Many American women are physically forced or coerced into having sex for the first time, and a new study suggests these women have a higher risk for developing sexual and general health problems.

Researchers surveyed 13,310 women, ages 18 to 44, between 2011 and 2017 and found 6.5% of them were forced to have sex during their first experience with intercourse. Nationwide, that translates into 3.35 million women who were assaulted or coerced to become sexually active during the study period.

The average age at which women became sexually active when they were forced was 15.6 years, compared with 17.4 years for women who reported a voluntary first sexual experience.

And women’s first sexual encounters were with much older men when they were forced: 27 years old on average compared with 21 years with voluntary sexual initiation.

“We’re talking about girls here,” said Dr. Laura Hawks, lead author of the study and a researcher at Cambridge Health Alliance and Harvard Medical School in Boston.

“We need a dramatic cultural shift to make sure young girls of all races are safe in their homes and schools, that we have an environment where they can seek help when it’s needed, and that we have resources readily available to provide treatment when violence occurs,” Hawks said by email. “Movements like #MeToo have started the conversation, but in my opinion have a lot of work to do to get to a place where girls and women are safe from sexual violence.”

Compared with women who voluntarily had sex during their first experience, women who were forced were almost twice as likely to have an unwanted pregnancy at some point and 50% more likely to have an abortion.

When they were coerced, women were also 60% more likely to have endometriosis, a painful condition in which tissue that’s supposed to grow inside the uterus grows outside instead.

Women who were forced were also more than twice as like to develop another painful condition, pelvic inflammatory disease, which happens when bacteria spread during sex travel from the vagina to the uterus, fallopian tubes, or ovaries.

Coerced women were also 80% more likely to have menstrual problems, the study found.

Non-gynecologic problems were also more common.

When women were forced during their first sexual experience, they were more than 3 times more likely to use illegal drugs, twice as likely to have fair or poor health, and more than twice as likely to report difficulty completing tasks because of physical or mental health conditions.

It’s possible that women might have experienced some of these negative health outcomes even before they had sex for the first time, the study team notes. But the young age when girls were forced to have sex makes it likely that many of the problems developed afterward, researchers point out in JAMA Internal Medicine, online September 16.

“Obviously a forced sexual experience can result in physical trauma to the genital areas of the body, transmission of a HIV or another sexually transmitted disease, or an unwanted pregnancy,” said Dr. Alison Huang, author of an editorial accompanying the study and a professor of medicine at the University of California San Francisco.

“But for many women, it’s likely that the most severe or enduring consequences of this event are not directly related to one of any of the above,” Huang said by email. “Instead, they may arise from the emotional trauma that women experience from being forced or coerced into sex at an early and vulnerable time in their lives.”

SOURCE: bit.ly/2Ak84Ev

JAMA Intern Med 2019.