Introduction

In this chapter I challenge conventional theories of the links between child sexual abuse (CSA) trauma and physical ill health.

The chapter explores the extent and possible causes of widespread physical ill health and chronic pain among adult survivors of CSA. This contributes to their suffering and disability throughout life, becoming an additional burden and stigma. Yet their physical health has received far less research attention than their mental health. Tenacious theories of ‘somatisation’ and ‘secondary gain’ explain away these often serious disorders, yet there are flaws in both theories. The greatest problem adult survivors of CSA have found in accessing respectful, appropriate healthcare and support is the assumption that their ill health must be psychosomatic, or even ‘hypochondriacal’, due to their actual or assumed mental health problems.

I argue the case for the little-considered, direct effects of sexual violence through injury, damage and sexually transmitted infections (STIs). I offer suggestive evidence on this for researchers to pursue. Future research into causes, treatment and recovery should investigate further these direct effects of sexual violence upon the body; the neurobiological impacts of serious early life trauma, where changes in the autonomic nervous system increase vulnerability to pain, infections and auto-immune conditions; and complex dissociative processes in face of violence and torture.

I call for much greater collaborative research and practice, nationally and internationally, with those working in fields as disparate as sports medicine and the care of political torture victims; for closer links between paediatrics and adult medicine; and for qualitative research with CSA survivors, on any connections they themselves discern between their childhood experiences and their adult health.

I believe that such changes, along with the rejection of prejudicial, gender-biased assumptions about CSA survivors in healthcare, will make more appropriate and effective the treatments and therapies available to them. It will not be sufficient in itself to carry through, in medical practice, excellent recommendations already available to healthcare professionals for sensitive approaches to abuse survivors: about ensuring that healthcare offers a safe welcoming environment, confidential services, the availability of chaperones, an awareness of ‘triggering’ examinations, and sensitivity in questioning about assault history (for example, Teram et al, 2006; Schachter et al, 2009; McGregor et al, 2009; Nelson, 2012b). Such thoughtful survivor-centredness in routine practice is very important, but it is only part of what is needed.