Last updated November 1, 2023

Sexual assault can have profound and enduring effects on both the physical and mental health of victim-survivors, highlighting its status as a significant public health concern. Both short- and long-term consequences can manifest in all areas of a victim-survivor's health and well-being. In the short-term, victim-survivors may experience shock as well as immediate emotional and physical injuries. In the long-term, victim-survivors may experience chronic physical health problems, ongoing mental health challenges, and difficulties adjusting their behaviors to different situations (i.e. maladaptive behavioral patterns) that go beyond the immediately visible effects of the assault. These intertwined physical, mental, and behavioral effects can create a cycle of distress, where health issues may exacerbate each other and contribute to economic and other stressors.

Short-Term Consequences

Physical Health

Sexual assault can cause physical health consequences for survivors, including injuries like bruises and cuts, genital trauma, sexually transmitted infections, unwanted pregnancy, miscarriage, and unsafe abortion. Additionally, survivors may experience gastrointestinal disturbances, headaches, body aches, sleep disturbances, fatigue, and appetite changes. Post-traumatic Stress Disorder (PTSD) can also manifest as physical symptoms, such as increased blood pressure and heart rate, joint and muscle pain, nausea, fatigue, headaches, and pain, among others.

Sexual Health

Sexual assault can contribute to the development of gynecological and reproductive health problems.[1] These problems may include vaginal infections, pain during intercourse, chronic pelvic pain, and urinary tract infections.[2] Additionally, victim-survivors may encounter difficulties related to their sexual health including the consequences of sexually transmitted infections (STIs) and unwanted pregnancies. In places where safe abortion is not accessible, many victim-survivors may experience unsafe abortions and may sustain injuries during such.[4] Effects on sexuality can include reduced interest in sex, declining sexual satisfaction, greater promiscuity, changes in the numbers of sexual partners, and riskier sexual behavior.[5]

Mental Health

Mental health consequences may manifest as soon as immediately after the experience of a sexual assault. Victim-survivors may experience intense shock, anxiety, depression, and even suicidal ideation as they grapple with the aftermath of the assault. In the short-term, victim-survivors can experience a wide range of psychological and emotional disorders, including shock, anxiety, depression, post-traumatic stress disorder, and other trauma-related mental health issues. Victims may also experience disturbed sleep, hypervigilance, loss of self-esteem, sexual dysfunctions, and behavioral and eating disorders. Psychological and emotional trauma can also manifest itself in physical reactions such as stomachaches, headaches, and back problems.[6]

Sexual assault and rape are traumatic life events with the greatest likelihood of leading to post-traumatic stress disorder (PTSD), inflicting devastating consequences on those affected by this condition.[7] Symptoms of (PTSD) include re-experiencing traumatic memories, hyper-arousal or feeling on edge, and avoidant behaviors.[8] Victim-survivors experience varied expressions of these symptoms, which can occur shortly after an assault or manifest years later.[9] At times, this trauma response can be understood by categorization of symptoms into a series of categories, each of which can have intersecting and coinciding occurrences. The acute phase generally begins after the initial shock of an assault has passed, and may be marked by experiences of extreme anxiety, diminished or hyper-alertness, disorganized thought, and sensitivity to the reactions of other people. After the culmination of the acute phase, the development of the outward-adjustment and underground phases may begin. While in the stage of outward adjustment, victim-survivors may show signs of “moving on” from their assault, but still experience the continuance of anxiety and lack of security. This phase may include the use of coping mechanisms like minimization (stating “everything is fine”) or suppression (refusal to acknowledge the assault), as well as larger shifts in lifestyle, such as changes to existing relationships and/or sexuality. The underground phase focuses on the victim-survivor's return to “normalcy,” although they may still be experiencing unresolved emotional responses. Next, the reorganization phase marks the return of fears or anxieties that may have previously felt resolved and is generally catalyzed by a major transition or external occurrence. From the reorganization phase, some victim-survivors may move into subsequent outward-adjustment and underground phases while others may experience a resolution to their trauma response and move into the “renormalization” phase. Renormalization is categorized by the integration of an individual’s experience of assault into their lives without being a disruptive, central focus to everyday life. It is important to note the experiences of PTSD and of each of these phases can vary widely from individual to individual.[10]

Long-Term Consequences

Sexual assault victim-survivors may be more likely to experience a variety of intertwined mental, behavioral, and physical health issues.  Survivors may be at a higher risk of developing chronic health conditions, such as cardiovascular diseases and autoimmune disorders.[11] The prolonged activation of the body’s stress response system, known as allostatic load, can have detrimental effects on victim-survivors' wellbeing.[12] Furthermore, sexual violence can have profound impacts on a person's development and overall functioning. Research indicates that individuals who have experienced sexual assault during childhood often face long-term physiological and psychological consequences. Increased susceptibility to stress later in life is due to disruptions in the hypothalamic-pituitary-adrenal (HPA) axis, which plays a crucial role in the body's stress response system. Experiencing a traumatic event such as sexual assault can dysregulate this axis, leading to alterations in the release of stress hormones, such as cortisol. These effects may persist well into adulthood.[13]

Behavioral Consequences

Victim-survivors may also face behavioral challenges and/or engage in risky behaviors, which can have long-term effects on their well-being. Individuals who experience sexual assault in childhood may be more likely to engage in behaviors such as smoking, alcohol and substance abuse, and disordered eating, which can increase the risk of developing chronic diseases.[14] Similarly, sexual violence in adulthood can also have linkages to chronic diseases. Studies have shown that sexual assault is associated with various health conditions and risk factors such as smoking, excessive alcohol use, arthritis, asthma, high cholesterol, stroke, and heart disease.[15]

In addition, victim-survivors may experience problems in relationships with intimate partners and friends. It is important for partners, family members, and friends to educate themselves to support someone who has survived sexual violence.[16]  Victim-survivors of sexual assault may exhibit social withdrawal as a coping mechanism to protect themselves from potential harm. The trauma of the assault can lead to feelings of shame, guilt, and fear, making it challenging for survivors to engage in social situations. Sexual assault can shatter a survivor's sense of trust in others, especially in close relationships.[17] Sexual assault can cause sexual dysfunction in victim-survivors. Studies have shown that survivors may experience sexual difficulties, such as decreased sexual desire, arousal problems, pain during intercourse, and aversion to sex. Many victim-survivors experience a change in their sexual behavior post-assault.[18]

Health Care Disparities among Marginalized Populations

The health consequences of sexual assault are even more pronounced amongst individuals from marginalized populations. Victim-survivors from historically marginalized communities and identities such as LGBTIQ+ individuals, individuals with disabilities, and racial and ethnic minorities face significantly higher rates of sexual assault, compounding the challenges they already endure due to systemic discrimination.[19]   According to the National Intimate Partner and Sexual Violence Survey (2016-17):

“More than 1 in 4 non-Hispanic Black (29.0%) and non-Hispanic White (28.1%), 1 in 5 Hispanic (19.7%), and 1 in 6 non-Hispanic Asian or Pacific Islander women (17.2%) in the United States were raped in their lifetime.”[20]

A study documented the health consequences that lesbian women suffer following sexual and physical violence and/or stalking. For example, 31.2% of lesbian women had asthma, 37% had recurrent headaches, and 60% had trouble sleeping.[21] These communities often encounter barriers in accessing the necessary resources and support systems to aid in their recovery. Moreover, post-gender-based violence medical and mental health care, including timely interventions, may be inaccessible or inadequate for addressing marginalized populations’ needs.

Studies have consistently shown the profound effects of sexual assault on mental health, including increased rates of depression, anxiety, post-traumatic stress disorder (PTSD), and other trauma-related disorders.[23] These effects can be further exacerbated when individuals do not have equal access to appropriate mental healthcare services. A 2021 study examining the health disparities between Black and White victim-survivors of sexual assault indicated several racial disparities in post-gender-based violence care. Not only were Black victim-survivors more likely than White victim-survivors to have experienced sexual assault in the form of intimate partner violence (IPV), but they were less likely to have access to mental health care than their White counterparts.[24] The combination of heightened vulnerability to sexual assault and limited access to equitable health care further exacerbates the physical, psychological, and emotional impacts experienced by victim-survivors from marginalized communities.