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With childhood sexual abuse, mental and physical after-effects closely linked

The key takeaway from this study is that one-sided treatment – one that addresses just the psychological after-effects or just the physical trauma – is inadequate. There is a need to follow a combined approach to treatment that doesn’t view these issues as separate.

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A Canadian study reveals that the psychological and physical effects of childhood sexual abuse are closely tied. The finding could help healthcare professionals develop more effective interventions and ultimately improve mental and physical health outcomes for survivors of abuse in childhood.

Authored by Pascale Vézina-Gagnon, a PhD candidate at Université de Montréal’s Department of Psychology, under the supervision of Professor Isabelle Daigneault, the study is published today in Health Psychology.

Twice as many diagnoses

The long-term consequences of childhood sexual abuse on survivors’ health have only been recognized recently.

An initial study of 1,764 children and adolescents, published in 2018, showed that girls who survived substantiated cases of sexual abuse received 2.1 times as many diagnoses of urinary health issues and 1.4 times as many diagnoses of genital health issues than girls in the general population.

This finding prompted a subsequent study to determine why and how sexual-abuse survivors suffered from genitourinary problems more often than their peers in the general population.

Specifically, the second study aimed to gain a better understanding of this phenomenon by testing the theory that increased psychological distress is partly responsible for the higher incidence of genitourinary issues – such as urinary tract infections, vaginitis and pain during sex or menstruation – among childhood sexual-abuse survivors.

‘A combined approach to treatment’

“The key takeaway from this study is that one-sided treatment – one that addresses just the psychological after-effects or just the physical trauma – is inadequate,” said Vézina-Gagnon. “We need to follow a combined approach to treatment that doesn’t view these issues as separate.”

She added: “Interdisciplinary care is increasingly becoming the standard, and that’s the message we hope our research sends to general practitioners, pediatricians, urologists, gynecologists, psychologists and psychiatrists so that they can help children recover as much as possible.”

This is the first study to look at the relationship between genitourinary and psychological issues over such a long period of time – more than a decade – in such a large sample of child survivors of substantiated sexual abuse versus a comparison group.

1,322 girls studied

The researchers used medical data provided by Quebec’s public health insurance agency, the Régie de l’assurance maladie du Québec, and the Quebec Ministry of Health and Social Services. The study involved 661 girls between the ages of 1 and 17 who survived one or more instances of substantiated sexual abuse and a comparison group of 661 girls from the general population.

The researchers had access to anonymized data on genitourinary and mental health diagnoses received following medical consultations or hospital stays the girls went through between 1996 and 2013. Several variables were taken into account, such as socioeconomic status, the number of years of access to medical data, and individual predispositions to genitourinary health problems before the sexual abuse occurred.

Childhood sexual abuse includes fondling and petting, oral sex, actual or attempted penetration, voyeurism, indecent exposure, inducement to engage in sexual activity and sexual exploitation (prostitution).

‘A wider range of psychiatric issues’

“The results show that girls who were sexually abused were more likely to see a health professional for a wider range of psychiatric issues–anxiety, mood disorders, schizophrenia or substance abuse–than girls in the comparison group,” said Vézina-Gagnon. “These consultations were also associated with more frequent medical appointments or hospitalizations for genital and urinary issues in the years after the sexual abuse was reported.”

The researchers also found that the more girls consulted their doctors or were hospitalized for multiple psychiatric issues (so-called comorbid psychiatric disorders) after experiencing abuse, the more importantly this explained subsequent genital health issues (62%) and urinary health issues (23%). This difference observed between genital and urinary health (62% vs. 23%) may be explained by factors not included in this study, said Vézina-Gagnon.

The key takeaway from this study is that one-sided treatment – one that addresses just the psychological after-effects or just the physical trauma – is inadequate. There is a need to follow a combined approach to treatment that doesn’t view these issues as separate.

“Additional studies are needed to investigate this difference and determine whether other important variables – ones that we didn’t have information on, such as the severity, length and frequency of the abuse -could be associated with more severe genitourinary health outcomes,” she said.

Two hypotheses offered

“On an emotional and behavioural level, two hypotheses can be formulated to explain these findings,” said Vézina-Gagnon. The first is that the association is due to a hypervigilant response. Survivors of sexual abuse who are affected by several mental health issues – such as anxiety, depression and post-traumatic stress disorder – may become hypervigilant or more likely to notice symptoms related to their genital or urinary health, which would lead them to see their doctor more frequently.

“In contrast,” she continued, “the second hypothesis is that the association is caused by avoidant behaviour. Survivors may put off or avoid asking for help or seeing a doctor for genitourinary issues, thereby increasing the risk that such problems deteriorate or become chronic conditions. Gynecological care may trigger memories of past abuse (due to the imbalance of power between patients and doctors, the removal of clothing, feelings of vulnerability and physical pain) and it may therefore be especially difficult for these girls.”

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Toward a holistic approach

The study’s findings align with the scientific literature on health psychology and abuse, and once again highlight how important it is to consider the relationship between physical and mental health,” said Vézina-Gagnon. A holistic approach (body-mind approach) is therefore needed to help girls recover from sexual trauma, she maintains.

“In light of these findings, healthcare practitioners should assess the level of psychological distress experienced by survivors of childhood sexual abuse who report genitourinary issues and direct them to the right mental health resources” Vézina-Gagnon said.

“The researchers behind this study believe that early and targeted intervention to reduce psychological distress among survivors may be helpful in preventing genitourinary issues from deteriorating or turning into chronic conditions.”

Health & Wellness

Trans women can safely maintain estrogen treatments during gender affirming surgery

The practice of withholding estrogen prior to gender affirming surgery was not necessary. Most transgender women can now safely remain on their estrogen therapy throughout surgery.

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There was no difference in blood clots when estrogen hormone therapy was maintained during gender affirming surgery.

This is according to a study (titled, “No Venous Thromboembolism Increase Among Transgender Female Patients Remaining on Estrogen for Gender Affirming Surgery”) helmed by John Henry Pang with Aki Kozato from Mount Sinai, and was published in the Journal of Clinical Endocrinology & Metabolism.

Historically, the lack of published data contributed to heterogeneity in the practice of whether doctors and surgeons advised transgender women to withhold their estrogen therapy before surgery. The sudden loss of estrogen in the blood was sometimes very uncomfortable with symptoms that amounted to a sudden, severe menopause.

So the researchers tapped 919 transgender patients who underwent gender affirming surgery at Mount Sinai’s Center for Transgender Medicine and Surgery between November 2015 and August 2019. Notably, including 407 cases of transgender women who underwent primary vaginoplasty surgery.

This study found that the practice of withholding estrogen prior to gender affirming surgery was not necessary. Most transgender women can now safely remain on their estrogen therapy throughout surgery.

The bottom line: This study found that most transgender women can  safely maintain their estrogen hormone treatments during gender affirming surgery.

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Health & Wellness

Bisexual men more prone to eating disorders than gay or straight men – study

80% of bisexual men reported that they “felt fat”, and 77% had a strong desire to lose weight, both figures higher than the 79% and 75% for gay men, respectively.

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Bisexual men are more likely to experience eating disorders than either heterosexual or gay men. This is according to a report from the University of California San Francisco, published in the journal Eating and Weight Disorders.

A handful of studies have actually indicated that gay men are at increased risk for disordered eating, including fasting, excessive exercise and preoccupation with weight and body shape. This newer study, however, suggest that bisexual men are even more susceptible to some unhealthy habits.

For this study, the researchers surveyed over 4,500 LGBTQ adults, and a quarter of the bisexual male participants reported having fasted for more than eight hours to influence their weight or appearance. This is higher when compared to 20% for gay men.

The research also found that 80% of bisexual men reported that they “felt fat”, and 77% had a strong desire to lose weight, both figures higher than the 79% and 75% for gay men, respectively.

Now this is worth stressing: According to study co-author Dr. Jason Nagata, not everyone who diets or feels fat has an eating disorder. “It’s a spectrum — from some amount of concern to a tipping point where it becomes a pathological obsession about body weight and appearance,”Nagata was quoted as saying by NBC News.

For Nagata, several factors may be at play here, including “minority stress” (the concept that the heightened anxiety faced by marginalized groups can manifest as poor mental and physical health outcomes).

“LGBTQ people experience stigma and discrimination, and stressors can definitely lead to disordered eating,” Nagata was also quoted as saying. “For bi men, they’re not just facing stigma from the straight community but from the gay community, as well.”

Of all the respondents, 3.2% of bisexual males were clinically diagnosed with eating disorders (compared to 2.9% of gay men). For heterosexual men, it’s only 0.6%.

For the researchers, there is a need to conduct eating disorder research on various sexual identities independently. This is also to raise awareness on this issue (and how it affects different people of various SOGIESCs).

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Health & Wellness

Timing and intensity of oral sex may affect risk of oropharyngeal cancer

Love giving head? Consider this: Having more than 10 prior oral sex partners was associated with a 4.3-times greater likelihood of having HPV-related oropharyngeal cancer.

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Human papillomavirus (HPV) can infect the mouth and throat to cause cancers of the oropharynx.

This is according to a study published in CANCER, a peer-reviewed journal of the American Cancer Society, which has found that having more than 10 prior oral sex partners was associated with a 4.3-times greater likelihood of having HPV-related oropharyngeal cancer. The study also shows that having oral sex at a younger age and more partners in a shorter time period (oral sex intensity) were associated with higher likelihoods of having HPV-related cancer of the mouth and throat.

Previous studies have shown that performing oral sex is a strong risk factor for HPV-related oropharyngeal cancer. To examine how behavior related to oral sex may affect risk, Virginia Drake, MD, of Johns Hopkins University, and her colleagues asked 163 individuals with and 345 without HPV-related oropharyngeal cancer to complete a behavioral survey.

In addition to timing and intensity of oral sex, individuals who had older sexual partners when they were young, and those with partners who had extramarital sex were more likely to have HPV-related oropharyngeal cancer.

“Our study builds on previous research to demonstrate that it is not only the number of oral sexual partners, but also other factors not previously appreciated that contribute to the risk of exposure to HPV orally and subsequent HPV-related oropharyngeal cancer,” said Dr. Drake. “As the incidence of HPV-related oropharyngeal cancer continues to rise… our study offers a contemporary evaluation of risk factors for this disease. We have uncovered additional nuances of how and why some people may develop this cancer, which may help identify those at greater risk.”

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Health & Wellness

Sexual, gender minority youths more likely to have obesity, binge eating disorder

Findings suggest that weight and eating disorder disparities observed in SGM adolescents/adults may emerge in childhood. As such, “clinicians should consider assessing eating- and health-related behaviors among SGM youths.”

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Sexual and gender minorities (SGM) youths were more likely to have obesity and full-threshold or subthreshold binge eating disorder. This is according to research – “Obesity and Eating Disorder Disparities Among Sexual and Gender Minority Youth” by Natasha A. Schvey, PhD; Arielle T. Pearlman, BA; David A. Klein, MD, MPH; et al -published in JAMA Pediatrics.

SGM are those who identify as lesbian, gay, bisexual and/or transgender, or whose sexual orientation and/or gender identity/expression do not conform to societal conventions.

For this study, the researchers noted that as it is, “obesity and eating disorders in youth are prevalent, are associated with medical and psychosocial consequences, and may persist into adulthood. Therefore, identifying subgroups of youth vulnerable to one or both conditions is critical.”

For them, one group that may be at risk for obesity and disordered eating is SGM.

In total, 11,852 participants were considered (aged 9-10 years), derived from the Adolescent Brain Cognitive Development Study. The mean age was 9.91, and 5,672 (47.9%) of the total number were female. The sample comprised 1.6% (n = 190) probable sexual (n = 151) and/or gender minority (n = 58) youths, of whom 24.7% (n = 47) responded yes and 75.3% (n = 143) responded maybe to the SGM queries.

The researchers found that one in six youths (1,987 [16.8%]) had obesity and 10.2% (n = 1,188) had a full-threshold (86 [0.7%]) and/or subthreshold (1103 [9.4%]) eating disorder.

They also reported that adjusting for covariates, SGM youths were more likely to have obesity (odds ratio, 1.64; 95% CI, 1.09-2.48) and full-threshold or subthreshold binge eating disorder (odds ratio, 3.49; 95% CI, 1.39-8.76).

SGM and non-SGM youths did not differ in the likelihood of full-threshold or subthreshold anorexia nervosa or bulimia nervosa. The same pattern of results remained when limiting SGM youths to those responding yes to the SGM items, although significance for the likelihood of obesity was attenuated.

For the researchers, the findings suggest that weight and eating disorder disparities observed in SGM adolescents/adults may emerge in childhood. As such, “clinicians should consider assessing eating- and health-related behaviors among SGM youths.”

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Health & Wellness

Sexual dysfunction hits some women harder than others as they age

Factors other than use of hormone therapy, such as higher importance of sex, positive attitudes toward sex, satisfaction with one’s partner, and fewer genitourinary symptoms associated with menopause appear to be protective and are linked to better sexual function across the menopause transition.

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Sexual dysfunction often accompanies the menopause transition. Yet, not all women experience it the same. A study identified the determinants that affect a woman’s risk of sexual dysfunction and sought to determine the effectiveness of hormone therapy in decreasing that risk and modifying sexual behavior.

The study – “Sexual behaviors and function during menopausal transition–does menopausal hormone therapy play a role?” – was published in Menopause, the journal of The North American Menopause Society (NAMS).

Although hot flashes easily rank as the most common symptom of menopause, the transition is often accompanied by other issues, including changes that affect a woman’s libido, sexual satisfaction, and overall sexual behavior. Because hormone therapy is the most-effective treatment option to help women manage menopause symptoms, it was the focus of a new study designed to determine why some women experience greater sexual dysfunction than others.

The study involving more than 200 women aged 45 to 55 years found that women with secondary and higher education and a greater number of lifetime sexual partners were less likely to experience sexual dysfunction. In contrast, women with more anxious behaviors during sexual activity and those with more severe menopause symptoms were more at risk for sexual dysfunction.

Hormone therapy was not found to mitigate the risk for sexual dysfunction, nor did it play a major role in determining sexual behaviors. However, women using hormone therapy typically had higher body esteem during sexual activities; better sexual function in all domains, except for desire/interest; better quality of relationships; and fewer sexual complaints (other than arousal problems) than those women who do not. Of importance to helping maintain a woman’s sexual function were positive sexual experiences, attitudes about sex, body image, and relationship intimacy.

“These results are consistent with the findings of prior studies and emphasize that factors other than use of hormone therapy, such as higher importance of sex, positive attitudes toward sex, satisfaction with one’s partner, and fewer genitourinary symptoms associated with menopause appear to be protective and are linked to better sexual function across the menopause transition,” says Dr. Stephanie Faubion, NAMS medical director.

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Health & Wellness

LGB adults less likely to take cholesterol-lowering meds

Lesbian, gay and bisexual (LGB) adults who could benefit from cholesterol-lowering medicine to prevent heart disease are less likely than non-LGB adults to take them.

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Lesbian, gay and bisexual (LGB) adults who could benefit from cholesterol-lowering medicine to prevent heart disease are less likely than non-LGB adults to take them.

This is according to new research – “Statin Use for Atherosclerotic Cardiovascular Disease Prevention Among Sexual Minority Adults” – written by Yi Guo, Christopher W. Wheldon, Hui Shao, Carl J. Pepine, Eileen M. Handberg, Elizabeth A. Shenkman, and Jiang Bian, and which appeared in the Journal of the American Heart Association.

As it is, sexual minorities – including LGB individuals – are at increased risk for cardiovascular disease. This can be attributed to elevated rates of health risk factors, including smoking and having obesity.

For this study, the researchers conducted a cross‐sectional online survey about statin use in adults ≥40 years of age between September and December 2019 using Facebook advertising. In total, 1,531 people responded to targeted Facebook ads.

The researchers calculated the prevalence of statin use by age, sexual orientation, and statin benefit populations. They used multivariable logistic regression to examine whether statin use differed by sexual orientation, adjusting for covariates.

Analysis showed that less than 21% of LGB adults were taking statins, compared to 44% of their non-LGB peers.

“We observed a significantly lower rate of statin use in the LGB versus non‐LGB respondents (20.8% versus 43.8%; P<0.001) in the primary prevention population,” the researchers reported.

In a news release, study author Yi Guo – an assistant professor of health outcomes and biomedical informatics at the University of Florida College of Medicine in Gainesville – said that “there could be many reasons for the difference we observed… LGB individuals may not go to the doctor as often, which leads to lower chances of being recommended statins for cardiovascular disease prevention.”

But looking at the use of statins among people who already had cardiovascular disease, there was no disparity between LGB and non-LGB adults.

For Guo, members of the LGB population may be less aware of the protective effect of statins.

For the researchers, the “results emphasize the urgent need for tailored, evidence‐based cardiovascular disease prevention programs that aim to promote statin use, and thus healthy aging, in the LGB population.”

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