A Qualitative Description of Women's Sexual Health during and after Violent Relationships

Purpose: Links between intimate partner violence (IPV), forced and coerced sex, and poor sexual health outcomes, such as HIV risk, are well established; yet, there is currently a limited understanding of the best strategies to address these risks among victim-survivors. The purpose of this study is to investigate and describes survivor’s sexual safety and protective strategies to inform interventions that are relevant to women’s lived experiences of IPV.

Methods: Semi-structured, in-person interviews were conducted with female survivors of IPV (n = 13). A purposive sample was recruited from domestic violence shelters and community agencies. Interviews were audio-recorded and transcribed. Using qualitative description, data were analyzed through process coding (first cycle coding) and focused coding (second cycle coding). Detailed process notes, analytic memos, coding checks with multiple coders, and the use of visual analytic displays in analysis were used to increase the trustworthiness of the findings.

Results: All women reported experiencing a range of sexually abusive and coercive behaviors, including sexual assault. One participant said, for example, that refusing sex “was a dangerous thing to do…the cost was too high.” Fights in participants’ relationship often revolved around sex, with the abusive partner demanding more sex or different types of sex acts (such as anal or oral sex). As one participant described, “Sex to him was about control, not intimacy.” Consistent with prior research, participants in this study reported poor sexual health outcomes, including unplanned pregnancy, miscarriages, cervical cancer, multiple yeast infections, pelvic inflammatory disease, and sexually transmitted infections. No woman reported being HIV positive.  

Participants engaged in protective strategies during and after abusive relationships. All participants reported visiting their sexual health care providers during and after the abuse. One recalled sneaking out of the house, without her abuser knowing, to do so. Women displayed resourcefulness, accessing community services such as free sexual health clinics. A positive relationship with a healthcare provider was an important factor for maintaining sexual healthcare. Survivors emphasized spirituality, self-esteem, sobriety, and separating from their abusive partners as important aspects of maintaining sexual health. Participants relied on improving themselves through creative endeavors, engaging in activities where they could see growth and accomplishment, “things that bring me in the moment and not in my head.” All participants believed they had progressed in their healing but had further to go: “The process of getting out of an abusive relationship is long term.”

Conclusions: These findings provide insight into how women’s strengths, resiliency, and resourcefulness can maintain and improve sexual health despite high-risk environments. They offer a unique contribution to social work research and practice, focusing on strategies women can harness and employ in sexual safety planning. With this pragmatic approach, survivor’s perspectives can shape the multi-disciplinary dialogue on intersecting HIV/IPV. From a policy perspective, this study suggests a need for increased or more targeted funding for sexual health promotion with this population.