Revictimization: The Hidden Truth Behind Childhood Sexual Abuse

In 2013 alone, a total of 60,956 child sexual abuse cases were confirmed in the US.1

As adults, children who’ve been sexually abused are at a greater risk for mental health problems, suicide attempts, and substance abuse.2 An eye-opening study published by the Boston University School of Medicine found childhood sexual abuse could even have biological implications, putting abused girls at a higher risk for developing uterine fibroids years later.3
An individual being attacked once is horrific. The thought of it happening repeatedly throughout a lifetime is unimaginable. But the often unspoken reality is this:

Children who are victims of sexual abuse are more than 3 times more likely to experience sexual victimization again as adults.3

This occurrence is referred to as revictimization. “Sexual revictimization occurs when a survivor of sexual abuse, such as childhood sexual abuse, is sexually victimized again,” Centers for Disease Control and Prevention reports. “Childhood sexual abuse survivors are more likely to experience adult sexual victimization compared to non-victims. Childhood sexual abuse is among the strongest predictors of continued victimization.”1

The connection between childhood sexual abuse and revictimization is multi-faceted. One theory is that children who are abused by people who are close to them associate love with sexual exploitation. Unable to create safe boundaries, sexual abuse may also lead to a belief pattern that sexuality is all an individual has to give and equates this with self-worth.4

Another mainstream belief surrounding revictimization involves an individual’s compulsion to reenact early abuse—not because a victim wants to be hurt—but to possibly regain control. In other instances, people who have been exposed to abuse as children learn to believe they have no control and come to accept this interaction as a way of life.4

The truth is, a victim of childhood sexual abuse could have a string of abusive episodes in their lifetime, but blame should never be placed on the victim. The violator is solely responsible for the attack.

According to Pandora’s Project, a support and resources online organization for survivors of rape and sexual abuse, “[Victim-blame] reflects a lack of knowledge about the workings of trauma: While some survivors may be overly cautious about everybody, other traumatized people actually have a harder time forming accurate assessments of danger.”4 Victim-blame will only perpetuate a dangerous environment where rape culture is considered acceptable.5 What’s more, a negative reaction to someone sharing her abuse experience may also lead to self-blame.6 And for some, it may mean choosing not to come forward at all.

A study published in the Journal of American College Health showed that among college women who experienced sexual abuse, the majority confided in someone close to them, but disclosure to formal support, law enforcement agencies in particular, was rare.7

Women have reported not formally coming forward because they fear their confidentiality will be at stake, they question the seriousness of their attack or don’t understand what constitutes as assault, or are afraid no one will believe them.7,8

If you’re a survivor of sexual abuse, confiding in someone you trust can help with recovery. There are also trusted organizations that provide support:

  • RAINN is the nation’s largest anti-sexual violence organization and leading authority on sexual violence. It offers phone and online Helplines, confidential support services, help resources, and consulting services. https://www.rainn.org
  • Pandora’s Project is an online support network for survivors of rape and sexual abuse. http://www.pandys.org
  • Planned Parenthood clinics provide crisis hotline services, in-person counseling, medical examinations, advocacy support during interaction with law enforcement, and community education programs for women, children and men who are survivors of sexual assault https://www.plannedparenthood.org
  • The National Sexual Violence Resource Center provides podcasts, eLearning opportunities, blogs, event calendars and other resources to improve sexual abuse education http://www.nsvrc.org
  • Take Back the Night offers online resources for abuse survivors and organizes community events around the globe to build awareness around sexual violence https://takebackthenight.org

April is both National Child Abuse Awareness Month and Sexual Assault Awareness month. If you want to become a voice for sexual abuse survivors, the National Sexual Violence Resource Center made 2017 the year of Engaging New Voices http://www.nsvrc.org/blogs/saam/announcing-2017-sexual-assault-awareness-month-theme-engaging-new-voices This month, and for the next 6 months, community leaders—especially members of campus Greek life, coaches, fathers, and faith leaders—are encouraged to come together and support Sexual Assault Awareness Month in their communities.

Because together we can put an end to attitudes that support sexual violence.

REFERENCES

  1. Ports, K., Ford, D., & Merrick, M. (2016). Adverse childhood experiences and sexual victimization in adulthood. Child Abuse Negl, Jan; 51: 313-322.
  2. Matta Oshima, K., Jonson-Reid, M, & Seay, K. (2014). The influence of childhood sexual abuse on adolescent

outcomes: the roles of gender, poverty, and revictimization. J Child Sex Abus, 23(4): 367-386.

  1. Boynton-Jarrett, R., Rich-Edwards, J. W., Jun, H. J., Hilbert, E. N., & Wright, R. J. (2011). Abuse inchildhood and risk ofuterine leiomyoma: the role of emotional support in biologic resilience. Epidemiology, 22(1): 6-14.
  2. Louise. (2009). Pandora’s Project. Revictimization. Retrieved from http://www.pandys.org/articles/revictimization.html

Soy. Fibroid Friend or Foe?
Alicia Armeli

Whether or not to eat soy is a puzzle for the everyday consumer. It can be even trickier if you’re a woman with uterine fibroids. And yet, the latest research shows we’re not that much closer to finding a clear-cut answer.

Soy is rich in phytoestrogens or plant estrogens called isoflavones, which are similar in structure to human estrogen but not as potent. Because they’re weaker, it’s believed these plant estrogens could act as anti-estrogens and serve as a potential protection against several hormonal diseases like breast cancer.1

Uterine fibroids, although noncancerous, are tumors thought to respond to estrogen and progesterone levels. For this reason, researchers question whether soy intake will protect or worsen the condition.

Published in Nutrition & Cancer, a review of current research looked at relevant studies investigating any potential links between soy intake and uterine fibroid risk.1 A Chinese case-control study involving 73 women with fibroids and 210 without examined the women’s dietary habits, physical activity, and stress through validated self-administered questionnaires.1,2 Results showed that soy food intake wasn’t linked to uterine fibroids in either premenopausal or postmenopausal women. A similar Japanese cross-sectional study that looked at 285 premenopausal Japanese women also found no association.1,3 The same was found true for the Black Women’s Health Study made up of 22,120 premenopausal US women.1,4 These studies show that soy intake doesn’t seem to be correlated to fibroid risk in adult women, but could soy intake early in life affect fibroid development and growth later on? The Study of Environment, Lifestyle & Fibroids (SELF), an ongoing cohort study of 1,696 African American women ages 23-34 years, surveyed 1,553 women (89%) concerning soy intake during infancy.5

Out of the 1,553 SELF participants, 22% had fibroids and 13% reported being fed soy formula. Results showed that soy formula-fed women had a slightly lower prevalence of fibroids (20%) in comparison to women who were not given soy formula (23%)—these were values considered too similar to be significant. There also wasn’t any association between soy formula intake and fibroid number.5

What did stand out to researchers was that among women with fibroids, those who were soy formula-fed as infants had significantly larger fibroids in comparison to those not fed soy formula. On average, soy formula feeding was linked with a 32% increase in fibroid diameter of the largest fibroid and a 127% increase in total fibroid volume. The researchers concluded that this study supports the theory concerning the effects of early life phytoestrogen exposure on the uterus.5 Even though no link was found between soy formula and fibroid prevalence and number, animal studies have shown that when exposed to a soy isoflavone called genistein early in life, it can affect the developing uterus and promote both of these occurrences.6

If the results to these studies don’t seem very cohesive, researchers examining possible fibroid links within the Black Women’s Health Study found data that was even more conflicting.7 After following 23,505 premenopausal women, 12-year follow-ups reported 7,268 had fibroids. But the researchers also stated “there was little evidence of an association between [fibroids] and…exposure to soy formula in infancy” and that “these findings do not support the hypothesis that intrauterine and early life factors are strongly related to [fibroid] risk.”7

As the latest research has shown, the jury is still out on whether or not soy intake is connected to fibroids. As we reviewed, it may not affect adult women but may influence a developing uterus in ways that could later lead to fibroid growth.

REFERENCES

  1. Parazzini, F., Di Martino, M., Candiani, M., et al. (2015). Dietary components and uterine leiomyomas: a review of published data. Nutr Cancer, Mar; 67(4): 569-579.
  2. He, Y., Zeng, Q., Dong, S., et al. (2013). Associations between uterine fibroids and lifestyles including diet, physical activity and stress: a case-control study in China. Asia Pac J Clin Nutr, 22(1): 109-117.
  3. Negata, C., Nakamura, K., Oba, S., et al. (2009). Association of intakes of fat, dietary fibre, soya isoflavones and alcohol with uterine fibroids in Japanese women. Br J Nutr, May; 101(10): 1427-1431.
  4. Wise, L., Radin, R., Palmer, J., et al. (2010). A prospective study of dairy intake and risk of uterine leiomyomata. Am J Epidemiol, Dec; 171(2): 221-232.
  5. Upson, K., Harmon, Q., & Baird, D. (2016). Soy-based infant formula feeding and ultrasound-detected uterine fibroids among young African-American women with no prior clinical diagnosis of fibroids. Environ Health Perspect, Nov; 124(6): 769-775.
  6. Greathouse, L., Bredfeldt, T., Everitt, J. (2012). Environmental estrogens differentially engage the histone methyltransferase EZH2 to increase risk of uterine tumorigenesis. Mol Cancer Res, Apr; 10(4): 10.1158/1541-7786.MCR-11-0605.
  7. Wise, L., Radin, R., Palmer, J., et al. (2012). Association of intrauterine and early life factors with uterine leiomyomata in black women. Ann Epidemiol, Dec; 22(12): 847-854.77
Why Collaboration of Care Is a Win-Win Solution to Treating Fibroids
Alicia Armeli

A new wave of collaborative fibroid care is emerging. In an effort to improve fibroid treatment by offering well rounded care, a group of progressive doctors in Orange County, Cali., collectively formed The Fibroid Treatment Network.

“The goal of The Fibroid Treatment Network is to ensure women are informed of all their treatment options,” says Dr. Todd Harris, Surgeon and Fibroid Specialist at The Fibroid Treatment Center in Newport Beach, Calif., and founder of The Fibroid Treatment Network. “It all started about 4 years ago when I was treating a lot of fibroid patients who were unable to find a gynecologist in their area willing to offer other options beyond hysterectomy. Because of this, we formed The Fibroid Treatment Network, which is a loose affiliation of about 40 physicians in the community. We refer patients back and forth and work together to provide the best care possible.”

And according to some research, finding a gynecologist who will refer patients out to other fibroid care specialists may be a challenge. In the US alone, 600,000 hysterectomies are performed annually, with the majority done to treat benign conditions like fibroids.1 However, a study published in the American Journal of Obstetrics & Gynecology revealed that almost one in five (18%) hysterectomies that were performed for benign conditions like fibroids were unnecessary.2 This number was seen to increase to nearly two in five (37.8%) women in the study under age 40. It also showed that there was no documentation of alternative treatments offered in 37.7% of women.

The unsettling reality behind the push for unnecessary hysterectomies may be that it’s a procedure only gynecologists are trained for and only feel comfortable doing. By referring a patient out to specialists who offer other minimally invasive treatment options, gynecologists may feel they are at risk of losing patients. However, research tells a much different story.

A hospital-based study looked at the outcomes of establishing a referral network between gynecologists and interventional radiologists—a type of doctor who performs a minimally invasive treatment option called uterine fibroid embolization (UFE).3 The study included 226 women seeking UFE for treatment of their fibroids. Of these women, 138 were referred to an interventional radiologist by a gynecologist and 88 were self-referred.

Any women in the study initially examined by an interventional radiologist were then referred to a gynecologist. Overall, 38% of the women underwent UFE. Those who did not were sent back to the referring gynecologist for further care. Results showed that 70% of self-referred patients and 92% of gynecologist-referred patients were satisfied with their original gynecologist and were referred back to their doctor for ongoing care. Patients who didn’t have a gynecologist or were unhappy with their original gynecologist were referred to a network gynecologist. Counting the women who were sent as new patients to gynecologists in the network, gynecologists saw an overall 119% return on the original 138 patients. In other words, for every patient who was referred out to another specialist, gynecologists got back nearly 1.2 patients or 20% more.3

What was also noticed was that women who chose a gynecologist in the network over their original doctor did so primarily because of “gynecologists failure to fully disclose treatment options or offer desired minimally invasive procedures.” The researchers of the study concluded that a collaborative referral network supports a “trusting, long-term, noncompetitive ‘win-win’ relationship” between specialties that actually “improves patient flow to a gynecologist practice”—and most importantly—“meets the patient’s desire for full disclosure.” 3

“In The Fibroid Treatment Network, we’ve found that having a collaborative referral base gives patients a group of doctors who are open-minded and who are going to do what’s best for the patient,” Dr. Harris explains. “Even if it means giving up a procedure or giving up a particular surgery that they don’t perform, gynecologists are still going to do what’s in the best interest of the patient. And at the same time, they’re still going to get that patient back after outside treatment and most likely have a life-long doctor-patient relationship because that level of trust is there.”

Dr. Harris takes this same approach in his own practice at The Fibroid Treatment Center. For every new patient who comes in for a consultation, Dr. Harris explains that he’ll continue to work with her gynecologist if she’s happy with her current gynecological care. If she’s not, then he’ll introduce her to gynecologists in The Fibroid Treatment Network in order to “bridge the care before and after treatment.”

Currently, The Fibroid Treatment Network is limited to Orange County, but Dr. Harris hopes their mission of “physicians dedicated to treating patients comprehensively” will catch on nationwide. “At the end of the day, as I say repeatedly, no one type of doctor can take care of every fibroid patient. It sometimes takes a team of doctors and different types of procedures to best care for a patient.”

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer and Editor, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community.

ABOUT THE DOCTOR Todd S. Harris, MD, is Medical Director of The Fibroid Treatment Center. Board certified in General Surgery, as well as fellowship trained in Interventional Radiology, Dr. Harris is highly experienced in Fibroid Surgery. Respected by both patients and doctors, Dr. Harris was awarded the prestigious 2017 Physician of Excellence Award by the Orange County Medical Association and published by Orange Coast Magazine. He was also awarded the rare and esteemed 2016 Southern California Super Doctors Rising Stars Award. Dr. Harris is a Fellow of the American College of Surgeons, one of the highest distinctions for a surgeon. Dr. Harris shares his knowledge and expertise by actively engaging in research and participating in volunteer work around the globe.