Can Sexual Trauma Have An Impact On Fertility?
Warning: This article contains sensitive content relating to sexual assault. *Names have been changed to protect people's anonymity.
'Just breathe and try to relax, it’s normal for this to hurt.' I’m lying on my back surrounded by nurses in lead X-ray aprons. Some stare at the monitor above my torso, while others huddle between my legs. I’m about to have a hysterosalpingogram, more commonly known as an HSG. I’ve read horror stories online about the pain of this test, in which ink is passed through the fallopian tubes to check for blockages.
I feel a sharp sting from the speculum, then a familiar sensation washes over me: absolute numbness. My mind has left my body. I’m embarrassed as one nurse strokes my arm and tells me I’m being brave. 'I’m not brave,' I tell her, 'I just can’t feel anything.'
This numbness is nothing new to me. Since I was raped in my late teens, my body has swung from hypersexuality to deadened dissociation. What was new in that moment, was the connection I made between my sexual trauma and fertility struggles.
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At that point, my partner and I had been trying for a baby for almost two years. This was the latest in a series of tests revealing that physically, there was nothing wrong. While the HSG feels different for everyone, after I left, I couldn’t stop thinking about that ever-present numbness. I have experienced it during sex with safe, loving partners. It’s been there through smear tests and pelvic scans, as though the nerve endings have shrunk back from the bottom half of my body. While years of therapy have led to some form of psychological peace, physically, I still sometimes find myself stuck.
Past sexual violence has been found to cause intense pain during sex, heightened cortisol, insomnia, chronic digestive issues, and PTSD. Could it have the power to impact the reproductive system too?
Apparently, yes. In our next consultation my doctor told me she often sees unexplained infertility in patients who have been raped. So why is it not openly discussed as part of fertility planning? An estimated one in four women in the UK have been sexually abused, and the trauma that comes after can be just as grueling.
When I investigated it, I found several studies suggesting there is a link. One from 2020 states that survivors of sexual abuse are twice as likely to experience problems with their fertility, citing fear around having regular sex, a higher percentage of endometriosis among survivors of abuse, and a higher rate of early follicle loss. Those interviewed spoke about physical pain that didn’t feel like their own; a sensation of death within their bodies; and the belief that there was something bad about their sexuality. While not every survivor of abuse is destined to struggle with fertility, it certainly seems to increase the likelihood.
Rape destroys the potential of sex as something creative and mutual. For me, it felt like a punishment of my sexuality, which at that time was a euphoric new force within my body that I wanted to revel in. This warping of sex’s pleasurable possibility is exacerbated by social stigma. In the US, politicians are simultaneously removing the right to choose abortion and wanting to ban IVF. Both deny reproductive autonomy and make natural bodily urges shameful.
The stigma of sexual trauma combined with the horrors of infertility can be a terrifying subject to broach. The women I have spoken to about the link initially made the connection for themselves, rather than being made aware of possible challenges by their medical professionals. There are scores of posts on Reddit tentatively enquiring if anyone else feels shackled by trauma during the fundamentally bodily experience of trying for a baby. Some worry that even asking this question is a form of victim blaming, as they bear the debilitating consequences of violence that wasn’t their fault.
For Kate*, who was raped as a teenager and a young adult, the experience of IVF has been eye-opening. During an internal scan she realised she was dissociating, and looking back after her egg retrieval, thinks she was physically detached through the process. 'I felt like they tainted me,' she tells me, when speaking about the men who attacked her. 'Men’s bodies go into things. That physical representation is still something that triggers me. After the egg retrieval, I realised I wasn’t physically connected with what I was doing; I felt very mechanical. I’ve been to so many womb workshops where they’re talking about different sensations, and I don’t even know how to have those feelings. I have no connection with that part of myself. It’s only recently that I’m realising that.'
She tells me that the rapes, which she has been processing throughout her adult life, made her question her value as a woman. It also placed her into a position of hypervigilance, compounded by subsequent, emotionally abusive relationships. 'If that’s where my body is at, constantly in a state of freeze, it’s not like my eggs are separate from me.'
Kate has since discussed the connection with her doctor, who agrees that trauma can keep only our essential functions operating fully, diverting energy from the reproductive system. Kate works with a therapist and since her egg retrieval has started practicing a mindful approach to her body, regularly checking in to see when she is in a state of hypervigilance. 'Something is definitely shifting,' she says. 'I’ve done a lot of slowing down.'
Sophie* was also raped in her late teens. When she started trying for a baby 12 years later, she had worked through the trauma in therapy and with a supportive partner who has been with her since the assault. But the pressure of having sex at a certain time each month was surprisingly triggering. 'I struggled with the lack of agency,' she explains. 'We tried really hard to make sex fun, and not like a chore. But eventually an element of that sneaks in, that you’ve got to have sex at certain times. I found the prescriptiveness of that really difficult, even though it was a choice, and it was with the person I loved.'
Before giving birth to her daughter in 2022, Sophie experienced six miscarriages. Added to the immense grief, she found the internal probes and lack of warning about when these would be used incredibly triggering. 'There is an intense lack of compassion in those situations. If not verbal compassion, just not being told what’s about to happen. This idea of having to be open at will.' Her first miscarriage happened at home, following an induction when no heartbeat could be found. She describes this as a turning point. 'It is an inherently traumatic experience, but I also felt very powerful, that the trauma wouldn’t break me.' In her seventh pregnancy, Sophie experienced some bleeding, and one scan when her daughter’s heartbeat was undetectable for five minutes. 'After they found it, I remember thinking, "I can’t keep living under this fear. If the worst happens, it’s going to be terrible anyway."'
Throughout this pregnancy, physical acts such as perennial massage were a painfully invasive reminder of the rape. 'It’s only because of the bond that me and my partner have that it was possible,' she tells me. Sophie credits hypnobirthing and her midwife for creating a containing experience around the birth. 'I told her I was a survivor and that I was sure it would impact on my pregnancy and birth. She really sweetly drew hearts under my name and said, "If any of my girls are on, they’ll know you need extra care." There are saints dotted through the NHS. I remember the excruciating pain, but also thinking, I have survived so much worse than this, and I’m going to meet our daughter. It was a proper reclamation: this is not someone forcing themselves inside of me, this is me pushing out the person I am going to love most in the world.'
With still limited research in this area, conversations are often led and advocated for by those living with the trauma rather than the systems that exist to care for them. Telling survivors to 'relax and allow the body do what it’s made to do' – something I have heard many times from well-meaning voices – ignores the enormous challenge that exists in simply letting go and feeling safe within the body after rape. It also encourages even more feelings of failure when 'just relaxing' doesn’t work.
Charlotte Bramley is an NHS maternity manager overseeing safeguarding and a team of midwives who look after vulnerable women. She also co-runs My Body Back, a service offering cervical screening, STI testing, contraceptive and maternity care for people who have experienced sexual violence. 'In terms of the connection between fertility and historical sexual abuse, I think a lot of it connects with mental health, perhaps undiagnosed symptoms, like anxiety,' she explains. 'We know how much stress and anxiety affects our bodies. A lot of women we see who are pre-conception also worry they are so damaged and traumatised that they will experience severe mental health during the pregnancy or be a terrible parent. In terms of fertility, there is often the question of "Will I even be able to get pregnant?", "Will that cause more issues?". Women we have seen in the past have diagnosed vaginismus which can make it difficult to become pregnant. Some people say the thought of being pregnant makes them want to rip the baby out of them because they feel so dirty.'
Charlotte sees a lot of women for whom the lack of control in fertility planning can feel incredibly traumatic. In the wake of sexual violence, many survivors long for a sense of control within the body. 'Becoming pregnant is ultimately out of our control,' she adds. 'We talk a lot about this in our clinics. How do we instil that confidence back in women who have experienced trauma?'
It is important for medical professionals not to pressure patients to disclose a history of sexual abuse, and Charlotte encourages her fellow midwives to take a trauma-informed approach to everyone. My Body Back is running an audit on this later in the year, with the goal of offering additional training to midwives throughout the NHS. 'How can we reduce the chances of retraumatisation? Should we think about advising all midwives to treat all women as if they might have had some kind of trauma? I don’t mean probe them, but the basics of treating everyone with kindness and compassion and really thinking about the language we’re using.'
Platforms like My Body Back bring some hope to a medical system that all too often seems blind to the immense impact of trauma. It can be incredibly painful to acknowledge that such a cruel and harrowing past experience is still influencing major life moments. But discussing these reverberations openly and with empathy can empower us to make more compassionate, informed decisions as we navigate our way through it.
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