992;5:455-475.
WeissDSMarmarCR. The Impact of Event Scale–Revised. In: WilsonJPKeaneT. eds. Assessing Psychological Trauma and PTSD. New York, NY: Guilford Press; 1996:493-511.
74.
FoaEB. Trauma and women: course, predictors, and treatment. J Clin Psychiatry. 1997;15:25-28.
75.
UllmanSEBrecklinLR. Sexual assault history and suicidal behavior in a national sample of women. Suicide Life Threat Behav. 2002;32:117-130.
76.
UllmanSEFilipasHH. Predictors of PTSD symptom severity and social reactions in sexual assault victims. J Trauma Stress. 2001;14:369-389.
77.
ZinzowHMResnickHSAmstadterABMcCauleyJLRuggieroKJKilpatrickDG. Drug- or alcohol-facilitated, incapacitated, and forcible rape in relationship to mental health among a national sample of women. J Interpers Violence. 2010;25:2217-2236.
78.
UllmanSEFilipasHHTownsendSMStarzynskiLL. Psychosocial correlates of PTSD symptom severity in sexual assault survivors. J Trauma Stress. 2007;20:821-831.
79.
Jacques-TiuraAJTkatchRAbbeyAWegnerR. Disclosure of sexual assault: characteristics and implications for posttraumatic stress symptoms among African American and Caucasian survivors. J Trauma Dissociation. 2010;11:174-192.
80.
LittletonHL. The impact of social support and negative disclosure reactions on sexual assault victims: a cross-sectional and longitudinal investigation. J Trauma Dissociation. 2010;11:210-227.
81.
CoidJPetruckevitchAChungWRichardsonJMooreySFederG. Abusive experiences and psychiatric morbidity in women primary care attenders. Br J Psychiatry. 2003;183:332-339.
82.
WeaverTLAllenJAHopperE. Mediators of suicidal ideation within a sheltered sample of raped and battered women. Health Care Women Int. 2007;28:478-489.
83.
UllmanSE. Comparing gang and individual rapes in a community sample of urban women. Violence Vict. 2007;22:43-51.
84.
BehnkenMPYen-ChiLLTempleJRBerensonAB. Forced sexual intercourse, suicidality, and binge drinking among adolescent girls. Addict Behav. 2010;35:507-509.
85.
CrosbyAEBucknerATaylorB. Addressing self-directed violence prevention for preventive medicine practitioners. Am J Lifestyle Med. In press.
86.
DavisRCBrickmanEBakerT. Supportive and unsupportive responses of others to rape victims: effects of concurrent victim adjustment. Am J Community Psychol. 1991;19:443-451.
87.
CampbellRAhrensCESeflTWascoSMBarnesHE. Social reactions to rape victims: healing and hurtful effects on psychological and physical health outcomes. Violence Vict. 2001;16:287-302.
88.
ResickPACalhounKSAtkesonBMEllisEM. Social adjustment in victims of sexual assault. J Consult Clin Psychol. 1981;49:705-712.
89.
MackeyTSereikaSMWeissfeldLAHackerSSZenderJFHeardSL. Factors associated with long-term depressive symptoms of sexual assault victims. Arch Psychiatr Nurs. 1992;6:10-25.
90.
AllersCTBenjackKJWhiteJRouseyJT. HIV vulnerability and the adult survivor of child sexual abuse. Child Abuse Negl. 1993;17:291-298.
91.
BoyerDFineD. Sexual abuse as a factor in adolescent pregnancy and child maltreatment. Fam Plann Perspect. 1992;23:4-10.
92.
BensleyLSVan EenwykJSimmonsKW. Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking. Am J Prev Med. 2000;18:151-158.
93.
WidomCSKuhnsJB. Childhood victimization and subsequent risk for promiscuity, prostitution, and teenage pregnancy: a prospective study. Am J Public Health. 1996;86:1607-1612.
94.
IrwinKLEdlinBRWongL. Urban rape survivors: characteristics and prevalence of human immunodeficiency virus and other sexually transmitted infections. Obstet Gynecol. 1995;85:330-336.
95.
KossMPKossPGWoodruffW. Deleterious effects of criminal victimization on women’s health and medical utilization. Arch Intern Med. 1991;151:342-357.
96.
WalkerEAGelfandAKatonWJ. Adult health status of women with histories of childhood abuse and neglect. Am J Med. 1999;107:332-339.
97.
SilvermanJGRajAMucciLAHathawayJE. Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. JAMA. 2001;286:572-579.
98.
GreenspanGSSamuelSE. Self-cutting after rape. Am J Psychiatry. 1989;146:789-790.
99.
FelittiVJAndaRFNordenbergD.Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences Study. Am J Prev Med. 1998;14:245-258.
100.
CloutierSMartinSLPooleC. Sexual assault among North Carolina women: prevalence and health risk behaviors. J Epidemiol Community Health. 2002;56:265-271.
101.
FinkelhorDBrowneA. The traumatic impact of child sexual abuse: a conceptualization. Am J Orthopsychiatry. 1985;55:530-541.
102.
LaumannEOGagnonJHMichaelRTMichaelsS. The Social Organization of Sexuality: Sexual Practices in the United States. Chicago, IL: University of Chicago Press; 1994.
103.
KimerlingRCalhounKS. Somatic symptoms, social support, and treatment seeking among sexual assault victims. J Consult Clin Psychol. 1994;62:333-340.
104.
MillerTRCohenMAWiersemaB. Crime in the United States: Victim Costs and Consequences. Washington, DC: US Department of Justice, Bureau of Justice Statistics; 1994.
105.
PostLAMezeyNJMaxwellCWibertWN. The rape tax: tangible and intangible costs of sexual violence. J Interpers Violence. 2002;17:773-782.
106.
MercyJARosenbergMLPowellKEBroomeCVRoperWL. Public health policy for preventing violence. Health Aff (Millwood). 1993;12:7-29.
107.
McMahonPMPuettRC. Child sexual abuse as a public health issue: recommendations of an expert panel. Sex Abuse. 1999;11:257-266.
108.
MercyJAHammondWR. Preventing homicide: a public heath perspective. In: SmithMDZahnMA. eds. Studying and Preventing Homicide: Issues and Challenges. Thousand Oaks, CA: Sage; 1999:274-294.
109.
FoegeWHRosenbergMLMercyJA. Public health and violence prevention. Curr Issues Public Health. 1995;1:2-9.
110.
MercyJ. Having new eyes: viewing child sexual abuse as a public health problem. Sex Abuse. 1999;11:317-321.
111.
HamburgerKPhelanM. Domestic Violence Screening and Intervention in Medical and Mental Health Care Settings. New York, NY: Springer; 2004.
HaegerichTMDahlbergLL. Violence as a public health risk. Am J Lifestyle Med. In press.
114.
BlackM. Intimate partner violence and adverse health consequences: implications for practitioners. Am J Lifestyle Med. In press.
115.
MacyRErmentroutDJohnsN. Health care for survivors of partner and sexual violence. In: RenzettiCMEdlesonJLBergenRK. eds. Sourcebook on Violence Against Women. 2nd ed.Thousand Oaks, CA: Sage; 2010:289-308.
116.
HambySCookS. Assessing violence against women in practice settings: processes and tools practitioners can use. In: RenzettiCMEdlesonJLBergenRK. eds. Sourcebook on Violence Against Women. 2nd ed.Thousand Oaks, CA: Sage; 2010:49-72.
117.
KlevensJSaltzmanL. Report from CDC: The controversy on screening for intimate partner violence: a question of semantics?J Womens Health. 2009;18:143-145.
118.
AbbeyAMcAuslanP. A longitudinal examination of male college students’ perpetration of sexual assault. J Consult Clin Psychol. 2004;72:747-756.
119.
BerkowitzA. College men as perpetrators of acquaintance rape and sexual assault: a review of recent research. J Am Coll Health. 1992;40:175-181.
120.
MalamuthNLinzDHeaveyCBarnesGAckerM. Using the confluence model of sexual aggression to predict men’s conflict with women: a 10-year follow-up study. J Pers Soc Psychol. 1995;69:353-369.
121.
DaleidenEKaufmanKHillikerDO’NeilJ. The sexual histories and fantasies of youthful males: a comparison of sexual offending, nonsexual offending, and nonoffending groups. Sex Abuse. 1998;10:195-209.
122.
van WijkAVreugdenhilCvan HornJVermeirenRDoreleijersT. Incarcerated Dutch juvenile sex offenders compared with non-sex offenders. J Child Sex Abuse. 2007;16:1-21.
123.
BorowskyIWHoganMIrelandM. Adolescent sexual aggression: risk and protective factors. Pediatrics. 1997;100:1-8.
124.
BanyardVLMoynihanMMPlanteEG. Sexual violence prevention through bystander education: an experimental evaluation. J Community Psychol. 2007;35:463-481.
125.
DeKeseredyWSKellyK. The incidence and prevalence of woman abuse in Canadian university and college dating relationships. Can J Sociol. 1993;18:137-159.
126.
DeKeseredyWSSchwartzMD. Woman Abuse on Campus: Results From the Canadian National Survey. Thousand Oaks, CA: Sage; 1998.
127.
FlahertyEGStirlingJ. The pediatrician’s role in child maltreatment prevention. Pediatrics. 2010;126:833-841.
128.
AlpertEJTonkinAESeehermanAMHoltzHA. Family violence curricula in U.S. medical schools. Am J Prev Med. 1998;14:273-282.
129.
CampbellRPattersonDLichtyLF. The effectiveness of sexual assault nurse examiner (SANE) programs: a review of psychological, medical, legal, and community outcomes. Trauma Violence Abuse. 2005;6:313-329.
130.
LoganTKColeJCapilloA. Sexual assault nurse examiner program characteristics, barriers, and lessons learned. J Forensic Nurs. 2007;3:24-34.
131.
MartinSLYoungSKBillingsDLBrossCC. Health care-based interventions for women who have experienced sexual violence: a review of the literature. Trauma Violence Abuse. 2007;8:3-18.
132.
AhrensCECampbellRWascoSMAponteGGrubsteinLDavidsonWSII. Sexual assault nurse examiner (SANE) programs: alternative systems for service delivery for sexual assault victims. J Interpers Violence. 2000;15:921-943.
133.
MadiganLGambleNC. The Second Rape: Society’s Continued Betrayal of the Victim. New York, NY: Lexington Books; 1991.
134.
HallJHaegerichT. Violence and men’s health: understanding the etiological underpinnings of men’s experiences with violence. Am J Lifestyle Med. In press.
