In many countries, chronic pelvic pain accounts for up to 10 per cent of all visits to gynaecologists and one quarter of all hysterectomies. Although chronic pelvic pain is normally caused by adhesions, endometriosis or infections, about half the cases treated have no identifiable pathology. A number of studies have found that women suffering from pelvic pain are consistently more likely to have a history of childhood sexual abuse, sexual assault or physical and sexual abuse by their partners. 23 Other gynaecological problems associated with sexual violence include vaginal bleeding, vaginal discharge, painful menstruation, pelvic inflammatory disease and sexual dysfunction. 24 Sexual assault also increases the risk for premenstrual distress, a condition that affects up to 10 per cent of menstruating women and causes physical, mood and behavioural changes.
Violence distorts the emotional lives of women and families.
In Nicaragua, for instance, focus group studies found that many women considered the persistent psychological effects of domestic violence to be more severe and debilitating than the physical ones. Violence can also lead to suicide. 26 Serious episodes of depression affect about one third of battered women in the United States. 27 One study found that one fourth of all suicide attempts were preceded by abuse. Data in the United States suggest that women who were sexually abused as children tend to end up in abusive relationships and have a higher than normal risk of becoming involved in prostitution and drugs.