Women's Sexual Health in the Context of Intimate Partner Violence: The Intersections of Gender, Race, Class, and Age

Background and Purpose: Women who experience intimate partner violence (IPV) have unique risk contexts that increase their susceptibility to negative sexual health outcomes and reduce their access to sexual healthcare. This study seeks to understand women’s sexual risk across intersectional identities including gender, race, class, and age.

Methods: For this qualitative study, women who experienced IPV (n=28) were purposively recruited from a domestic violence program, a statewide coalition to end domestic and sexual violence, and social media. The sample represented diverse ages (range = 22-60) and races (57% White; 14% African American; 11% Hispanic; 7% Native American; 7% multiracial; 4% South Asian). Data were collected with semi-structured, in-person interviews, averaging 59 minutes. Interviews were audio-recorded and transcribed. Data were stored and analyzed by three coders in Dedoose using an intersectional feminist framework and paying particular attention to within- and across-cases analyses by race, class, and age. Detailed process notes, analytic memos, coding checks, and the use of visual analytic displays increase the study’s trustworthiness.

Findings: IPV negatively impacted women’s sexual health, with 86% of the sample reporting poor sexual health outcomes; it also resulted in long-lasting harm to women’s body image and self-esteem. Younger women focused on the idea that trauma ages a person in terms of lasting physical conditions and negative mental health impacts, while older women described how biological concerns changed as they aged. In regards to their gendered social selves, women said that their voices were silenced, their sexual needs were not met, and they prioritized their partners’ needs over their own. Most participants, but especially older women, stated that they were more naïve, voiceless, and willing to sacrifice their own needs earlier in life. In regards to gendered social expectations, women described cultural and religious-based gender norms about sexuality, passed down from their families of origin, that increased their sexual risk; however, families, and especially grandchildren, also provided a reason to live and care for oneself. There was an intersection between race and class, as women of color were more likely to be using shelter services at the time of the interview (OR = 8.33; X²(1) = 5.88, p = .02). Homelessness, lack of resources—primarily health insurance—and lost economic opportunities (related to aging as women and, in one case, to immigration status), reduced women’s access to sexual healthcare and created obstacles for leaving relationships. Survivors with more privilege, as evidenced by the combination of financial independence, being White, and having more education, more commonly described long-term relationships with sexual health care providers.  For participants with limited financial resources, having access to free clinics was essential to maintaining their sexual health and crucial to having control over their sexual health.

Conclusions and Implications: IPV experiences impact women’s sexual health with differences by race, class, and age. An intersectional lens that focuses on interlocking, overlapping oppressions and how women overcome them gives a more nuanced understanding as to how social workers can support IPV survivors develop plans for their sexual health and safety.