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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Content warning: This article contains sensitive topics related to sexual violence and trauma. If you’re impacted by sexual violence or have experienced trauma in any way, please consider reading this piece with a trusted person, take breaks, and stop if you feel emotionally unsafe.
After experiencing sexual violence, it can feel like nothing will ever be the same again. A violation of the body can leave people feeling perpetually unsafe — or becoming preoccupied with what happened and worrying that it may happen again. Close friendships, family, and intimate relationships can change dramatically as a result of what has happened. The way we view our bodies and the ability or desire to be intimate with a partner can change. Navigating fertility and trying to conceive can present unique challenges to a person who has experienced sexual trauma.
In this article, we’ll elaborate on some of the challenges and experiences that can occur while trying to conceive for someone who has experienced sexual trauma. Here are your main takeaways:
- Survivors of sexual trauma may be more likely to experience physical and emotional conditions that may affect their experience of trying to conceive, such as discomfort with sex, challenges within intimate relationships, and high stress.
- Accessing trauma-informed fertility and OB-GYN care can create the opportunity for a safer, more comfortable experience of trying to conceive.
- There are effective and transformative ways to heal from sexual trauma, particularly modalities that involve somatic experiencing.
- There are incredible support opportunities for sexual trauma survivors as they engage in the process of trying to conceive.
Though the pendulum has begun to shift, too often, silence stifles conversations about fertility and sexual trauma. We want to break the silence because it’s a powerful way to show that people are not alone in their unique challenges as sexual trauma survivors who are trying to conceive.
How can sexual trauma impact survivors?
“Sexual trauma is how our bodies process and try to protect us from a threatening, unwanted sexual or intimate experience,” explains Modern Community mental health clinician and licensed certified social worker (LCSW-C) Meghan Cassidy. “The result of trauma can involve two factors: what happened to us and how our body perceives and responds to the harm.”
Though trauma doesn’t manifest in every instance of sexual violence, and it certainly doesn’t manifest in the same way for everyone, it’s quite common for survivors to experience long-lasting emotional and physical effects after nonconsensual sexual encounters — and if you do, you’re not alone.
According to the Rape, Abuse & Incest National Network (RAINN), the effects of sexual violence may include:
- Post-traumatic stress disorder (PTSD)
- Panic attacks
- Eating disorders
- Sleep disorders
- Issues with substance use
Layered on top of these effects may be how we treat survivors in our society. “People with ovaries are held responsible in sexual encounters. When sexual violence occurs, the survivor can internalize their experience, believing they are to blame or could have done something to avoid the violence,” Meghan says. “Compounding this is an expectation that survivors remain silent, as speaking up will lead to potentially adverse reactions such as not being believed, being told that they ruined the life of the person who assaulted them, or being ridiculed or blamed for the abuse or violence.”
How can a history of sexual trauma affect the process of trying to conceive?
“Sexual trauma history comes up a lot in preconception counseling in the clinic. Because it is so prevalent in general, I make it a point to screen all of my patients because trauma-informed care is key in the patient-physician relationship,” says Dr. Jenn Conti, MD, MS, MSc, OB-GYN and Modern Fertility medical advisor. “While there isn’t a clear biological connection between sexual assault and fertility, there is absolutely a connection between past assault and subsequent intimacy or medical procedures required to conceive. Addressing and supporting someone through this is crucial.”
Because the way each individual processes sexual trauma is unique, these are just some of the ways (by no means an exhaustive list) a history of sexual violence can impact the steps involved in trying to get pregnant.
Expectations around parenthood
According to Meghan, people who experience sexual violence may internalize oppressive societal expectations, which can affect their belief about their worthiness as a parent. “People with ovaries not only often experience the pressure of what it means to be the ‘right’ kind of sexual partner, but also to perform parenthood in a certain way,” she explains.
Meghan adds that this pressure to be the “perfect” parent can be particularly complicated when there’s a struggle to conceive — which could manifest in the belief that they deserve the struggle because of the sexual trauma they experienced. How our society treats survivors of sexual trauma can also contribute to grief, depression, and anxiety, which can in turn make the process of trying to conceive more difficult.
Discomfort with sex and intimate relationships
For survivors of sexual assault who want to try to get pregnant through sex, feelings and anxieties around sex may make the process more challenging. The University of Alberta Sexual Assault Center says that some of the more common sex-related symptoms after assault include:
- Avoidance or fear of sex
- Viewing sex as an obligation
- Associating touch with negative feelings
- Difficulties with arousal, sensations, or orgasm
- Vaginal pain
- Intrusive sexual thoughts and images
When we discuss sexual assault, it’s imperative to recognize that everyone’s experience manifests differently. In some cases, people disassociate from their bodies as a coping mechanism to sexual trauma. Many of these traumatic effects can make sex — whether it’s to get pregnant or connect with a partner — scary, painful, or uncomfortable. Processing past experiences with a trauma-informed therapist can help survivors better manage these symptoms and work toward an improved relationship with sex and intimacy.
Triggers when accessing OB-GYN and fertility care
For some survivors, going to the doctor’s office is an experience filled with dread and apprehension. It’s possible for victims of sexual abuse to be triggered in situations where their body is being examined or touched, which is common in a doctor’s office but especially in OB-GYN, fertility, and pregnancy care. This fear and apprehension may also result in people avoiding opportunities to seek out healthcare and reproductive health conditions going unnoticed — contributing to the possibility of negative fertility outcomes. Survivors may also feel they have to submit to someone else making (sometimes very quick) decisions about their bodies and the birthing process, which can feel incredibly invasive.
If your doctor is trauma-informed or someone you feel you can trust, it may help to disclose your trauma history to them. By doing so, your healthcare provider can use their knowledge of trauma-informed care to personalize your care (which may improve outcomes for people with history of sexual trauma) and validate your experience. But disclosing information about sexual abuse with a doctor in order to personalize your care (or for any other goal) can be difficult for a myriad of reasons — and the experience of doing it may vary among diverse populations of socioeconomic status and demographics.
This is why it’s so crucial that providers become trauma-informed and learn how to support patients with a history of trauma. In April of 2021, the American College of Obstetricians and Gynecologists urged all OB-GYNs to train in the trauma-informed model of care. Some key components of this medical care may include:
- Seeking permission before initiating contact.
- Providing descriptions before and during examinations and procedures.
- Allowing clothing to be shifted rather than removed.
- Agreeing to halt the examination at any time upon request.
But, like most changes in medicine, explains Dr. Conti, universal acceptance of this framework will likely take several years.
Psychological effects with physical symptoms
It is important to reiterate that there’s no evidence to suggest that surviving sexual trauma is connected to infertility. However, there might be a relationship between the psychological impact of trauma and physiological changes that could affect fertility outcomes.
When someone has experienced trauma, there can be changes to their stress response — a survival mechanism (commonly known as the “fight or flight response”) in which hormones such as cortisol and adrenaline release into the bloodstream, allowing us to respond to an emergent situation:
- Stress and post-traumatic stress disorder (which is commonly associated with sexual trauma) can cause a malfunctioning release of cortisol and impact the part of the brain that controls ovulation, causing missed or irregular menstrual cycles.
- One very small observational study found that as the number of adverse childhood events increased, risk of fertility difficulties and amenorrhea (lack of periods) also increased. But due to the size and design of this study, the results may not be generalizable — and the study didn’t account for other potentially confounding factors.
Trauma and/or PTSD can also contribute to other mental health challenges that could influence fertility, like eating disorders or substance use.
As we’ll cover in the next section, addressing trauma-related stress and anxiety with a trauma-informed therapist can help you work through physiological and emotional symptoms — and take steps toward improving your overall well-being.
How can you find trauma-informed care after sexual assault?
Finding a trauma-informed healthcare team can provide security and foster trust for those who have experienced sexual trauma. In trauma-informed healthcare, professionals are trained to understand that survivors are prone to flashbacks and can be triggered by words, gestures, or physical examinations. Providers are taught to use affirming language while speaking with survivors, continually ask for consent, and explicitly explain the process before and during procedures. Trauma-informed providers will be particularly adept at noticing signs that a survivor is experiencing distress and adjust accordingly.
Whether or not you’re with a healthcare provider who’s trauma-informed, you always have the right to create boundaries and advocate for yourself:
- Consider how you might feel more comfortable sharing your trauma history and whether or not you would like your provider to ask you questions about it.
- You can also consider and ask for certain conditions to be met while you’re accessing healthcare, such as having a trusted person with you or asking that your provider ask permission before each step in any procedure or examination. You get to set the terms regarding your care.
“I remind every single patient I’m meeting for the first time that they are in control and can tell me to stop at any point in the exam, and that I will,” says Dr. Conti. “It’s also important that people feel safe talking about past assault because providers can help provide recovery resources and actively avoid retraumatization through medical examination of sensitive areas.”
Mental health support and healing modalities
“A trauma-informed therapist will use specific modalities that will help you to process and heal from the emotions that are held in your body as a result of traumatic events,” Meghan explains. “Trauma therapy can provide the opportunity for your body to no longer hold the emotions that have been stored during a time when control was taken away or survival was necessary.” Importantly, adds Meghan, working with a trauma therapist can give you relief from symptoms related to trauma, like flashbacks, reactivity, anxiety, depression, insomnia, and physical ailments.
Meghan highlights these three modalities as evidence-based practices for healing trauma:
- Internal Family Systems (IFS)
- Somatic Experiencing (SE)
- Eye-Movement Desensitization and Reprocessing (EMDR)
Somatic therapy in particular has proven successful in treating psychological and physical distress from past trauma. Somatic practitioners (which can also be acupuncturists, massage therapists, or reiki practitioners) facilitate healing by focusing on the way emotions manifest in the body.
You can search for trauma-informed and somatic therapists on nationwide databases like:
Networks of communities exist to provide a safe space and support to those who are healing from sexual trauma. In the free online Modern Community, we’ve created a place where we can hold one another’s grief as well as joy. We host meetups where members can connect and share their stories with folks who are going through similar things. We believe in the power of human connection, and that finding a community to work through trauma is key to healing and moving forward in one’s journey.
Our Modern Fertility mental health clinician, Meghan, sees this support in action every day in our community. “Humans are social beings — we heal in relation to one another through our shared experiences,” she says. “Within the safe container of our community, people offer one another support and model transformative healing that occurs when we hold space for pain.”
You’re not alone, and support is available
Survivors of sexual trauma may have unique considerations when it comes to trying to conceive. There is no one set experience, but you’re not alone if you have experienced sexual trauma and are also experiencing disruptions to fertility such as irregular or absent menstrual cycles. You may experience physical or emotional pain because of what you have survived, which also can impact your decision about becoming a parent and the process of trying to conceive. If you experience flashbacks or triggers during sexual activity or during fertility care, this is a normal reaction to enduring the unthinkably difficult experience of sexual trauma.
Awareness about how sexual trauma can impact our experiences when trying to conceive provides an opportunity to seek the trauma-informed support that can help. You’re not alone and you’re not to blame for what happened to you. Support for sexual trauma is more prevalent than ever, and it can be a powerful tool in your journey of trying to conceive.
Dr. Jenn Conti is an OB-GYN and serves as an adjunct clinical assistant professor at Stanford University School of Medicine.