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What is Intimate Partner Violence (IPV)?
Intimate partner violence (IPV), is a pattern of manipulative or coercive behavior and control tactics used to emotionally, verbally, physically, sexually and/or economically abuse a current or former intimate partner or blood relation. This abuse is perpetrated in order to establish and maintain control over the victim. The onset may be gradual as abusers progressively isolate, intimidate, stalk, deprive and threaten to maintain power and control over their victims.
This type of violence can occur among heterosexual or same-sex couples and does not require sexual intimacy. Intimate partner violence is a major public-health problem resulting in injury, homelessness, or death of victims, as well as billions of dollars in health-care costs, and lost work productivity.
The statistics about those who are affected by intimate partner violence are staggering. In 2017, The Centers for Disease Control estimated that IPV affects four to six million relationships each year in the United States. Over 1 in 3 women, 42.5 million, will experience physical violence, rape, and/or stalking by an intimate partner in her lifetime. IPV is more prevalent among women than diabetes, breast cancer, and cervical cancer. Despite the myth that violence against men does not occur it is estimated that; 800,000 men are victims of IPV.
In 2015, the Williams Institute estimated that about 25% of LGBTQ individuals are victims of intimate partner abuse. It is estimated that 50,000 to 100,000 women are battered by a same-sex partner each year in the U.S. However, they are offered fewer protections and services than heterosexual women who are battered. Seven states exclude same-sex violence from their definitions of domestic violence, which can prevent lesbian victims from getting help. Battered women’s shelters, if uneducated about lesbians’ and bisexual women’s lives, may also discriminate. Intimate partner violence strikes couples of all races, religions, social economic status, and sexual orientations. Risk factors for men or women becoming victims or abusers include poverty, lack of a high school education, witnessing family violence as a child, and attitudes of male domination and substance abuse, especially alcohol abuse
The impact on the healthcare system that results from intimate partner violence is great. For this reason healthcare providers are uniquely positioned and can play an important role in addressing the issue of IPV. IPV impacts all primary care, emergency, and surgical specialties. It presents as a wide variety of acute physical injuries; obstetrical, gynecological, and mental health conditions as well as frequent stress-related somatic complaints due to ongoing or past violence. Gynecological problems are the largest physical health difference between battered and non-battered women. Battered women’s odds for developing gynecological problems are three times that of non-battered women. These are related to forced sex and include: urinary tract infections, pelvic inflammatory disease, and sexually transmitted diseases, including AIDS.
Nurses, doctors and other healthcare professionals can address IPV by identifying victims, offering support and referring patients to community agencies. Early identification and intervention can prevent serious injuries and chronic illnesses. Screening provides the opportunity for disclosure in a safe and confidential environment and provides victims with knowledge of options available to them. Screening affirms that domestic violence is an important health care issue.
IPV and Health
IPV has been associated with multiple negative physical and mental health conditions and health risk behaviors among women of all backgrounds. The psychological impact of IPV on ethnic minority women includes higher rates of depression, posttraumatic stress disorder (PTSD), low self-esteem, and suicide as compared to their counterparts who have not experienced IPV. In addition to the known adverse physical and mental health consequences, IPV can affect sexual and reproductive health outcomes. In particular, forced sex by an intimate partner can result in acute and chronic problems including vaginal and anal tearing, sexual dysfunction and pelvic pain, dysmenorrhea, pelvic inflammatory disease, cervical neoplasia, and sexually transmitted infections, including human immunodeficiency virus (HIV).
IPV and Sexual Desire
IPVs impact on sexual desire is both mental and physical. Sexual desire is all encompassing and the way a woman feels about herself on the inside as well as the outside impact sexual function, because self and sexuality are linked often synonymously for women. Abusive partners often use sexuality and gender to impair a woman’s self-worth and self-confidence and often that will also have an impact on sexual desire and functioning. When looking at studies that analyze IPV and sexual desire, sexual dysfunction was higher when a woman was raped rather than in sexual harassment and verbal harassment. Thus, the more the severity of violence increased, the more the decrease of the sexual function. There is also significant dyspareunia as the degree of violence increased especially rape. This concern felt by patients can seriously affect their psychological well-being. In addition, this abuse may decrease the sexual desire of their partners, with more disturbed sexual relations.
On average women with a history of sexual abuse do not experience worse sexual function; rather, they may experience more distress regarding sexual activity and that may cause sexually related distress and desire even in the context of ‘‘normal’’ sexual functioning. While sexual desire has been shown to be contingent on a number of factors besides sexual functioning, those who experience IPV may be more relevant for women with a history of sexual abuse. For example, studies show women with a history of rape report worse social functioning than women without this history especially in intimate relationships. Given their comparative lack of social support, factors like intimacy and trust may take on additional meaning for women with a history of sexual abuse, making these factors more important in determining how they affect sexual functioning.
There is also a large body of research suggesting that women with sexual abuse histories are more likely to filter sexual experiences through negative self image and are much more likely to experience negative feelings such as guilt, regret, and disgust during sexual arousal. These negative feelings are thought to stem from the shame and violation of trust that is often tied to early abuse experiences. The resulting negative reaction to sexual activity and one’s own sexual response makes it more difficult for these women to view themselves as sexual beings and eliminate the positive effects of good sexual functioning.
A trauma-informed health care provider can help you through your history of trauma and sexual dysfunction and help you to develop an individualized treatment plan. The goal of the patient and provider relationship should be personalized, and survivor-centered around care and planning in relation to IPV and the effects of sexual dysfunction post IPV. Look for a provider who will hold your hand through the process of safety planning, prioritizing safety and self-care, and reducing the risk of further violence. Remember that you are not alone, and you are not to blame for being in a situation around IPV.
Do you need help finding resources as well as a provider who is trauma informed and can help you manage your IPV and sexual dysfunction?
- The International Pelvic Pain Society
- The International Society for the Study of Women’s Sexual Health
Dr. Heather Quaile is a Womens’s Health nurse practitioner, sexual assault nurse examiner, and sexuality counselor. She is the CEO and founder for The SHOW (sexual health optimization and wellness) Center as well as clinical director for a human trafficking organization in Georgia. www.theshowcenter.com