Psychosexual Functioning Among Adults Who Were Sexually Abused as Children

Background and Purpose: A growing body of research has demonstrated a link between child sexual abuse (CSA) and long-term problems in psychosexual functioning. Many of the studies, however, have narrowly measured sexual functioning as a physiological problem, have relied on clinical or college-aged samples, and have not considered moderating factors such as disclosure. As a result, little is known about which factors predict problems in psychosexual functioning among adults who were sexually abused as children. The purpose of this study was to identify potential predictors of variability in psychosexual functioning among adults with CSA histories. This study used a multi-dimensional framework of psychosexual functioning that included variables in three dimensions: emotional, behavioral and evaluative. The first objective was to determine whether abuse characteristics (e.g., severity, age at time of abuse, relationship to abuser), disclosure variables, or demographic factors predicted problems in psychosexual functioning. The second objective was to identify moderators of the relationships between predictors and psychosexual functioning. Methods: The study was based on data collected in semi-structured telephone interviews conducted by staff at the Centres Against Sexual Assault in Australia. Respondents were recruited from the community through newspaper advertisements, radio announcements, and posters in public places. The final sample consisted of 165 adults with CSA histories who were distributed into four age groups (20s, 30s, 40s, and over 50). A Generalized Estimating Equation (GEE) model was used to test the relationship among the predictors, moderators and five binary outcomes of psychosexual functioning: fear of sex and guilt about sex (emotional dimension), problems with touch and impaired sexual arousal (behavioral dimension), and sexual satisfaction (evaluative dimension). GEE was used because of its ability to address correlations among multivariate binary dependent variables and to produce more efficient, unbiased estimates. Results: In the multivariate analysis, respondents who were injured, had more than one abuser, said abuse was incest, were older when they were first abused, and told someone at the time of the abuse were more likely to experience problems in at least one dimension of psychosexual functioning. Telling someone at the time of the abuse was the only factor that increased the odds of having problems in all three psychosexual dimensions: guilt during sex (2.44, p<.05), problems with arousal (3.65, p<.05), and dissatisfaction with sex (3.20, p<.05). Telling also moderated the relationship between age at the time of the abuse and two outcomes: fear of sex and problems with touch. Among respondents who told someone, those who were older at the time of the abuse were more likely to report more fear of sex (14.01, p<.10) and problems with touch (7.95, p<.05). Conclusions and Implications: Rather than treating psychosexual functioning exclusively as a physiological problem, the results underscore the importance of using a multi-dimensional framework for future research on psychosexual functioning. Clinicians and therapists should assess clients with CSA histories for these unique predictors and incorporate them into treatment. In particular, disclosure history should be examined thoroughly to understand its influence on a client's psychosexual functioning.