sex violence essay

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4.4 Violence against Women: Rape and Sexual Assault

Learning objectives.

• Describe the extent of rape and sexual assault.
• Explain why rape and sexual assault occur.

Susan Griffin (1971, p. 26) began a classic essay on rape in 1971 with this startling statement: “I have never been free of the fear of rape. From a very early age I, like most women, have thought of rape as a part of my natural environment—something to be feared and prayed against like fire or lightning. I never asked why men raped; I simply thought it one of the many mysteries of human nature.”

When we consider interpersonal violence of all kinds—homicide, assault, robbery, and rape and sexual assault—men are more likely than women to be victims of violence. While true, this fact obscures another fact: Women are far more likely than men to be raped and sexually assaulted. They are also much more likely to be portrayed as victims of pornographic violence on the Internet and in videos, magazines, and other outlets. Finally, women are more likely than men to be victims of domestic violence , or violence between spouses and others with intimate relationships. The gendered nature of these acts against women distinguishes them from the violence men suffer. Violence is directed against men not because they are men per se, but because of anger, jealousy, and the sociological reasons discussed in Chapter 8 “Crime and Criminal Justice” ’s treatment of deviance and crime. But rape and sexual assault, domestic violence, and pornographic violence are directed against women precisely because they are women. These acts are thus an extreme manifestation of the gender inequality women face in other areas of life. We discuss rape and sexual assault here but will leave domestic violence for Chapter 10 “The Changing Family” and pornography for Chapter 9 “Sexual Behavior” .

The Extent and Context of Rape and Sexual Assault

Our knowledge about the extent and context of rape and reasons for it comes from three sources: the FBI Uniform Crime Reports (UCR) and the National Crime Victimization Survey (NCVS), both discussed in Chapter 8 “Crime and Criminal Justice” , and surveys of and interviews with women and men conducted by academic researchers. From these sources we have a fairly good if not perfect idea of how much rape occurs, the context in which it occurs, and the reasons for it. What do we know?

Up to one-third of US women experience a rape or sexual assault, including attempts, at least once in their lives.

Wikimedia Commons – public domain.

According to the UCR, which are compiled by the Federal Bureau of Investigation (FBI) from police reports, 88,767 reported rapes (including attempts, and defined as forced sexual intercourse) occurred in the United States in 2010 (Federal Bureau of Investigation, 2011). Because women often do not tell police they were raped, the NCVS, which involves survey interviews of thousands of people nationwide, probably yields a better estimate of rape; the NCVS also measures sexual assaults in addition to rape, while the UCR measures only rape. According to the NCVS, 188,380 rapes and sexual assaults occurred in 2010 (Truman, 2011). Other research indicates that up to one-third of US women will experience a rape or sexual assault, including attempts, at least once in their lives (Barkan, 2012). A study of a random sample of 420 Toronto women involving intensive interviews yielded an even higher figure: Two-thirds said they had experienced at least one rape or sexual assault, including attempts. The researchers, Melanie Randall and Lori Haskell (1995, p. 22), concluded that “it is more common than not for a woman to have an experience of sexual assault during their lifetime.”

Studies of college students also find a high amount of rape and sexual assault. About 20–30 percent of women students in anonymous surveys report being raped or sexually assaulted (including attempts), usually by a male student they knew beforehand (Fisher, Cullen, & Turner, 2000; Gross, Winslett, Roberts, & Gohm, 2006). Thus at a campus of 10,000 students of whom 5,000 are women, about 1,000–1,500 women will be raped or sexually assaulted over a period of four years, or about 10 per week in a four-year academic calendar. The Note 4.33 “People Making a Difference” box describes what one group of college students did to help reduce rape and sexual assault at their campus.

People Making a Difference

College Students Protest against Sexual Violence

Dickinson College is a small liberal-arts campus in the small town of Carlisle, Pennsylvania. But in the fight against sexual violence, it loomed huge in March 2011, when up to 150 students conducted a nonviolent occupation of the college’s administrative building for three days to protest rape and sexual assault on their campus. While they read, ate, and slept inside the building, more than 250 other students held rallies outside, with the total number of protesters easily exceeding one-tenth of Dickinson’s student enrollment. The protesters held signs that said “Stop the silence, our safety is more important than your reputation” and “I value my body, you should value my rights.” One student told a reporter, “This is a pervasive problem. Almost every student will tell you they know somebody who’s experienced sexual violence or have experienced it themselves.”

Feeling that college officials had not done enough to help protect Dickinson’s women students, the students occupying the administrative building called on the college to set up an improved emergency system for reporting sexual assaults, to revamp its judicial system’s treatment of sexual assault cases, to create a sexual violence prevention program, and to develop a new sexual misconduct policy.

Rather than having police or security guards take the students from the administrative building and even arrest them, Dickinson officials negotiated with the students and finally agreed to their demands. Upon hearing this good news, the occupying students left the building on a Saturday morning, suffering from a lack of sleep and showers but cheered that they had won their demands. A college public relations official applauded the protesters, saying they “have indelibly left their mark on the college. We’re all very proud of them.” On this small campus in a small town in Pennsylvania, a few hundred college students had made a difference.

Sources: Jerving, 2011; Pitz, 2011

The public image of rape is of the proverbial stranger attacking a woman in an alleyway. While such rapes do occur, most rapes actually happen between people who know each other. A wide body of research finds that 60–80 percent of all rapes and sexual assaults are committed by someone the woman knows, including husbands, ex-husbands, boyfriends, and ex-boyfriends, and only 20–35 percent by strangers (Barkan, 2012). A woman is thus two to four times more likely to be raped by someone she knows than by a stranger.

In 2011, sexual assaults of hotel housekeepers made major headlines after the head of the International Monetary Fund was arrested for allegedly sexually assaulting a hotel housekeeper in New York City; the charges were later dropped because the prosecution worried about the housekeeper’s credibility despite forensic evidence supporting her claim. Still, in the wake of the arrest, news stories reported that hotel housekeepers sometimes encounter male guests who commit sexual assault, make explicit comments, or expose themselves. A hotel security expert said in one news story, “These problems happen with some regularity. They’re not rare, but they’re not common either.” A housekeeper recalled in the same story an incident when she was vacuuming when a male guest appeared: “[He] reached to try to kiss me behind my ear. I dropped my vacuum, and then he grabbed my body at the waist, and he was holding me close. It was very scary.” She ran out of the room when the guest let her leave but did not call the police. A hotel workers union official said housekeepers often refused to report sexual assault and other incidents to the police because they were afraid they would not be believed or that they would get fired if they did so (Greenhouse, 2011, p. B1).

Explaining Rape and Sexual Assault

Sociological explanations of rape fall into cultural and structural categories similar to those presented earlier for sexual harassment. Various “rape myths” in our culture support the absurd notion that women somehow enjoy being raped, want to be raped, or are “asking for it” (Franiuk, Seefelt, & Vandello, 2008). One of the most famous scenes in movie history occurs in the classic film Gone with the Wind , when Rhett Butler carries a struggling Scarlett O’Hara up the stairs. She is struggling because she does not want to have sex with him. The next scene shows Scarlett waking up the next morning with a satisfied, loving look on her face. The not-so-subtle message is that she enjoyed being raped (or, to be more charitable to the film, was just playing hard to get).

A related cultural belief is that women somehow ask or deserve to be raped by the way they dress or behave. If she dresses attractively or walks into a bar by herself, she wants to have sex, and if a rape occurs, well, then, what did she expect? In the award-winning film The Accused , based on a true story, actress Jodie Foster plays a woman who was raped by several men on top of a pool table in a bar. The film recounts how members of the public questioned why she was in the bar by herself if she did not want to have sex and blamed her for being raped.

A third cultural belief is that a man who is sexually active with a lot of women is a stud and thus someone admired by his male peers. Although this belief is less common in this day of AIDS and other STDs, it is still with us. A man with multiple sex partners continues to be the source of envy among many of his peers. At a minimum, men are still the ones who have to “make the first move” and then continue making more moves. There is a thin line between being sexually assertive and sexually aggressive (Kassing, Beesley, & Frey, 2005).

These three cultural beliefs—that women enjoy being forced to have sex, that they ask or deserve to be raped, and that men should be sexually assertive or even aggressive—combine to produce a cultural recipe for rape. Although most men do not rape, the cultural beliefs and myths just described help account for the rapes that do occur. Recognizing this, the contemporary women’s movement began attacking these myths back in the 1970s, and the public is much more conscious of the true nature of rape than a generation ago. That said, much of the public still accepts these cultural beliefs and myths, and prosecutors continue to find it difficult to win jury convictions in rape trials unless the woman who was raped had suffered visible injuries, had not known the man who raped her, and/or was not dressed attractively (Levine, 2006).

Structural explanations for rape emphasize the power differences between women and men similar to those outlined earlier for sexual harassment. In societies that are male dominated, rape and other violence against women is a likely outcome, as they allow men to demonstrate and maintain their power over women. Supporting this view, studies of preindustrial societies and of the fifty states of the United States find that rape is more common in societies where women have less economic and political power (Baron & Straus, 1989; Sanday, 1981). Poverty is also a predictor of rape; although rape in the United States transcends social class boundaries, it does seem more common among poorer segments of the population than among wealthier segments, as is true for other types of violence (Truman & Rand, 2010). Scholars think the higher rape rates among the poor stem from poor men trying to prove their “masculinity” by taking out their economic frustration on women (Martin, Vieraitis, & Britto, 2006).

Key Takeaways

• Up to one-third of US women experience a rape or sexual assault, including attempts, in their lifetime.
• Rape and sexual assault result from a combination of structural and cultural factors. In states and nations where women are more unequal, rape rates tend to be higher.

For Your Review

• What evidence and reasoning indicate that rape and sexual assault are not just the result of psychological problems affecting the men who engage in these crimes?
• Write a brief essay in which you critically evaluate the cultural beliefs that contribute to rape and sexual assault.

Barkan, S. E. (2012). Criminology: A sociological understanding (5th ed.). Upper Saddle River, NJ: Prentice Hall.

Baron, L., & Straus, M. A. (1989). Four theories of rape in American society: A state-level analysis . New Haven, CT: Yale University Press.

Federal Bureau of Investigation. (2011). Crime in the United States, 2010 . Washington, DC: Author.

Fisher, B. S., Cullen, F. T., & Turner, M. G. (2000). The sexual victimization of college women . Washington, DC: National Institute of Justice.

Franiuk, R., Seefelt, J., & Vandello, J. (2008). Prevalence of rape myths in headlines and their effects on attitudes toward rape. Sex Roles, 58 (11/12), 790–801.

Greenhouse, S. (2011, May 21). Sexual affronts a known hotel hazard. New York Times , p. B1.

Griffin, S. (1971, September). Rape: The all-American crime. Ramparts, 10 , 26–35.

Gross, A. M., Winslett, A., Roberts, M., & Gohm, C. L. (2006). An examination of sexual violence against college women. Violence Against Women, 12 , 288–300.

Jerving, S. (2011, March 4). Pennsylvania students protest against sexual violence and administrators respond. The Nation . Retrieved from http://www.thenation.com/blog/159037/pennsylvania-students-protests-against-sexual-violence-and-administrators-respond .

Kassing, L. R., Beesley, D., & Frey, L. L. (2005). Gender role conflict, homophobia, age, and education as predictors of male rape myth acceptance. Journal of Mental Health Counseling, 27 (4), 311–328.

Levine, K. L. (2006). The intimacy discount: Prosecutorial discretion, privacy, and equality in the statuory rape caseload. Emory Law Journal, 55 (4), 691–749.

Martin, K., Vieraitis, L. M., & Britto, S. (2006). Gender equality and women’s absolute status: A test of the feminist models of rape. Violence Against Women, 12 , 321–339.

Pitz, M. (2011, March 6). Dickinson College to change sexual assault policy after sit-in. Pittsburgh Post-Gazette . Retrieved from http://www.post-gazette.com/pg/11065/1130102-1130454.stm .

Randall, M., & Haskell, L. (1995). Sexual violence in women’s lives: Findings from the women’s safety project, a community-based survey. Violence Against Women, 1 , 6–31.

Sanday, P. R. (1981). The Socio-Cultural Context of Rape: A Cross-Cultural Study. Journal of Social Issues, 37 , 5–27.

Truman, J. L., & Rand, M. R. (2010). Criminal victimization, 2009 . Washington, DC: Bureau of Justice Statistics.

Social Problems Copyright © 2015 by University of Minnesota is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

AGNI is publishing this essay as part of The Ferrante Project.

“What would happen,” the poet Muriel Rukeyser asks in her oft-quoted poem “Käthe Kollwitz,” “if one woman told the truth about / her life? / The world would split open.” Over the past few years, I’ve begun to question the truth of that statement, especially as it relates to telling the truth about sexual violence. What is the purpose and function of writing about rape? More to the point, what to me is the purpose and function of writing when writing about my rape?

These questions grew more painful to consider after I published my first book, which examined the long-term effects of violence and survival, and more painful still when I learned this book had ended up on the reading lists of various feminist tastemakers on Twitter, one of whom noted that she was using the book as a writing prompt for her students’ exploration of violence. Thus my personal experience was to become a jumping-off point for others’ creativity, my descriptions of my assault disseminated and refracted through the exercises of strangers so they could understand the effects of such violence themselves. My assault would thus become both symbol and trope, something that could be parsed and imitated until all the rage and humanness drained out of it.  I had always known, of course, that this one of the possible outcomes of publishing such a book, especially one that ended up in the maw of social media. But actually reading this student’s response to my essay, in which my assault was reimagined and repeated back to me in her language, made me feel both sickened and small.

Speak truth to power, writers and non-writers alike declaim, and now I’ve seen this phrase trickle through the feeds of people on Facebook and Twitter. The aim is to tell the truth of our lives as we see it, as directly and with as little remorse as possible. Such an outpouring of personal testimony has indeed cracked open the world, in part by reminding participants in social media that the things most American institutions want to forget about our nation—its violence against people of color, its killing of LGBTQ people, its seemingly implacable hatred of women and their bodies—stubbornly persist. There is indeed a power and value to truth-telling. But truth-telling relies on narrative, and narrative telling—even supposedly artless, immediate telling—is in fact crafted. It wants a particular response, and nothing crafts language so effectively as a Web format that requires you to express yourself in 280 characters or less, and sells these truth-telling nuggets in a stream of visual media, making it impossible for the audience to focus on any but the most extreme, compelling, and direct language.

Social media and truth-telling both encourage the reader, primarily, to emote. And having emoted, having felt all the things and thought all the thoughts the writer has asked us to think and feel within that limited format, we can walk away from the engagement satisfied with the blunt, brute fact of our feelings. Social media offers a veneer of authenticity that claims the authority of survivorship and thus makes autobiography and resilience satisfactory political goals.

A memoir about sexual assault guarantees a certain amount of attention, because it is sensational and because writing about violence encourages a kind of voyeurism. But while this may be one possible response, it is not this writer’s desire to make the reader participate in the imagined reconstruction of violence. And reconstructing another person’s trauma is not what we teach other budding writers about the purpose of testimonies of violence, in particular the testimonies of violence that women might produce. If anything, we argue, women’s testimonies should inspire not empathy (or not only empathy) but political outrage, in large part because women’s autobiographical writing has been so effectively suppressed over centuries. Women’s writing about violence serves as a public novelty, one which, if it does not always receive the social stamp of high art, at least promises an authentic expression of rage, of grief, of endurance and survival, and—most powerfully—of hope.

But I’m not actually that interested in resilience. I want jail time for offenders. I want politicians tossed out of office, priests defrocked, federal judges fired and replaced. I want a country that doesn’t treat violence against women as sexual entertainment.

Over the past year, I’ve begun to hate the book I published. The more I read from and talk about it, the more politically and aesthetically suspicious my own writing appears to me. Who had I written it for? Who did I really imagine as its audience? The project started, in part, as a reaction to the 2009 Lilly Ledbetter Fair Pay Act, which got me thinking about the ways in which sex discrimination has shaped my working life, which got me thinking about the sexual assault I experienced as a twenty-year-old woman at a coat factory where I worked one summer as a down stuffer along with several itinerant workers, one of whom attacked me. The book was finally published around the time that our current president, then a presidential candidate, admitted to grabbing women “by the pussy,” which made the #MeToo hashtag started by Tarana Burke in 2006 erupt into a firestorm. Into this storm my book was tossed, and while I was happy at first to add my voice to the movement, over time I began to feel that the book sounded less like me than an automated reply. Using the same language that has characterized the experience of so many other women certainly brings me into community with them, but that shared language also makes the stories of survivors feel depressingly interchangeable and flat.

Perhaps this flattening is created in part by our social expectations about female psychology and women’s writing, in particular our assumption that women’s writing is primarily or only autobiographical, not imaginative, and that it stems from an institutionally disadvantaged position that we equate with pain. This, too, enrages me. It feels as though, because I am female, I was born into this language and psychology; as a woman and a writer, I am a grievance waiting to be heard and endured. At times it feels that the best I can do is pay close attention to that grievance, to give it a slightly different shape and coloration. By writing about my assault, I confirm the most inarguably authentic position of the not-male, and also the not-white: the pained, the wounded, the helpless, the small .

To speak about one’s assault in a way that feels actually authentic is to thread the needle through an incredibly slender eye, made ever more narrow: by the pressure of therapeutic services, which argue that such narratives are not only good, but necessary for psychic healing; political and social institutions, where truth-telling makes for good rallying cries and possible legislation; and by social media, which argues for ever more devastating expressions of the self to be streamed and consumed and disseminated.

Effective writing about violence shares many of the aesthetic traits of political language, which is to say its directness resists excessive or subtle interpretation. It compresses time and context in order to focus on the moment at hand. Writing about violence authenticates itself through the performance of immediacy and vivid feeling. This is what suggests truth—and it is surprisingly, distressingly easy to duplicate.

The social media performances of grief, selfhood, and outrage I daily read feel suspiciously like masquerades. In my feeds, writers try to outshine and outthink the politicians and abusers inspiring our outrage, using language whose nuance rarely rises above theirs. In this way, we are shackled to victimizing doubles. As much as I despise the self-help books, the prayer circles, the thin whine of grief on Twitter and its overuse of the word trauma , the only identity that seems unable to be challenged or shamed is that of the victim. Thus I and others willingly write into and about how we have been diminished or shamed, to stop ourselves from being attacked by those claiming to be more morally progressive online, because the only way to keep yourself safe within that group, it seems, is to become the witting accomplice to your own self-objectification.

Refracting and repeating narratives of violence also risk downplaying or even ignoring matters of race and class in favor of the sensational act itself, even as race and class make violence a more or less likely experience for a person to have. It is not lost on me, for example, that I come from a middle-class family and was attacked by someone skirting the poverty line, that what brought us together was a coat factory that relied on both our labor to exist: me, the mixed-race college student earning money for her next year’s tuition; my attacker, a white man who moved from job to job, city to city, aimless and resentful of the opportunities I would have in a world he imagined pandered to minorities. It is not lost on my either that the stories we repeat most often online are those told by and about middle and upper middle class white women. Our retweeting and sharing of these stories replicates the culture’s co-opting of Tarana Burke’s #MeToo hashtag into the world of (largely) white and (largely) middle-class feminism.

The young student, consciously or unconsciously, performed this co-option when she imitated my writing. She understood that some part of writing about and against violence, especially the violence that women experience, is imitative and coercive. One does not have to be a victim of violence to render that violence believably or powerfully. The actual experience of an assault may be private, it may reveal the world to be artless and cruel, but the sharing of it depends entirely on creative skills, detailed images, and ideas of identities that can be appropriated.

 Even as I write this, it strikes me that perhaps I’m wrong to think we’ve become numb to, or jaded about, female narratives of pain. I think back to that look on Arizona senator Jeff Flake’s face in the elevator as he fled the Kavanaugh hearings, the moment when a protester pried apart the elevator doors to demand he hear about the assault she’d survived. I see again the pain twist across his face. Perhaps the reason the #MeToo movement hasn’t achieved more substantial victories for women is not that its language has started to feel formulaic, but that it really is too painful for people to witness. It’s too painful because it asks those who have not suffered to imagine the limits of their physical invulnerability—to realize, if only empathetically, that their sense of self-protection is a fantasy. We turn away from the language of violence not because it has become anodyne, but because we see how easily each of us can be made a victim.

“Perhaps writers like us really can change the world,” one young woman wrote to me recently in a private Twitter message. “Your book inspired me to tell my own story. You can check out my feed.” I thumbed down the screen to read it, the words of this stranger who, like me, was humiliated and hurt, raw and furious, her own terrible story wedged now between video grabs from a Trump rally and a trailer for John Wick 3 . I stopped reading and her story flickered past. I wrote privately to thank her, added a few glib notes of praise, and told her I hoped she’d continue writing. Then I deleted her message.

The Ferrante Project: The freedom of anonymity brings together sixteen women writers of color (alongside sixteen visual artists in a linked project with the Warhol Museum) who anonymously contributed new works in response to, or critique of, the cult of personality, posturing, and preemptive celebrity of writers at the expense—sometimes—of the quality and provocation of the work itself. This is a collaboration between Aster(ix) and CAAPP: Center of African American Poetry and Poetics.

Contributors include Angie Cruz, Sarah Gambito, Dawn Lundy Martin, Khadijah Queen, Ru Freeman, Ayana Mathis, Vi khi nao, Cristina García  Cathy Linh Che, Aimee Nezhukumatathil, Deborah Paredez, Emily Raboteau, Paisley Rekdal, Natalie Díaz, Lyrae Van Clief-Stefanon, and Jamey Hatley.

This page collects the works of anonymous writers published by  AGNI.

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Yes, It Is 'That Bad': Why Victims' Stories Matter

• Amy Carleton

In the wake of the stories of powerful men perpetuating sexual violence on women, many have wondered how we can create a climate where this behavior has no place.

At times, the accounts of behavior from men like  Harvey Weinstein ,  Matt Lauer  and others have seemed almost indistinguishable when repeated over news wires and radio broadcasts. Though the victims themselves are distinct individuals who all have their own stories to tell, the  patterns  of male behavior — ranging from inappropriate innuendo to criminal violence — are very much the same. And given the rapid pace of media sound bytes and our own societal amnesia comes the risk that we may fail to realize the full impact of rape culture’s deleterious effects on our society. But we mustn’t.

Fortunately, the 29 essays contained in Roxane Gay’s new edited collection, " Not That Bad: Dispatches from Rape Culture ," ensure that we will not. The anthology offers essays from a wide range of voices; all but two are female. There are recollections of painful trauma as well as sharp observations of a world that often takes advantage of women’s’ vulnerability — even as it both rewards and punishes them for the same. This is not an easy read, but it is an important one.

In her introduction to the book, Gay opens with the story of her own horrific rape at the age of 12. Further, she notes the impulse of sexual assault victims to cast their experience as “not that bad” — partially as a coping mechanism that compartmentalizes the trauma, but also from the internalization of society’s message that victims are instead “survivors” who are “lucky to be alive” because “it could be worse.” Gay’s motivation, to first make space in the collection for people to tell their own stories in order “to share how bad this all is” is part of a larger idea — which is to grow a movement that has the potential to overwrite a culture that has long created, allowed, normalized and reinforced sexual violence and aggression.

Actress Ally Sheedy, who now teaches and mentors young actors in New York City validates the experiences of her adolescent students trying to break into an industry that sees them only as the sum of their body parts in an essay titled, “Stasis.” Through Sheedy’s own experiences (upon receiving her first big movie role, she was given a ThighMaster and told to squeeze it between her legs at least 100 times a day) and the title, itself translated from the Greek as “standing still” highlights the contiguous loop of sexism in a professional context where nothing has changed despite decades of “awareness.”

Some of the essays are matter-of-fact in their accounts, evidencing a controlled authorial restraint, though for the reader, they are heavy with sadness. xTx’s “The Ways We Are Taught to Be a Girl” shares vignettes, framed as a series of lessons, of a young girl’s stolen innocence from those in her life she should be able to trust but can’t: friends of siblings and parents, camp counsellors. The writer wonders why these violations always happen from friends or “friends of” rather than strangers, positing, “maybe because the door was already open, less work? Sitting ducks? Easy prey?” A chilling thought, but statistically accurate.

Other narratives, like Nora Salem’s “The Life Ruiner,” reveal a palimpsest of sexual transgression that follows a timeline from childhood to adulthood. Echoing Gay’s mission at the outset, Salem writes, “I’m writing this for the other girls, some of whom may be in my family…I’m writing this so it can be a part of the compendium of other sad and bad stories like these, because maybe the compendium will say something in totality that we cannot say alone.”

Before a society can change its direction, it needs to know where it is coming from. That’s why victims’ stories are an essential step on the journey. And the more they share their stories, whether from #metoo point of view or from one of advocacy, the overarching narrative will shift. There is strength in numbers, particularly when (much needed) disruption is afoot. As Leigh Gilmore writes in her 2017 book, " Tainted Witness: Why We Doubt What Women Say About Their Lives ," when the narrative “conforms to dominant cultural notions of legitimacy, the 'I' who narrates it will accrue authority.”

For women, that first part of Gilmore’s assessment has always been the challenge:  though one in six women in the U.S.  has been the victim of a sexual assault, though media continues to glamorize sexual violence , and though women around the world are  publicly shamed and threatened  for telling their truths, many still fear going public with their stories. Writer xTx observes, “We learn not to tell everything. We know telling everything will make them see the bad in us. How it is our fault.”

The essays contained in this volume bear testimony, but it is important to note that they are not police reports or news accounts, they are also art and should be appreciated for that as well as the truths they contain. Women have a long history of making art out of their pain, and these writers craft incisive narratives that typify poet W.B. Yeats’ notion of a “terrible beauty” — something that is at once ugly and beautiful.

While reading, I couldn’t help but think of The Odyssey’s Penelope, who, after the loss of her husband, finds her house occupied by men that are agitating for her hand in marriage — against her will. To keep the men at bay, every night she sits at her loom, weaving what she says will be a shroud for the hero Laertes. She says that she will choose a suitor once she is finished, though this is not what she wants. She mourns the loss of her husband Odysseus. Every night, she unravels her work — to protect herself, and to prevent what increasingly seems to be inevitable. Once her strategy is discovered by the suitors, she is forced to finish the work she has started. But Penelope is not forced to suffer, not this time. With perfect synchronicity, Odysseus returns home and order is restored.

Like Penelope, for years victims have been telling and then recanting their words in acts of self-preservation. Now that the moment has arrived where they  must  tell their stories, the timing is right. People are listening and talking back — in affirmation and validation. "Not That Bad," then, now in its fourth printing since its May release, has the potential to tip the balance in favor of those previously underrepresented and undervalued public voices. It is through this exposure that women’s own stories can — and should — become the dominant accounts of their own lived experiences.

• Julie Wittes Schlack: The Pain Of A Large Woman In A Small-Minded World
• Also by Amy Carleton: What's In A Name? The Freighted Title 'Mrs.'

Amy Carleton Cognoscenti contributor Amy Carleton holds a Ph.D. in English Literature and is a lecturer in MIT's Comparative Media Studies division.

More from WBUR

About Sexual Assault

Sexual violence happens in every community and affects people of all genders and ages. Sexual violence is any type of unwanted sexual contact. This includes words and actions of a sexual nature against a person’s will and without their consent. A person may use force, threats, manipulation, or coercion to commit sexual violence.

Forms of sexual violence include:

• Rape or sexual assault
• Child sexual assault and incest
• Sexual assault by a person’s spouse or partner
• Unwanted sexual contact/touching
• Sexual harassment
• Sexual exploitation and trafficking
• Exposing one’s genitals or naked body to other(s) without consent
• Masturbating in public
• Watching someone engage in private acts without their knowledge or permission
• Nonconsensual image sharing

There is a social context that surrounds sexual violence. Social norms that condone violence, use power over others, traditional constructs of masculinity, the subjugation of women, and silence about violence and abuse contribute to the occurrence of sexual violence. Oppression in all of its forms is among the root causes of sexual violence. Sexual violence is preventable through collaborations of community members at multiple levels of society—in our homes, neighborhoods, schools, faith settings, workplaces, and other settings. We all play a role in preventing sexual violence and establishing norms of respect, safety, equality, and helping others.

What is consent?

Consent must be freely given and informed, and a person can change their mind at any time.

Consent is more than a yes or no. It is a dialogue about desires, needs, and level of comfort with different sexual interactions.

Who does sexual violence impact?

Victims of sexual violence include people of all ages, races, genders, and religions — with and without disabilities.

• Nearly one in five women in the United States have experienced rape or attempted rape some time in their lives (Black et al., 2011).
• In the United States, one in 71 men have experienced rape or attempted rape (Black et al., 2011).
• An estimated 32.3% of multiracial women, 27.5% of American Indian/Alaska Native women, 21.2% of non-Hispanic black women, 20.5% of non-Hispanic white women, and 13.6% of Hispanic women were raped during their lifetimes (Black et al., 2011).

Victims often know the person who sexually assaulted them.

People who sexually abuse usually target someone they know.           

• Nearly three out of four adolescents (74%) who have been sexually assaulted were victimized by someone they knew well (Kilpatrick, Saunders, & Smith, 2003).
• One-fifth (21.1%) were committed by a family member (Kilpatrick, Saunders, & Smith, 2003).

Victims are never at fault.

Choosing to violate another person is not about “drinking too much,”  “trying to have a good time,” or ”getting carried away,” nor is it about the clothes someone was wearing, how they were acting, or what type of relationship they have with the person who abused them. Violating another person is a choice.

Rape is often not reported or convicted.

A person may choose not to report to law enforcement or tell anyone about a victimization they experienced for many reasons. Some of the most common include:

• a fear of not being believed
• being afraid of retaliation
• shame or fear of being blamed
• pressure from others
• distrust towards law enforcement
• a desire to protect the attacker for other reasons

The Impact of Sexual Violence

The impact of sexual violence extends beyond the individual survivor and reaches all of society.

Impact on survivors

An assault may impact a survivor’s daily life no matter when it happened. Each survivor reacts to sexual violence in their own way. Common emotional reactions include guilt, shame, fear, numbness, shock, and feelings of isolation.

Physical impacts may include personal injuries, concerns about pregnancy, or risk of contracting a sexually transmitted infection. Economic impacts of sexual violence include medical and other expenses in addition to things like time off work. The long-term psychological effects survivors may face if their trauma is left untreated include post-traumatic stress disorder, anxiety, depression, isolation, and others.

Impact on loved ones

Sexual violence can affect parents, friends, partners, children, spouses, and/or coworkers of the survivor. As they try to make sense of what happened, loved ones may experience similar reactions and feelings to those of the survivor such as fear, guilt, self-blame, and anger.

Impact on communities

Schools, workplaces, neighborhoods, campuses, and cultural or religious communities may feel fear, anger, or disbelief when sexual assault happens in their community. Violence of all kinds destroys a sense of safety and trust.  There are financial costs to communities including medical services, criminal justice expenses, crisis and mental health service fees, and the lost contributions of individuals affected by sexual violence.

Impact on society

The contributions and achievements that may never come as a result of sexual violence represent a cost to society that cannot be measured. Sexual violence weakens the basic pillars of safety and trust that people long to feel in their communities because it creates an environment of fear and oppression.

A recent study from the Centers for Disease Control and Prevention found that individual victims of sexual violence incur $122,461 over a lifetime in costs associated with lost wages, health, criminal justice, and property damage (Peterson et al., 2017). Additional research shows that sexual violence can derail a person’s education and employment, resulting in a $241,600 income loss over a lifetime (MacMillan, 2000).

Sexual assault and the related trauma response can disrupt survivors’ employment in several ways, including time off, diminished performance, job loss, and inability to work (Loya, 2014).

In 2015, the Equal Employment Opportunity Commission alone recovered $164.5 million for workers alleging harassment (Equal Employment Opportunity Commission, 2016). Indirect costs for employers include decreased productivity, higher turnover, and reputation damage.

Black, M. C., Basile, K. C., Breiding, M. J., Smith, S. G., Walters, M. L., Merrick, M. T., Chen, J., & Stevens, M. R. (2011). National Intimate Partner and Sexual Violence Survey: 2010 summary report . Retrieved from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention: http://www.cdc.gov/violenceprevention/pdf/nisvs_report2010-a.pdf

Equal Employment Opportunity Commission. (2016). Final Report of the EEOC Select Task Force on the Study of Harassment in the Workplace. Washington. D. C. Retrieved from: https://www.eeoc.gov/eeoc/task_force/harassment/index.cfm

Kilpatrick, D. G., Saunders, B. E., & Smith, D. W. (2003). Youth victimization: Prevalence and implications (NIJ Research Brief NCJ 194972). Retrieved from the National Criminal Justice Reference Service: https://www.ncjrs.gov/pdffiles1/nij/194972.pdf

Loya, R. M. (2014) Rape as an economic crime: The impact of sexual violence on survivor’s employment and economic well-being. Journal of Interpersonal Violence , 30 (16), 2793-2813. doi:10.1177/0886260514554291

MacMillan, R. (2000). Adolescent victimization and income deficits in adulthood: Rethinking the costs of criminal violence from a life-course perspective. Criminology, 38 (2), doi: 10.1111/j.1745-9125.2000.tb00899.x

Peterson, C., DeGue, S., Florence, C., & Lokey, C. N. (2017). Lifetime economic burden of rape among U.S. adults. American Journal of Preventive Medicine . doi:10.1016/j. amepre.2016.11.014

Sexual Violence. Explaining Serious Offences Essay

Serious sexual offences, definition and discussion, explanations for serious sexual offences, reference list.

Sexual violence continues to be an issue for modern society, affecting both developed and developing nations across the world. These actions are a variety of different crimes, including assault, rape, acts against sexual integrity and a variety of other actions that violate a person’s freedom and right to choose partners. Apart from the legal definitions of serious sexual offences, scholars have developed multiple theories that aim to explain this type of behaviour. This paper aims to define serious sexual offences from a sociological and legal perspective, present and discuss significant theories that explain these offences and outline the main issues associated with these crimes.

The definition and attitudes towards serious sexual offences vary from and incorporate the legal perspective of the matter and social approach to viewing these offences. This explains why in different countries different types of sexual crimes may be classified and prosecuted differently. From a legal perspective, the Sexual Offenses Act of 2003 regulates these crimes, their perception, and prosecution ( Sexual Offences Act 2003, 2003; Sexual offences, no date). Most importantly, this legal document outlines the types of abuses and discriminatory actions that can be considered a sexual offence, protecting the victims of these crimes. Firstly, any sexual contact without consent is considered a sexual offence.

However, in order to prosecute the criminals, the policymakers must have clear definitions of each type of crime. For example, rape is defined as a “penetration by penis” in the Sexual Offences Act ( Sexual Offences Act 2003, 2003). It should be noted, however, that crimes are both social and legal concepts, and the definition provided by the latter may not be the same as provided by academic or other approaches to serious sexual offences. While the legal prosecution of sexual offenders is crucial, Simons (no date) highlights the fact that to make society safer, it crucial to understand the underlying causes of serious sexual offences.

It is evident that not all sexual offences are reported to the police. Moreover, not all victims are able to report them in surveys because of personal feelings or fear, which may make it challenging to examine and evaluate the variety of crimes and the underlying causes. In general, these offences occur in different countries and for different reasons. Moreover, the Sexual Offences Act outlines a variety of possible sexual offences that can occur, ranging from voyeurism to lack of consensual sex ( Sexual Offences Act 2003, 2003). Several national and international organizations developed their definitions of sexual offences. For example, the American Psychological Association, (no date, para. 1) defines it as “unwanted sexual activity, with perpetrators using force, making threats or taking advantage of victims not able to give consent.” This approach highlights the central aspect of such offences – use of force or other methods. The Crown Prosecution Service (no date) incorporates any non-consensual activities, including those that target children or aim to exploit individuals as serious sexual offences. The following section will review significant theories that aim to explain why these crimes occur.

Over the years, several theories that aim to explain the reasoning for serious sexual offences emerged. Some of them emphasize human nature or physiological issues. Others focus on society and more complex factors leading to rape. The typology introduced by Groth (1979) in the author’s book “Men who rape” outlines three key categories of sexual offences, more specifically rape. The author distinguishes anger rapists, power rapists, and sadist rapists. The first category of rapists according to Groth (1979) commits these crimes with an emphasis on humiliation and power, the second uses their power to carry out a sexual act without the consent of a victim, and the last category commits cruel acts to fulfil their fantasies. In general, this theory highlights some of the elements of sexual offences.

The main weakness of this typology is the actual analysis of criminal cases, which suggests different patterns of behaviour that can correspond to more than one category outlined by Groth. Arguably, the approach developed by Groth (1979) is partially outdated since more recent data by the World Health Organization (no date) and other research on the topic suggest that sexual offences are complex crimes. For instance, a study by Farmer, McAlinden and Maruna (2016) suggests that the majority of convicted sex offenders cite a variety of contextual factors that motivated them to commit crimes. In many cases, offenders are motivated by multiple factors defined in this theory. In other cases, they may have a different motif, which is not presented in the classification. Additionally, Faupel and Przybylski (no date) argue that multiple studies focusing on the population of sex offenders suggest that one of the key characteristics in Groth’s model – aggression is not prevalent in this population. The main issue that arises as a result – this theory of sex offences do not account for all variations and is not helpful in gaining a complete comprehension of sexual offences and their causes.

The explanation of serious sexual offences offered by the supporters of this model related to brain abnormalities or other physiological dysfunctions, due to which people commit these crimes (Faupel and Przybylski, no date). Other possible explanations of why some individuals engage in acts of sexual offences and others do no maybe genetics, chromosomes or hormones, according to this model. One can argue that this theory ignores the personal motivation of individuals and delegates the responsibility for the crime towards factors that he or she have no control over.

The biological theory, however, lacks concrete evidence that would show consistent evidence of abnormalities and dysfunctions. Multiple studies on brain abnormalities conducted in 1988 by Langevin et al., and throughout 1990 and 2000 by Aigner et al., Corley et al., Galski, Thornton and Shumsky, 1990 have proven that they are not present in most cases of the examined offenders (cited in Faupel and Przybylski, no date). Based on this, it can be argued that the biological theory lacks concrete empirical evidence that would support the claim that some abnormalities or malfunctions lead to serious sexual crimes. As such, these issues cannot help understand the behaviour of offenders and develop strategies for mitigating the risk of sexual assault based on the premises of the biological theory.

Sociological

According to this approach, sexual assault is a result of societal factors. A case of rape and murder of an Indian girl in 2012 is an example of such attitudes. In the article explaining Leslee Udwin’s documentary based on these events, the journalist describes the shock when talking to the men who committed the crime and their lawyers ( Delhi rapist says victim shouldn’t have fought back , 2015). Primary, they believe that what they committed was fair since girls in India have no right to go out at night. Such an approach is a disturbing practice, and Udwin explains that in India girls have little value in the view of their family when compared to boys ( Delhi rapist says victim shouldn’t have fought back , 2015). This leads to this inequality, supported by society, despite the fact that legally both men and women are equal and rape is considered a crime in India.

This model is supported by statistical data and reports made by international organizations. For instance, according to the statistics by the World Health Organization (no date), rape rates are higher in countries where the society is patriarchal. For example, in India, 32,500 of cases were reported in 2017, which is lower than the estimated 40,000 cases in 2016 (Reuters, 2019). It should be noted that the overall population of this country exceeds one billion people, making it a country with a relatively low per capita rate of sexual offences. This signifies one of the issues with the sociological theories, although it is possible that many of the victims do not report these offences.

All in all, this theory appears to be valid for explaining the outside factors that motivate sexual offenders. However, a question of why in India, despite the societal acceptance and prevalence of rapes, these crimes are not committed by everyone remains. The question is, why in a society that views women as lesser than men, not everyone has a connection to sexual offences remains. This inconsistency suggests that there are other, more personal factors that motivate individuals to commit these crimes, which are not explained by the sociological theory. Therefore, this approach does nor help understand the personal motivation of a person who commits sexual offences.

Malamuth’s ‘Confluence Model’

The confluence model highlights several characteristics that enable sexual offences. Faupel and Przybylski (no date, para. 20) outline the two key elements of this model – “promiscuous-impersonal sex and hostile masculinity.” When the two are combined, they result in aggressive sexual behaviour of a person. Such individuals do not have a desire to establish a long-term relationship, which would imply intimacy (Malamuth and Hald, 2016). In addition, this theory draws on some implications of the difference in evolution and sexual activity of men and women, suggesting that men have a less significant preference for a long-lasting relationship.

In general, some of the implications of this model are valid and help understand serious sexual offences. For example, the link between dominance and aggression has been reported in different researches (Terranova, Ferris, and Albers, 2017; Vize et al., 2019). However, there are shortcomings connected to use of the evolution model as a basis for explaining human behaviour. Additionally, situational factors, such as society’ perception as the basis of the sociological model are not included. Despite these factors, this theory provides some valuable insight into the question.

Finkelhor’s ‘Precondition Model’

The premises of this model is the idea that there are four components, ore preconditions that must exist in order for abuse to occur. It was introduced and developed by Finkelhor in 1984 and can be applied to understand child sexual abuse (Faupel and Przybylski, no date). It incorporates motivation, overcoming internal and external inhibitions and battling resistance of a victim. The precondition model does not explain the emergence of the first factor -motivation to commit such crime, which is its primary weakness. However, as suggested by Faupel and Przybylski (no date) little empirical evidence that would support Finkelhor’s hypothesis currently exists. This means that in general, the model is useful, but more research of real-life cases is necessary to support this model.

Ward and Siegert’s ‘Pathways Model’

The Pathway Model can be applied to explain the serious sex offences of children. The main implication of it is the dysfunctioning of psychological mechanisms. Ward and Siegert highlighted the following mechanisms – “intimacy deficit pathway, deviant sexual scripts pathway, emotional deregulation pathway and antisocial cognition pathway” (as cited in Faupel and Przybylski, no date, para. 50). These elements include taking advantage of a situation, distorted thoughts and emotions and antisocial lifestyle. The issue with this model is a lack of evidence since the majority of the theory’s premises are based on ideas from other fields.

Ward and Beech’s ‘Integrated Theory of Sexual Offending’

The varied models that aim to examine and evaluate serious sexual offences presented above all offer distinct approaches to this issue. Ward and Siegert made an attempt to integrate different theories and create a comprehensive and unique model (Faupel and Przybylski, no date). The main implication of it is that a variety of experiences during childhood as well as situational factors and sociocultural specifics result in people becoming sexual offenders. Additionally, sex from this perspective serves as a mean of satisfying not only physiological but also the psychological needs of an individual. The issue with this theory is the emphasis on impulse control, which is not always the case with offenders (Faupel and Przybylski, no date). However, it offers a cohesive explanation of serious sexual crimes.

Overall, serious sexual offences are a type of crimes that involve abuse and discrimination, as well as sexual contact without consent. The following are the main classification theories used to explain why these offences happen – biological, sociological, confluence mode, precondition mode, paths, and integrated theory of sexual offending. This paper discusses the straight and weaknesses of each sexual offence theory, outlining the key characteristics and statistics that either support or refute a model.

American Psychological Association (no date) Sexual abuse . Web.

The Crown Prosecution Service (no date) Sexual offences. Web.

Delhi rapist says victim shouldn’t have fought back (2015). Web.

Farmer, M., McAlinden, A.-M. and Maruna, S. (2016) ‘Sex offending and situational motivation: findings from a qualitative analysis of desistance from sexual offending’, International Journal of Offender Therapy and Comparative Criminology , 60(15), pp. 1756–1775.

Faupel, S. and Przybylski, R. (no date) Chapter 2: etiology of adult sexual offending . Web.

Groth, N. A. (1979). Men who rape. New York: Plenum Press

Malamuth, N. and Hald, G. (2016) ‘The confluence mediational model of sexual aggression’, The Wiley Handbook on the Theories, Assessment and Treatment of Sexual Offending, pp.53-71.

Reuters (2019) Statistics on rape in India and some well-known cases. Web.

Sexual Offences Act 2003. (2003). Web.

Sexual offences (no date). Web.

Simons, D. A. (no date) Chapter 3: sex offender typologies. Web.

Terranova, J., Ferris, C. and Albers, H. (2017) ‘Sex differences in the regulation of offensive aggression and dominance by Arginine-Vasopressin’, Frontiers in Endocrinology , 8, pp. 1-10.

Vize, C. E. et al. (2019) ‘Using dominance analysis to decompose narcissism and Its relation to aggression and externalizing outcomes’, Assessment , 26(2), pp. 260–270.

World Health Organization. (no date) Sexual violence. Web.

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IvyPanda. (2021, August 3). Sexual Violence. Explaining Serious Offences. https://ivypanda.com/essays/sexual-violence-explaining-serious-offences/

"Sexual Violence. Explaining Serious Offences." IvyPanda , 3 Aug. 2021, ivypanda.com/essays/sexual-violence-explaining-serious-offences/.

IvyPanda . (2021) 'Sexual Violence. Explaining Serious Offences'. 3 August.

IvyPanda . 2021. "Sexual Violence. Explaining Serious Offences." August 3, 2021. https://ivypanda.com/essays/sexual-violence-explaining-serious-offences/.

1. IvyPanda . "Sexual Violence. Explaining Serious Offences." August 3, 2021. https://ivypanda.com/essays/sexual-violence-explaining-serious-offences/.

Bibliography

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Unsubstantiated: An Essay of Sexual Violence

Susan straight on what it really means to believe women.

There is no documentation for these narratives. Call them what you wish. This cannot be fact checked. There are no police reports/medical examinations/official statements/newspaper stories. No proof in the way that you want proof. No paper trail. Only story. That’s what women have had forever. How can we ascertain whether any of this is true? Where did your friend/cousin/sister/teammate tell you this? She told me in the bleachers/near the lockers/in the gym/in my car/in the dorm room/with the candles lit/in the driveway/on the train/in the parking lot.

This is not he said/she said, because we said these things only to each other. Every day, in the southern California city where I was born and still live, I drive past the places where we were attacked. Passing the parking lots where my friends and I were in cars, I remember the silver mushrooms of the door locks. We took rides home from football games and house parties. Gas, grass or ass—no one rides for free. I remember the bumper sticker on vans, cars, trucks. Does this hurt? Does this hurt ? What about that? Not murmured in apology, but in anticipation. We were 14. We did not ride for free. We were told if we walked home, worse could happen to us.

I drive past the bleachers at the park where my brothers played Little League. I worked the snack bar because girls didn’t play baseball. We sold snacks. In the dark storage room behind the bleachers. I was 12. The two boys only a year older. First base and you can go . Do boys still use that term now?

I write this because women asked me to. Last year, I finally put into narrative form some stories of my life and my friends, cousins, relatives. I was told the essays could not be published because they could not be fact checked, and the phrase I learned as a college journalist, even as men were groping and attacking me then, came back like a finger poked against my spine. The details we remember? Insignificant. The events themselves, if we told someone, if we asked for help, would have been deemed insignificant, because we were insignificant as girls, and then women. Now years have passed, so the details cannot be verified. But we told each other. What we remember is rooted in the body and the senses: Dr. Christine Blasey Ford remembering her bathing suit, E. Jean Carroll remembering the lace of the underwear she was holding, the young women remembering the exact painting on the wall of the “massage room” of Jeffrey Epstein, and now that he is dead, there is no he said/she said . There is only the bravery that they told someone what happened.

I am 58 years old. Weekly I drive past the parking lot where at a broken cement stop, my 15-year-old friend and I sat side by side, our knees before us in our shorts, as it was summer, while she told me about the boy who’d raped her the night before. He was two years older than we were. He knew exactly what he was doing. He gained her trust over weeks. He talked more than any other boy we knew. She put her forearms on her knees and put her face into that cradle and I remember the back of her neck. That was 1976. I believed rape inevitable, and I didn’t want to have a baby by someone who attacked me, so I went to Planned Parenthood.

In their testified memories, Dr. Christine Blasey Ford was 15, and Judge Brett Kavanaugh 17. They spoke quite separately, their sentences braiding together in vividly different threads. They grew up in the same place. They have friends and acquaintances who brought forth their own memories. It seems undeniable that something happened, on that night. The only written record was a calendar kept by a high school boy. Often, men confronted with the memories of sexual violence recalled by women deny them altogether, as if we fabricated not only the hurt but the entire night or series of weeks or months or years. That never happened. I was never there. She is mistaken. Her very existence is called into question. It’s as if two cars collided, both were damaged, but one driver insists he and his vehicle were never even at the scene, though the other car is smashed and dented and sometimes, completely totaled.

What were you wearing/drinking/thinking/expecting/when you went to the party? What did you say to make him think that’s what you wanted/what was he led to believe? We were in the wrong place of our own accord: meaning we entered a structure while alive and expecting nothing. I remember strange details about one house party. New Year’s Eve, 1977. My future husband and I were high school seniors. The house in a neighborhood wealthier than ours, abutting the foothills of our southern California city, more than a hundred people, dancing inside, moving through the kitchen, congregating to drink in the front yard.

A man staggering across the street toward us, maybe 25, older, with black hair in long wings down his face and neck, bellbottom jeans, blood covering his right hand, dripping from a cut. I was the kind of girl who corralled him quickly before he could get in trouble with the athletes, including my boyfriend. We were black, white, Mexican-American, Japanese-American. He was olive skinned, delirious, mumbling. I steered him inside the house, into the bathroom. I remember the beautiful gilt-edged mirror, so 1970s. I propelled him by the elbow toward the sink, and quickly he turned, locked the door, and grabbed my breasts, covering the front of my white sweater, featuring thin gold-thread horizontal stripes, with bloody handprints. (My first thought: Damn, I paid $17.98 for this sweater! Most of my paycheck for the week!) (My second thought: He’s going to rape and kill me.) He broke a perfume bottle on the sink and stood there, daring me to move. I don’t remember what he said, because I didn’t look at his mouth, only at the blood dripping on the white shag rug and the jagged glass thrust toward me.

I remember this distinctly: the music was so loud no one would have heard me scream. After what seemed like hours, the hand holding the glass slanting back and forth like a cobra’s head, boy pounded on the door shouting, “Who the fuck is in there? We gotta drain the lizard! Are you girls in there putting your fuckin makeup on? Open the door!” Then they broke it open with their shoulders. Baseball players. I still see the face of the first baseball player, golden brown, and his curly natural; I still see him now and then in my city. He saved me. They punched the man, dragged him outside and called the police. But none of the officers asked me anything. They took him away without speaking to me. My future husband was angry that I’d been so stupid. Someone gave me a letterman jacket to cover the blood on my breasts, because he said it made him feel sick. But I had to give it back before my future husband took me home. If we were in a car or workplace accident, or military battle, or natural disaster, we would be “in shock.” My teeth chattered in the silence. At home, I washed my sweater that night. Dried blood is hard to get out, but I had three brothers. I was good at bloodstained laundry. I wore that sweater for years.

I remember the places. Sewer pipe on the elementary school playground/back seat of a car/front seat of a car/stairwell in college/dorm room/office of a teaching assistant/lab of a chemical engineer at work. I remember the college-educated chemist 30 years older than me, as I was 20, held the back of my bra as if it were a harness and I a small horse merely trying to get across the room to do my work. He was out to prove I couldn’t leave until he allowed me to. He said, every time, that he was merely checking to make sure I was wearing a bra. That reminded me so vividly of sixth grade I didn’t even know how to react, and then I just refused to go into that workspace and was disciplined. I do not remember the dates, or the floor of the building. I remember the beakers on the counter.

What room of the house/seat of the car/kind of carpet/part of the couch/area of the yard/end of the pool/section of the bleachers/corner of the store/row of the theater/where the alleged assault took place? Was it a twin bed/queen/king? What was the day/week/year/time? What was the make and model of the car/truck/van/camper? The address of the house? Which bedroom? How many bedrooms were there? (Did we girls ask that question the minute we arrived at the party? Did someone give us a tour, so we could identify the master bedroom, the bedspread, the bathroom? Should that be standard?) How many people were there? (Guest lists, also standard?) What time were you taken/forced/carried/or did you voluntarily go into the bedroom/bathroom/garden shed/kitchen/basement/closet/office/laboratory? Who saw you enter that place? Who saw you leave? If you were hurt, how were you able to walk?

Every time I hear the song “Sexual Healing,” by Marvin Gaye, and it is played often, I remember another high school friend in my car, angry and then weeping. The song was new. She reacted violently, telling me to turn it off. She said the lyrics were disgusting. She whispered the words that made her cry. You’re my medicine/Open up and let me in. An adult in her family had forced his way into the place where she slept, and raped her. She was so shaken hearing those words, and I was so shaken when she told me, that I turn the song off, even now.

Every time I enter my kitchen, I remember a woman sitting at the maple table my mother bought when I was three. Eight years ago, both of us grown, she told me how her mother had been assaulted repeatedly by an adult man when she was a girl. Ten years old. Her mother told no one, until one morning the girl couldn’t walk to school. She had advanced syphilis. The woman said, “They never told us who he was! And later same thing happened to me. But I told! I told them!” She told only her mother and grandmother.

Why didn’t you report this? I did. Who did you report it to? My sister/mother/aunt/grandmother/cousin/friend. What did that person do? She listened/cried/hit me/hugged me/washed me/cried/combed my hair/washed sewed dyed dried burned my clothes/cried/shook her head/said she knew/said that couldn’t be true/said she’d kill him/said he’d kill me/said get in the car/said we’ll never tell anyone/said I love you.

We could tell you: the smell/gum/whiskers/one finger/two fingers/three/fingernails/rings/song/engine/bedspread/the smell/carpet like stiff worms/carpet like cement/burns on our shoulders/above our hipbones/our tailbones/astroturf/leather / vinyl/Naugahyde/grooved metal bleachers/asphalt/jeans/zippers/metal teeth drawing blood/human teeth drawing blood/braces/bracelets/dog tags/Irish Spring/cologne/four fingers a solid gate over our mouths/French fries/hot sauce/motor oil/there is no name for the inside of a knuckle pressed hard on our lips.

Last month, I sat with a cousin in the dim light of her living room, 100 degrees outside, security screen door letting in the noise of the street. We talked about house parties. She told me about the night when she was 12, at a house party a few blocks from where we were, and an older boy, maybe 19, bumped and bumped against her while they danced until she was in a hallway and then in a bedroom. Having been raised in Los Angeles during the Black Panther movement, she talked him out of assault by bringing up unity, the violence already done to her school and family by police, and his responsibilities to her as a young black man she called brother. That was 1970.

I told her about the 1977 house party and the sweater. We laughed about the sweater. I told her about the dorm room two years later, where a large athlete lay on top of me, threatening rape, and that I invoked our male cousin, who had an Uzi, and would arrive in the morning to shoot off the athlete’s testicles. If I told. I didn’t tell anyone, because the man removed his forearm from my throat and got up, and I left.

Then I told her about the doctor. He might have been 50. Sixty. I was 13. I remember only: glasses shining like small lakes in the bright reflection of the high-powered light. Does that hurt? Does that? What about that? I am lying on a table. No clothes. Shivering uncontrollably in the frigid air. A tube. He stands in the doorway watching. Maybe he was filming, I realize now. Maybe just watching. My mother is in a waiting room far away. She thinks I have a bladder infection. The bare metal table is swimming with my tears, running into my hair and down my neck. He tortures me for a long time, or for half an hour. Was I restrained—by equipment, or by obedience? I have no details for that.

This is what my cousin did not say. Let’s review/Let’s make sure you have your story straight/Let’s go over this again/Let’s assume you’re not exaggerating/misremembering/dreaming/telling tale tales/being dramatic because you were a teenaged girl/menstruating/hysterical/looking for attention.

I had never told anyone, not my mother or anyone else. But this year, writing about my childhood, I remembered. I have always been afraid to go to doctors, or to the hospital. But at an appointment with a nurse/practitioner, for a possible minor surgery, the first time we’d ever met, I told her why I was afraid of even minor procedures, why I had never spent the night in a hospital since my third daughter was born, in 1995. I had that child 17 minutes after arriving in labor and delivery because I didn’t want to go inside.

I avoided doctors for so long that I got severe anemia, detached retinas, and other illnesses. We sat two feet from each other, our knees companionable. She told me that when she was four, in the rural place where she was raised, a boy had threatened her with a knife and told her to pull down her pants. She told me that when she was 12, in a field across from her house, a man pulled up in a car and asked for directions, opened the door and said things so shocking and dirty that she ran into the fields to hide. She told me that when she was a young nurse, a physician had casually affixed a sticker to her uniformed breast. She protested vehemently. Though she saw him pull other nurses onto his lap, and affix stickers to them, he never approached her again. I cried, just a little, with this woman I had known for 20 minutes. She tended to my physical ailment. I went home, grateful. That night, I picked apricots from my tree and took them to my cousin, and we sat in the heated dark room on her couch for three hours. We told stories of our aunts, our grandmothers, of razors slashing clothes, of guns pulled from coats, of girls who survived and told only each other. We might never tell anyone else. We told someone. We told a woman. We are alive. It is documented in our mouths.

———————————————

Susan Straight’s memoir,  In the Country of Women   is now available from Catapult. 

Susan Straight

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Study Protocol

Understanding sexual violence in sex working populations—Law, legal consciousness and legal practice in four countries (2021–2023): Study Protocol v2.5

Roles Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Resources, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Law School, University of Strathclyde, Scotland, United Kingdom

Roles Conceptualization, Investigation, Methodology, Resources, Writing – original draft, Writing – review & editing

Affiliation School of Criminology, University of Leicester, England, United Kingdom

Roles Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing – original draft

Roles Formal analysis, Investigation, Methodology, Writing – review & editing

Affiliation Department of Population Health, University of Otago, Christchurch, New Zealand

Affiliation Sociology, University of Nevada, Las Vegas, Nevada, United States of America

Roles Investigation, Methodology

Affiliation School of Law, Queen’s University Belfast, Northern Ireland, United Kingdom

Roles Formal analysis, Methodology

Affiliation Marriott Statistical Consulting, Bristol, England, United Kingdom

• Jane Scoular, 
• Teela Sanders, 
• Susie Balderston, 
• Gillian Abel, 
• Barbara Brents, 
• Graham Ellison, 
• Nigel Marriott

• Published: November 9, 2023
• https://doi.org/10.1371/journal.pone.0283067
• Reader Comments

Globally, the most important human rights and public health issue that sex workers face is their experience of high levels of violence (Kinnell, 2006, Kinnell, 2008, Alexander, 1999). Deering’s systematic review estimated levels of sexual violence in sex working populations as being between 14% and 54% (Deering et al, 2014).

This international, robust mixed methods study will explore the frequency of sexual violence against sex workers, barriers in criminal justice and the legal consciousness of sex workers regarding their rights and consent. The hypothesis to be tested is that the safety of sex workers from sexual violence is mediated by the differing legal contexts of sex work environments. We will compare experiences across research sites in the context of legalisation (Nevada USA), client criminalisation (Northern Ireland), decriminalisation (New Zealand) and partial criminalisation (England, Scotland and Wales) [henceforth ESW].

An international survey (n = 1,000) will be translated into several languages, to disaggregate experiences by demographic categories (gender, ethnicity, sexual orientation) and sex work sector (including online, street-based and brothels). Interviews (n = 100) with sex workers, police, prosecutors and service providers will be thematically analysed to explore legal consciousness, why the patterns occur and contextualise the statistical findings. These data will be supplemented with comparative legislative, policy and case analysis. Research study data will be used to compare the social factors and legal norms shaping sex workers experiences of sexual violence, justice and support interventions. Recommendations for a ‘best practice’ review of legal improvements and support interventions will be produced following completion of the study.

Given the sensitive nature of the research, robust ethical and data protection mechanisms are in place. The research has ethical approval from each research site, an Advisory Board and trained, paid peer researchers to assist with data gathering, analysis and dissemination. The study will report findings in 2023/2024.

Citation: Scoular J, Sanders T, Balderston S, Abel G, Brents B, Ellison G, et al. (2023) Understanding sexual violence in sex working populations—Law, legal consciousness and legal practice in four countries (2021–2023): Study Protocol v2.5. PLoS ONE 18(11): e0283067. https://doi.org/10.1371/journal.pone.0283067

Editor: David James Carter, University of Technology Sydney, AUSTRALIA

Received: September 26, 2022; Accepted: March 1, 2023; Published: November 9, 2023

Copyright: © 2023 Scoular et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.

Funding: JS,ES/V002465/1, Economic and Social Research Council, https://www.ukri.org/councils/esrc/ The funders had and will not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

1. Introduction

Globally, the most important human rights and public health issue [ 1 , 2 ] that sex workers face is their experience of violence [ 3 – 5 ], with a systematic review estimating levels of sexual violence as being between 14% and 54% [ 6 ]. Whilst there are variances between markets and with more online harms occurring, the marginalisation of sex workers can leave them vulnerable to victimisation and with restricted access to the criminal justice system [ 7 ].

Repeat victimisation is common, as is significant under-reporting of crimes to the police [ 8 – 11 ]. Even when cases do get reported, sex workers often experience discrimination [ 12 , 13 ] and mixed responses from police officers [ 14 ]. This has led to increased evidence-based calls to make violence against sex workers a public health and human rights priority on national and international policy agendas [ 15 – 17 ].

A detailed examination of the research and policy literature shows the issue of violence against marginalised sex working populations has been dominated by the ‘politics of sex work’, with violence often used rhetorically in battles over what overall legal model would best promote safety [ 18 , 19 ]. A more collaborative public health response is required; to facilitate this, there is an urgent need for studies that document sex workers’ experiences of violence [ 20 ]. Crucially, comparative and peer-led research is required, to better document and respond to the contextual factors shaping sexual violence against sex working populations. Greater provision of evidence-based interventions that best promote safety, health and justice for victims are also required in more areas [ 21 – 23 ].

The hypothesis to be tested in this study is that the safety of sex workers from sexual violence is mediated by the differing legal contexts of sex work environments. We will compare experiences across research sites in the context of legalisation (Nevada USA), client criminalisation (Northern Ireland), decriminalisation (New Zealand) and partial criminalisation (ESW).

2. Materials and methods

2.1 research aims.

The overarching question this study seeks to address is how social, legal, and judicial contexts shape the safety and well-being of people engaging in sex work and, in particular, how context shapes experiences of sexual violence.

Our aims are threefold:

1. Theoretical: to explore sex workers’ experiences and prevalence of sexual violence against the legal norms and boundaries in each of the four legislative models, also examining the least investigated inflictions such as ‘stealthing’ (removal of condom without permission). A desk analysis of legislation and case law in each site, regarding sexual violence and how these laws were operationalised for sex workers. This will assist us to understand how the legal system operates in different jurisdictions and explore how consent, violence and sex work are incorporated in legal judgements. These will be analysed for characteristics, perpetrator, outcome, and tariff.

2. Empirical: to enhance what is known about sex workers’ experiences of the criminal justice system by gathering and analysing new empirical data on how the system operates in different jurisdictions, looking at the impact of legislative models on how sexual violence is responded to, the impact of different settings, and attrition, outcome, and conviction. This will be applied across the four study locations through online surveys of sex workers on sexual violence, which will measure prevalence, experiences, attitudes and understandings of the law, experiences with the police, courts and other agencies, support received and interventions.

3. Practice-based: to facilitate the integration of best practice from a review of what works regarding supporting victims into safety and health-related provision, policies and agencies, led by ‘experts by experience’. These experts are four peer researchers who are sex workers / survivors of sexual violence, who will be trained in research skills, and work as a core part of the research team to interview sex workers who have experienced sexual violence (n = 10 per research site). The research team will also conduct interviews with practitioners (NGOs and statutory health service professionals), police, and criminal justice personnel (n = 10 per research site) to assess issues such as reporting, signposting, available resources, therapy, and criminal justice support.

2.2 Research design

The research study is designed to deliver the research objectives, which are to:

• Generate empirical data and build theory on the relationship between legal consciousness, legal norms, and legal practices and experiences of sexual violence and sexual autonomy in different models of governance;
• Generate empirical data and build theory on how marginalised groups (sex workers) interpret the sexual violence they experience, their rights regarding sexual violence, how and whether they seek redress through the criminal justice system, and outcomes in different models of governance;
• Generate empirical data and build theory on how various criminal justice institutions respond to sexual violence among various sex-working populations in both theory (law and legal norms re consent) and practice (police actions, reporting systems, court dispensation) in different models of governance;
• Account for differences among groups of sex workers by gender, age, ethnicity, sexual orientation, citizenship, and sex market, especially for trans, MSM sex workers, and migrant communities;
• Build knowledge of how researchers and expert advisors can work together in the research process to interpret findings and build theory, and empower expert advisors with evidence for better practices;
• Generate and disseminate evidence-based information on best practices to help provide justice for sex workers.

2.2.1 Research questions.

The research questions (RQs) for the project are as follows:

RQ1 What is the frequency of sexual violence as reported by the diversity of sex workers, and what are the characteristics and nature of their reporting of sexual violence?

RQ2 How do different parts of the criminal justice system (police, lawyers, judges) respond, record, investigate and prosecute reports of sexual violence against sex workers?

RQ3 How do sex workers experience the reporting, recording, investigation and prosecution of sexual violence? How do sex workers experience court processes when crimes enter the criminal justice system?

RQ4 What processes and policies (sentencing guidelines or other legal norms) include sex work explicitly and, if they do, how does this influence how police, prosecutors and other agencies respond?

RQ5 How does the response, recording, investigation and prosecution or reports of sexual violence vary by community of sex worker (gender, race, ethnicity, sexuality, citizenship, sex market)?

RQ6 How do legal regimes differ in how parts of the criminal justice system (police, judges, attorneys, witnesses) respond to sexual violence against sex workers?

RQ7 How has consent, conditional consent and non-consent by sex workers been recognised historically? What are the current legal norms with regards to rape and sexual assault and conditions of consent?

RQ8 What and how are the conditions of consent understood and negotiated by sex workers? How do they understand violations of consent and their legal rights?

RQ9 How is consent and conditional consent (e. g., cases where condoms were removed and non-payment) classified in different legal systems, (e. g., as fraud or sexual violence)? How does this compare to sex workers’ own perceptions of harm?

RQ10 How do understandings and negotiations of consent vary by community of sex worker (gender, race, ethnicity, sexuality, citizenship, sex market)?

RQ11 How do understandings and negotiations of consent vary by legal system?

RQ12 From the empirical findings, are there examples of good practice in supporting sex workers at various levels and stages of criminal justice interactions, including sex worker or witness support services?

RQ13 Are there other forms of justice that survivors report, and what do these look like?

2.2.2 Study setting.

We will address the research questions above by comparing four different legal environments: legalisation (Nevada USA) where legal brothels are permitted in 10 of Nevada’s 17 counties; client criminalisation (Northern Ireland) whereby following the Nordic model, paying for sexual services is now a summary offence with a maximum penalty of 12 months in prison; decriminalisation (New Zealand) where prostitution, including the operation of brothels is permitted subject to municipal regulation and partial criminalisation (England, Scotland and Wales) whereby the act of selling sex itself is not illegal, but laws have been drafted around a number of facets of sex work such as brothel keeping, soliciting, living of the proceeds of prostitution and so forth.

2.2.3 Study period.

The study began in July 2021 and data collection is taking place across an estimated 11-month period from March 2022 to February 2023. The end date of survey data collection will depend on the point at which a sufficient sample is achieved for the survey in each jurisdiction.

2.3 Data collection

This is a mixed methods (quantitative and qualitative) research study, comprising three work packages:

Work Package 1: An online survey of sex workers (n = 1,000) will gather data on experiences of sexual violence in sex work across the research sites. It will analyse harms, reporting, consent, non-payment, condom removal, experience of police and support services and be analysed according to socio-demographic of respondent and sex work sectors. This will be used to answer Research Questions 1, 3, 5, 8, 10 and 13. Recruitment will be through key online sex work platforms and NGO/health outreach and support services for sex workers.

Work Package 2: Interviews with victim-survivors of sexual violence in sex work (n = 10 per research site), practitioners from NGOs and health providers, police, lawyers and prosecutors (n = 10 per research site) will explore reporting, signposting, investigation, trauma management and criminal justice system experiences. The interview sample sizes aim to reach thematic saturation at 10 practitioners (including criminal justice professionals) and 10 sex workers each of the four sites. As a minimum, 6 interviews from each group in each site should provide an 80% saturation of themes at ≤5% new information [ 24 ]. These interviews will be used to answer Research Questions 2, 4, 6 and 12. Recruitment will be through Advisory Group members and partner organisations. Peer researchers with a lived experience of sex work / sexual violence will be trained to conduct interviews with sex workers.

Work Package 3: A desk analysis of legal norms and relevant case law will assist us to understand how the legal system operates in different jurisdictions and explore how consent, violence and sex work are operationalised in legal judgements. This analysis will be used to answer Research Questions 7, 9 and 11.

2.3.1 Online survey of sex workers.

There is no existing, robust international survey instrument concerning sex workers, sexual violence and legal consciousness.

Experiences of sexual violence in sex work are under-researched and differ from standard data measuring sexual violence (for example, many sexual violence statistics are gathered using women only, and most sexual violence data are gathered about violence by intimate partners, rather than strangers or acquaintances, and do not contain information about transactional sex or sex in a workplace). Unfortunately, standard sexual violence surveys do not include samples from New Zealand. Therefore, a new pilot survey instrument is required for this project.

2.3.2 Survey design.

The online survey for this study has been iteratively through 11 drafts, developed from existing instruments, adapted for relevance to sex working populations in the study sites, with pilot elements added.

The initial draft consulted existing surveys from Survivors UK, West Cork Health Authority, The NI Department of Justice, Criminalisation of Paying for Sex Survey [ 25 ], Beyond the Gaze Online Sex Work Survey [ 26 ] and the Evaluation of Protection From Abuse (Sc) Act 2001 survey [ 27 ]. Each draft was reviewed by the research team, with three drafts written in consultation with Expert Advisory Boards in each site and an Academic Advisory Group. The consulting statistician reviewed two drafts.

The final survey utilises adapted existing victimisation survey items from the Crime Survey of England & Wales Self Completion Module: Domestic Abuse, Sexual Victimisation and

Stalking Module [ 28 ], with methodological adaptations from Walby & Towers [ 29 ] and the National Intimate Partner and Sexual Violence Survey [ 30 ]. In addition, questions for sex workers were adapted from the context of sex workers’ condom use study [ 31 ], to begin to elucidate consciousness of sexual consent.

Novel and exploratory questionnaire items were added to be relevant to sex-working populations in the study sites and to reflect the particularity of the legal context in each area. Some questions from the Beyond the Gaze [ 32 , 33 ] project and in Northern Ireland [ 34 ] were added. Site specific scales for different jurisdictions (comprising no more than 20% difference between surveys) were added, for example to align ethnicity and income categories with national data in the sites. Income demographics were harmonised across the sites using OECD methodology [ 35 ], and all categories were taken from 2019 existing instruments, to assist comparability across the sites.

The survey was piloted with members of Advisory Boards, sex workers and other NGOs, using test-retest methodology [ 36 ]. This was conducted to check that the questions–and their translations–accurately collect the data required, to improve the reliability of the survey instrument and minimise measurement error.

The survey will be launched in September 2022, with data gathered simultaneously in all sites. The survey will remain open until February 2023 (or until a sufficient sample size has been reached for statistical significance, within the time constraints of the study). The survey will be translated into Portuguese, South American (Brazilian) Spanish, Romanian, Filipino, Thai and Mandarin; these languages have been identified as the most crucial to reach migrant sex workers in the research sites.

Respondents will be recruited through the project Advisory Boards in each research site, adult sex work platforms and NGOs delivering outreach with sex workers, as well as via the broader project teams’ connections with sex work communities. Given the hard-to-reach nature of sex working populations and the sensitivity of sexual violence, random sampling methods are not appropriate for this study. Therefore, non-random strata sampling by sector and demographic group will be employed.

2.3.3 Survey platform.

Microsoft Office Forms was chosen as the platform for the survey, as it meets GDPR data protection requirements and has secure storage to meet regulations in all the research sites. It has accessible audio plugins to read questions and a design that enabled the use of translations into different languages required in the research sites.

2.3.4 Survey eligibility criteria.

Survey respondents are sex workers or people who have exchanged sex for something of value (e. g. accommodation, substances, gifts) and who;

• Are over 18 years old;
• Have sold or exchanged sex in one of the study regions (New Zealand, Nevada, USA, ESW and/or Northern Ireland).

2.3.5. Survey sample size.

Despite the frequent experiences of violence in some forms of sex work, accessing workers with violent experiences among the entire population of sex workers can be challenging. This population is often under-represented in standard sexual violence surveys, which prevents weighting methodology being employed in this study–this is because there are not sufficient existing independent data with which to compare populations. In other sex work contexts, too many invitations to participate in studies targeted at a few individuals, stigma, and working without legal protection can mean some sex workers are reluctant to engage with research [ 37 ].

Unfortunately, the sample for this survey cannot be randomised, as too few responses would be received and there are no intervention arms in this study or reliable population estimates in the sites [ 38 ]. However, stratified sample groups for distribution by sector and site have been designed for the recruitment, to attempt to ensure as far as possible that no under- or over-representation of one particular sector of sex work in each research site.

To ensure that we achieve an adequate sample size, calculations were made to test our null hypothesis, namely that there is no difference in the experience of sexual violence by jurisdiction. We used the chi-squared test to test for independence of outcome (binary Yes, No) and jurisdiction (4 levels) with 3 degrees of freedom. Since a significance level of 5% is desired, the chi-squared statistic would need to exceed 7.81. To test the null hypothesis, a minimum sample size of 1760 respondents for the survey would be required, with a minimum of 440 respondents in each jurisdiction.

We derived an alternative hypothesis from a low conservative estimate from Deering et al [ 39 ], that circa 15% of sex workers experience violence. We anticipated the overall probability of sexual violence at 15% across all 4 jurisdictions, with 2 jurisdictions differing by 10 points (ie. one records 10% and the other 20%) to be detectable at least 80% of the time. We calculated that we would need a maximum sample size of 3200, where p = 55%. Fifty-five per cent was our upper estimate of sexual violence in sex work [ 40 ]. The chi-squared statistic was 7.84 from this calculation.

To test for numerical differences between sub-populations–for example, how experiences and frequency of sexual violence, harms, reporting and attitudes to safety vary between gender, race, ethnicity, citizenship, sexual orientation, income and/or sex market–a larger sample size may be required. With a suitable numerical scale devised and tested, a smaller size may be sufficient.

2.3.6. Survey data analysis.

Survey data analysis will be conducted at mid- and endpoints of the data gathering phase. The mid-point analysis will enable further recruitment where a sample is insufficient and to produce indicative results to inform analysis.

Logistic regression will be used to test the study’s null hypothesis, that there is no significant difference in victimisation by the jurisdiction. In addition, we will assess whether action and harm are mediated by socio-demographic category (gender, ethnicity, age, sexual orientation, citizenship status, income/financial autonomy). Other variables included in the survey are: attitudes to policing, criminal justice response and access to support. Information on conditional consent specific to sex work will also be analysed–for example, under-payment/non-payment, condom removal (‘stealthing’)–as will situations in which consent could not be given; because of intoxication, for example.

Multivariate analysis will be used to identify clusters of respondents by experience of victimisation, jurisdiction and sex work sector with the aim of producing the first statistical international typology of respondent experiences of sexual violence (and justice/support after it) in sex work. Whilst our preference is to use either AHC (Agglomerative Hierarchal Clustering) or PCA (Principal Components Analysis) to generate the clusters, it is unlikely that all variables can be converted into numerical form. Should this not be possible, then our intention is to use Multiple Correspondence Analysis (MCA), which is capable of handling categorical variables. Once our clusters have been generated, we will then explore how they differ in terms of socio-demographic category (gender, ethnicity, age, sexual orientation, citizenship status and income) in different jurisdictions and sex work sectors.

Statistical analysis, reports and publications will be, wherever possible, in line with the SAMPL guidelines [ 41 ].

2.3.7. Research interviews.

Semi-structured interviews will be conducted to understand why patterns occur in the different research sites, provide best practice recommendations and inform work to address barriers to support and justice for victim-survivors. Interviews will be adapted to the requirements of each site, to have regard for relevant legal, policy and practice differences. Interviewees will be given the opportunity to have the interview schedules in advance if requested.

Research team members will conduct interviews (n = 10 per research site) with NGO and health service practitioners, police and criminal justice personnel who have experience of dealing with sexual assault against sex workers. These interviews will assess practice and issues such as reporting, signposting, available resources, therapy, and criminal justice support.

Current and former sex workers–individuals who have exchanged sex for money or something of value, of any gender, ethnicity and who are over 18 years old–and who have experienced sexual violence will be interviewed (n = 10 per research site). A variety of sex work locations (brothels, on-street, online, etc.) will be included in each jurisdiction.

These trauma-informed interviews will be conducted by four trained peer researchers who are sex workers / survivors of sexual violence. Support and advice signposts will be provided to all participants. Sex worker interviewees will be recompensed for their time with shopping vouchers to the value of £50, and peer researchers are recruited, paid and contracted in accordance with best practice guidance for participation [ 42 ].

2.3.8. Researcher training.

The project has recruited peer ‘Experts by Experience’ researchers in each research site who have a lived experience of sex work and/or sexual violence. This peer researcher method is utilised to democratise and improve the relevance of the research process in academia [ 43 ].

A Training Needs Analysis was conducted to ascertain gaps, qualifications and experience in the team. We then devised training and learning activities to address these. It is recommended [ 44 ] that interviewers should be specially trained in violence research, because they tend to elicit more reliable responses from respondents as opposed to those who do not receive the specialised training. An Action Learning Set method was chosen to deliver this training. An Action Learning Set is a small group of people who work together to understand and improve a situation, practices and the world; all participants learn and create knowledge through the process [ 45 ]. Each participant is an equal, focussing on their own perspective of one area of the project at a time. The whole group listens, observes and reflects, and the group decides ways of progressing with it. This method ensures we have a safe space for discussion; and everyone learns from each other, with one issue worked on at a time.

The whole research team, including peer researchers, are trained together using Action and Learning Set methods, to:

• Discuss the themes of the research (consent legal norms, sexual violence, sex work regulation, reporting and justice);
• Analyse the risks to researcher and participant when interviewing about sex work and sexual violence;
• Learn techniques to mitigate and manage those risks;
• Understand trauma-informed ways of working to protect the researcher and participant from experiencing distress;
• Build research interviewing skills (accessibility, active listening and communication skills, prompting, disclosure, identifying barriers to participation);
• Explore the ethical hurdles in researching vulnerable groups;
• Consider the impact of results, dissemination and engagement.

The peer researchers will be conducting interviews with survivors of sexual violence who have sex-worked or are sex working and will be involved in disseminating the survey, supported by the research team, with debriefing and reflective elements to ensure safety of participants and peers in dealing with sensitive subjects.

The team intends to apply for additional funding to include the peers in writing up and dissemination of the results, to influence policy, practice and public attitudes to sexual violence and sex work, in the future.

To ensure the integrity of this involvement, the project has adopted the 4PI National Involvement Standards [ 46 ] and the Survivors of Abuse Manifesto.

2.3.9. Thematic analysis.

All interviews will be anonymised and stored with a unique participant ID number, in a secure Sharepoint data store at the University of Strathclyde. They will be transcribed by professional transcribers who are contracted to the project, with Confidentiality Agreements in place.

Analysis will then be conducted within a framework process adapted from Gale [ 47 ], as follows:

• Transcriptions will be coded in NVivo by one research team member for consistency.
• Coding will be conducted using a deductive, pre-defined coding frame (including micro, meso and macro levels of analysis), devised from the research questions and key words for the study.
• One sex worker and one practitioner transcript from each site will be coded inductively, to test and adapt the codebook.
• Emergent additions will then be indexed and reviewed. Reports by global and sub-themes, with parent and child code reports, will be accompanied by thematic network diagrams, as recommended by Attride-Stirling [ 48 ] and distributed to relevant project team members in each site for analysis and study reporting.
• Additional matrices and reports by themes and research questions will be produced in NVivo to highlight patterns in data, main arguments, gaps and patterns of evidence [ 49 ].

3. Ethics and safety

3.1. ethics approvals.

Approval has been granted for this study by the following Ethics Committees:

• University of Strathclyde Approval: UEC20/74
• University of Leicester Approval: 28758-tlms1-ss/cr:criminology (03/02/2021)
• Queen’s University Belfast: School of Law, Research Ethics Committee (26/02/2021)
• University of Otago Approval: 21/007 (01/02/2021)
• The Commissioner of New Zealand Police–Approval signed by the Director of Evidence Based Policing (n.d.)
• University of Nevada, Las Vegas (UNLV) Social/Behavioral IRB: 1701767–3 (12/03/2021)

A Research Request Application was also made to the Crown Prosecution Service of England & Wales, based on the UK Government Social Research Ethics Guidance (currently pending).

3.1.1. Safety and risk mitigation.

Sex work is a stigmatised occupation and, as a result, many sex workers do not disclose their work. In addition, some of them are working in a criminalised context. Confidentiality, privacy and anonymity are therefore of utmost importance. This research will examine the experiences of sexual violence in sex-working populations, ¬ an issue which is sensitive and carries risk of emotional harm for everyone involved. We discuss these ethical issues below and steps we will take to mitigate the risks.

The danger of failing to hear sex worker voices accurately

This ethical dimension relates to the use and interpretation of data. There is a very real risk in research about sex work that inaccurate or misleading claims are made about a vulnerable population, which either do not seek their views or misrepresent what they say. Consequently, the overall methodological framework gives weight to the views and experiences of sex workers rather than privileging the views of other organisations such as the police and those in authority who claim to speak on behalf of sex workers. The research will adhere closely to the guidelines suggested by Jeffreys [ 50 ], as adopted by the UK Network of Sex Work Projects (UKNSWP) in 2015, which advocates for ethical, interdisciplinary scholarship which can inform grassroots activities with sex workers in communities that promote their human rights.

There are additional issues regarding ethics that are immediately evident in this project:

Potential vulnerability of participants

Sex workers are vulnerable to stigmatisation and exploitation. The normal concerns of confidentiality, anonymity and personal safety are crucial in this research, especially in ESW where sex work is partially criminalised; in Nevada where sex workers are only legal if they are working in a licensed brothel; and in Northern Ireland, where clients and other third parties are criminalised.

These sensitivities are exacerbated when we involve, as we intend to, potentially vulnerable participants who have direct and personal experiences of the matters we seek to learn about. These risks will be mitigated by the experience of the team and safeguards built into the research design as outlined below.

People who have experienced sexual violence are potentially vulnerable to emotional distress when recalling their experience in an interview. This research focuses on policy and sex workers’ experiences of law and reform, where there is less risk of causing emotional distress. We are less interested in the experience of sexual violence but rather in the processes whereby these crimes are dealt with or not, for example, individuals’ feelings about what they did to contact authorities, seek justice, seek assistance and support, or whether they felt able to do any of these things and, if not, what inhibited them from doing so.

Several steps will be taken to mitigate risk of emotional harm, physical harm, breach of confidentiality, and increasing vulnerability to exploitation:

• Advisory Boards of experts, who have significant knowledge of working with sensitive groups and sensitive issues like sexual violence, provide oversight and advice to the research team.
• We will engage with groups representing sex workers, e. g. campaigners, activists and NGOs, who will participate in the development of interview and survey questions.
• Researchers will be employed and will receive training from the PI, RF and Co-Is on interviewing, methodological techniques, safeguarding and confidentiality.
• The researchers will be experienced in dealing with sensitive questioning and any fallout from discussing such issues.
• We will ensure that we do not interview anyone with obvious vulnerabilities, e. g. someone who is unable to give informed consent if they are under the influence of drugs or someone who is in extreme distress. Whilst there may be trains of practice which consider this exclusionary, the safety (in all aspects) of our participants is key.
• All participants recruited will be over the age of 18.
• Participants will be reminded of their right to terminate the interview at any time. If they do become upset, interviews will be stopped and only resumed with consent.
• Appropriate support will be provided where it is deemed appropriate. We will also calibrate how the participant is feeling and act accordingly regarding the timing and pacing of questions.
• We are aware that we cannot elicit information about ongoing police or legal cases since to do so could prejudice an ongoing case. We will be including in the consent documentation for both the survey and the interviews a warning to NOT discuss explicitly any current cases, names, etc, as this would then risk the information being requested by a court and could be construed as evidence. We will inform participants of this at the beginning of the interview and this information, as well as the participant’s response, will be recorded.
• Contact with support agencies is vital for the mitigation of harm to participants. Local drug charities, sex worker organisations and sexual violence advisory services are identified in each study site and contact information provided to participants.
• Anonymity: the survey will be anonymous.

Dealing with underage sex workers

If we become aware that we have been contacted by an underage sex worker (defined as someone of an age where special protection is given by law due to young age against sexual exploitation) then we will adhere to the longstanding convention that the researcher has a responsibility to act around issues of child protection, in line with the Economic and Social Research Council (ESRC) ethical guidelines [ 51 ]. In this case we shall directly notify a support organisation and, if necessary, the police, under the laws of each country. Likewise, if we are informed during the course of the interview about confirmed or suspected instances of trafficking for sexual exploitation, we will pass this information on for further investigation. These will be the only instances where we will make aspects of our data available to law enforcement agencies given the issues around trust.

Researcher safety in home country sites

This project involves fieldwork across a number of international sites: New Zealand, the US (Nevada), ESW, and Northern Ireland. In order to ensure the researchers’ and participants’ safety, which is paramount, a number of precautions will be taken:

• Experienced RAs will be recruited for each site and supervised by the Co-I in each country.
• Fieldwork will only take place online or in well-lit areas that can be accessed safely by both the researcher and participants (i.e., university/support service offices).
• To protect researchers conducting fieldwork, they will check in with a PI or Co-I in each site before and after each interview, with emergency interview details that can be accessed by the PI / Co-I if the researcher goes out of contact.
• Each university’s protocols for ‘Working in Isolation/Lone Working’ and ‘Working away from the University’ will be adhered to by members of the research team during fieldwork and data collection.
• Recording equipment will be insured and will be carried in a discreet and secure bag. This equipment will not unnecessarily be taken anywhere in order to minimise risks.
• The PI, Co-Is and RAs in all countries will have monthly meetings via Skype/Zoom prior to and while fieldwork is underway. Each country’s lead researcher will meet weekly with the local RA during their contracted period.
• During fieldwork the RAs will not only be supervised directly by Co-Is in the team but will also be connected to established researchers and/or centres of excellence to ensure they are not isolated and can benefit from academic contacts, expertise and support.
• All of our research personnel, employed by the University of Strathclyde, will be covered by the University of Strathclyde’s insurance provisions whilst working overseas.
• Any Serious Adverse Incidents or harms are not expected, but should they occur, they will be reported to the relevant site Ethics Committee in line with granted approval conditions.

3.1.2. Support and triaging process.

Trigger warnings and links to support will appear at relevant intervals in the survey. Survey respondents, on pressing the final submit button, will be presented with the option of asking for specific support in their own locality. To do this they have a project email set up specifically for this purpose. Emails will be triaged every 24 hours to:

• the country where the individual is from, and
• a red/amber/green tag allocated depending on the severity of the concerns.

Appropriate, country specific services will then offer support to the individuals by making direct contact.

Post-survey submission support

At the end of the survey the participants will have a pdf of their answers, which includes the support information.

The project will be visible in sex-work spaces for approximately 18 months after the survey has finished so that there are avenues through which participants can contact us for any reasons.

The project website has a tab for support where the above information will be permanently posted until the project ends.

3.1.3. Consent and withdrawal.

Information is provided to potential survey respondents and interviewees through Participant Information Sheets and the study website.

Informed consent to interview will be provided by signing a consent form or giving verbal consent on the recording of the interview, depending on the relevant ethics approval in each site. All survey respondents are required to provide affirmative, free and informed consent and to confirm that they are over 18 years of age, before they can access the survey.

Interview participants can withdraw their data up to one month after their interview has been transcribed. Survey respondents cannot withdraw their data, as it is given anonymously.

3.2. Data management plan

3.2.1. data storage and confidentiality..

Where interviews are online (Zoom, etc) we will ensure that the security of these sites for recording interviews and storage is thoroughly checked. We will move all data to the University of Strathclyde Sharepoint server for storage. All data will be transferred internationally using lawful and secure methods, in line with the appropriate General Data Protection Regulation (GDPR) [ 52 ] safeguards and policies [ 53 ] and within FAIR data principles [ 54 ].

Our data management procedures will be communicated to participants via the participant information sheet prior to interviews commencing.

We will use corporate versions of recording tools where possible–if personal devices or apps are used for the interview, data will be moved to university storage systems as soon as possible, and not retained on personal devices.

3.3. Advisory boards

Four Advisory Boards have been recruited to cover the individual sites: Northern Ireland; ESW, Nevada; and New Zealand. There is an Academic Advisory Board for the project which covers all sites. The Boards exist to provide a forum for discussion, feedback, oversight, guidance, meaningful involvement and independent advice to support the integrity and value of the research, following best practice [ 55 ].

Three of these Boards provide guidance in each geographical research site. Members were invited by the Research Team at the start of the study. The Boards comprise;

• ‘Experts by experience’ who are sex workers with lived experience;
• NGOs that are sex worker-led organisations and/or that work or have worked in supporting survivors of sexual violence;
• Academics working in the field.

The fourth Advisory Board is an Academic Advisory Committee for the study, covering all the research sites. This Board comprises internationally renowned experts who are providing specific and technical guidance and oversight for the whole study, particularly around methodology, analysis and reporting of results.

3.4. Status and timeline of the study

This Study is Active and currently recruiting participants as at September 2022 ( Fig 1 ).

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pone.0283067.g001

4. Discussion

4.1. reporting.

The anonymised quantitative datasets generated and analysed during this study, will be available from the: https://ukdataservice.ac.uk/ repository within three months of the end of the grant. Links to journal articles and briefings produced from the study will be available from the project website at: https://sexworkandsexualviolence.com within twelve months of the end of the grant. Where possible, outputs and reports will be available free of charge and open access.

Limitations of the study and any material difficulties encountered will be reported transparently, in order to assist future research.

4.2. Dissemination and impact

The Impact Plan will:

• Educate policy and service delivery agencies by sharing up-to-date data on the experiences of sexual violence among sex workers.
• Engage practitioners, witness support, court personnel and police, sharing evidence on the experiences of sex workers in the criminal justice system, focusing on areas for improvement, continuation and change.
• Provide sex worker-led resources to survivors of sexual violence.
• Inform public debate on the issues around sex work, using our findings to dispel myths and present current trends and patterns.

We plan to engage all members of the team to write and devise the outputs as a collective approach to writing and knowledge exchange. We will write together more formal academic peer reviewed journal outputs, but will also write more accessible pieces for practitioner platforms and related conferences. We will seek out spaces where violence is a core focus (such as violence against women and girls’ strategic boards; policing authorities; government task and finish groups, etc.), to disseminate the findings more broadly, where violence against marginalised groups is being tackled. We will contribute to and host workshops / events specifically for the sex work community. We will also distribute our findings into existing organisations who work to end violence against sex workers.

4.3. Study limitations

There is no existing international survey of legal consciousness and/or violence against sex workers on which to build comparative results, so future replicability cannot be entirely assured. However, the transparent reporting of methods in this protocol and robust statistical tests employed should assist in future replication of this study.

Regrettably, the survey sample cannot be randomised, given the population size, sensitivity of the research and the small size of the sex working population (particularly in Northern Ireland). Online sex workers cannot be recruited simply in jurisdictions where it is illegal. Blinding of participants into different cohorts is not possible, given the lack of consistent or standard interventions on which to assess the validity of outcomes. Data are self-reported and gained through existing networks, which may result in self-selection bias from respondents and the under-representation of certain groups in results.

Inference from these data gathered in the study sites (all English-speaking, high-income countries) cannot be made to the Global South or populations of sex workers operating in other contexts.

Given the short length of the project data gathering phase, longitudinal follow-up is not possible with this cohort. The sample cannot include sex workers in prison or hospital due to ethical restrictions. It is not possible to interview people about current, ongoing legal cases so as not to risk transcripts being requested as evidence and biasing proceedings.

Supporting information

https://doi.org/10.1371/journal.pone.0283067.s001

https://doi.org/10.1371/journal.pone.0283067.s002

https://doi.org/10.1371/journal.pone.0283067.s003

Acknowledgments

The research team would like to acknowledge the help and support of sex workers, NGOs and practitioners in the research sites who have advised the project, participated and recruited others. We are very grateful for the help and support of the Research Assistants, Rachel Howard and Cherida Fraser and peer researchers in the project. We are very grateful to the Advisory Board members for advice and support. Thanks to David Pedder and Nicki Brown of Transcribe It for note-taking, Nvivo input and transcriptions of interviews respectively. We are grateful to the reviewers and editors at PLOS ONE for their helpful comments and assistance. All errors and omissions are the authors own.

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• 36. Lavrakas PJ. Encyclopedia of Survey Research Methods (Vols. 1–0). Thousand Oaks, CA: Sage Publications; 2008.
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Sexual Violence and Trauma in Childhood: A Case Report Based on Strategic Counseling

Valeria saladino.

1 Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, 03043 Cassino, Italy

Stefano Eleuteri

2 Faculty of Medicine and Psychology, Sapienza University of Rome, 00178 Rome, Italy; [email protected]

Elisa Zamparelli

3 Institute for the Study of Psychotherapies, 00185 Rome, Italy; [email protected]

Monica Petrilli

4 Academy of Social and Legal Psychology, 00198 Rome, Italy; ti.liamtoh@illirtepacinom

Valeria Verrastro

5 Department of Medical and Surgical Sciences, University of “Magna Graecia”, 88100 Catanzaro, Italy; ti.zcinu@ortsarrevairelav

Children and adolescents are too often victims of sexual abuse and harassment. According to the World Health Organization (WHO), approximately 150 million girls and 73 million children <18 have been victims of violence and sexual exploitation during their childhood. Data show that females are more likely to be a victim of abuse and violence than males (20% vs. 5–10%). Such abuses lead to long-term psychophysical and relational consequences and victims are often afraid of asking for support from both parents and professionals. This case report shows the story of a 17-year-old adolescent, Sara, involved by her mother in a strategic counseling process, to solve BDSM-type sexual addiction (slavery and discipline, domination and submission, sadism and masochism), self-aggressive behavior, and alcohol abuse issues. The strategic counseling process is structured in 15 sessions and was based on problem-solving techniques and corrective behavioral strategies. During the sessions, it emerged that Sara had been a victim of sexual violence at the age of 6 and that she had never talked about the rape with anyone. At the age of 12, she began to experience social anxiety and shame, feelings that led her to use alcohol and seek violent sexual partners and bondage relationships. During the counseling sessions, Sara elaborated on her trauma, becoming more aware of her resources and her desires, and she learned to manage the sense of guilt and shame associated with the violence suffered, through alternative strategies. At the end of the process, Sara normalized her relationship with sex and alcohol, regaining her identity.

1. Introduction

1.1. sexual abuse in childhood: definitions, spread, and consequences of the phenomenon.

The World Health Organization defines “child maltreatment” as all the forms of abuse and neglect that involve children. This definition includes physical and emotional violence, sexual abuse, neglect, and exploitation. These abuses lead to damage to children’s health, impacting their development [ 1 ]. According to the fundamental rights of the European Union and the United Nations Convention on the Rights of the Child, children should be protected against all forms of violence, and adults should promote their well-being [ 2 , 3 ]. There are different definitions of child sexual abuse. For instance, sexual harassment can arise on a continuum of power and control, from non-contact sexual assault (such as exhibitionistic actions) to contact sexual assault (such as rape). Additionally, Internet sexual offending is included in the definitions of child sexual abuse. This category concerns the distribution, acquisition, and possession of child sexual exploitation material, child grooming, and online contact with children for gratifying sexual desire (e.g., receiving sexually explicit images or cybersex) [ 4 ]. Regarding the spread of this phenomenon, it is estimated that one billion children are a victim of some form of violence. Thus, one out of two children per year worldwide suffers from some form of violence. Furthermore, the COVID-19 pandemic has increased the risk of children being victims of violence within their families [ 5 , 6 ]. Indeed, social distancing and restrictions impacted the levels of stress and anxiety, reducing usual sources of support and increasing online abuse [ 7 , 8 ].

Our study focuses on sexual violence and sexual abuse, which means the involvement of children or teens in sexual coercion or sexual harassment. These experiences may not involve explicit violence or injury and could occur without physical contact or be experienced as observers. Sexual abuse can be divided into different categories depending on the relationship between the child and the perpetrator. Intra-familial abuse is implemented by family members, peri-familial abuse is implemented by people external to the family but who take care of the child; and extra-familial abuse involves perpetrators who are not part of the family environment [ 9 ].

Child sexual abuse is connected to several unpleasant consequences. Victims may develop mental health problems, such as affective disorders, suicidal ideas, drug or alcohol addiction, social anxiety, conduct disorder, borderline personality disorder, post-traumatic stress disorder, and eating disorders, in particular bulimia nervosa [ 4 ]. Furthermore, child sexual abuse harms the physical health of children, leading to urogenital complaints (e.g., genital pain, dysuria, genital bleeding, and incontinence problems) [ 10 ]. According to Adams et al. [ 11 ], the severity, duration, and onset of sexual abuse influence the level of depressive, anxiety, and post-traumatic stress disorder (PTSD) symptoms. Regarding gender differences, the authors found that sexual abuse produces the worst effects in females. Indeed, the early onset of sexual abuse may cause anxiety symptoms in females but not among males. In the same line, it seems that sexual abuse may determine PTSD mostly in females but not in male adolescents.

The stage of development in which children suffered from abuse (early childhood, childhood, adolescence) can influence the severity of the consequences for health. Traumatic experiences, such as violence and abuse, lived during the first few years of life have a stronger impact on the development than those experienced in another period [ 12 ]. Van Duin et al. [ 13 ] examined the impact of extra-familial sexual abuse among children under four years old and the consequences for their parents. The results show that 3% of children developed a PTSD diagnosis, 30% of them exhibited clinically significant sexual behavioral problems, while 24% of them showed internalizing problems, 27% attachment insecurity and 18% received a psychiatric disorder diagnosis. Regarding parents of children who suffered from abuse, 20% reported high levels of PTSD symptoms, with mothers reporting PTSD symptoms more often than fathers. They also suffered from feelings of guilt, shame, and anger. The authors hypothesized that the psychological treatment provided to 25% of the victims and 45% of parents mitigated the negative consequences.

Additionally, suffering from extreme abuse for a long period, having a close relationship with the perpetrator [ 14 ], and living in dysfunctional families are risk factors associated with the development of severe psychological symptoms [ 15 ]. Moreover, the risk of re-victimization is higher among children who suffered from sexual abuse compared to others. The disclosure of the trauma is hard because of feelings of shame, guilt, and intimidation by the perpetrators and the wish to not burden the family. The stigmatizing response by the social environment influences the development of shame and guilt linked to sexual victimization. This is also connected to the feeling of being blamed or judged.

These data underline the importance of educating society in understanding the consequences of sexual victimization and in supporting prompt reporting. These results might be useful in promoting therapeutic interventions to support victims and to decrease the dysfunctional cognitions of sex offenders [ 16 ].

1.2. Sexual Addiction and BDSM among Survivors of Childhood Sexual Abuse

Several authors have reported that 80% of people [ 17 ] who experienced child sexual abuse (CSA) developed compulsive sexual behavior and sexual addiction in adulthood. Pereira et al. [ 18 ] confirmed the relationship between childhood sexual abuse and a later disposition toward compulsive sexual behaviors. They found that sexual abuse experiences and poor family relationships during childhood enhance vulnerability to initiating and maintaining out-of-control sexual behaviors. They confirmed this association, with a prevalence in the male population that seems to be more susceptible to the development of sexual addiction and compulsion. Thus, this behavior is a transversal phenomenon that vulnerable people can use to manage intense and negative emotions related to the distress of abuse [ 19 ].

The experience of women with sexual compulsivity is intensely shame-based and difficult to deal with. The family preconditioning of abandonment in childhood emerges through inadequate care, experiences of abuse, abandonment, and the presence of other addictions, as shown by case studies analysis [ 20 , 21 ]. As children, these women were looking for something to ease their distress when they could not rely on their caregivers. Mostly, they use maladaptive coping mechanisms, such as compulsive masturbation, binge eating, and violent fantasies, to maintain their sanity in childhood.

According to Freud’s theory, at the basis of this behavior might be a trauma suffered by the children caused by the experience of impotence and the contact with a threatening adult [ 22 ]. This experience triggers strong anguish in the face of which the child activates a series of defenses to protect themselves, including the conversion of the trauma and identification with the aggressor. These modalities convert, to quote Stoller, “the infantile trauma into an adult triumph” [ 23 ].

Sexual atypia and paraphilias lead to reliving the traumatic experience while preserving the illusion of control and sexual gratification, which provides individuals with a false sense of power that preserves their integrity. The strong aggression and anguish distort the vision of the other, who becomes a dehumanized object. This is the mode implemented to cope with strong emotions derived from traumatic experiences [ 24 ].

Indeed, at the origin of masochism, there could be an infantile experience of passivity and annulment. In this case, the mechanism of reversal of the experience undergone is structured as a masochistic defense. In the adult re-perpetration of the trauma staged in the perversion, the person is no longer the passive victim of an executioner but the holder of control. It is the subject who asks the executioner to suffer and to be objectified. This perception gives masochistic pleasure to the person. From this point of view, the masochist’s pain is a defense against the greater and deeper pain of rejection [ 22 ].

In this way, sadomasochistic sexual practices could assume a key role in sexual trauma processing. BDSM (slavery and discipline, domination and submission, sadism and masochism) is receiving increasing attention from the scientific community. The term BDSM identifies a wide range of erotic practices between two or more consenting partners who share sexuality based on games of power, dominance, and submission from which they derive satisfaction and pleasure. Today, the BDSM phenomenon is viewed from a biopsychosocial perspective [ 25 ].

Studies show a positive correlation between BDSM interests and personality traits, adverse childhood experiences, education levels, sexual orientation, and biological indicators. The limitations of the research lie in the fact that most studies so far are only descriptive [ 26 , 27 ]. Some researchers have focused on better understanding the aspect of pain within a BDSM interaction [ 28 , 29 ], as experiencing afflicting or receiving pain is a relevant part of BDSM interaction. The result is that BDSM practitioners seem to have a higher pain threshold overall and, specifically, submissive BSDM interaction results in a constant increase in pain thresholds [ 28 ].

Further research focused on the rewarding biological mechanism associated with BDSM interaction. They found that submissive practitioners showed increased cortisol and endocannabinoid level due to the BDSM interaction, while dominant practitioners only showed increased endocannabinoid levels when the BDSM interaction was associated with power-plays [ 30 ].

1.3. Strategic Counseling

Strategic counseling is an intervention that refers to the theory of strategic psychotherapy and aims to reach a specific goal through techniques based on communication. Strategic counseling is efficient in modifying patients’ points of view and in promoting the solution of their issues [ 31 , 32 ].

Strategic counseling is effective in managing personal, relational, and working problems. One of the most important characteristics of strategic counseling is the focus on the function and the dynamic of the issue (“how my problem works”), instead of on the causes (“why I have a problem”). The focus is on the present and the future and not on the past, which represents a starting point to assess patients’ cognitions [ 33 ]. According to the process of strategic counseling, there are solutions as well as problems and these solutions are strongly related to the characteristics of the issue, akin to a dress tailored to the patient. Strategic counseling is a flexible type of counseling—it adapts to the specific problem until it leads the person to perceive the problem differently and therefore to change their behavior. The most used element of strategic counseling is communication, the so-called “strategic dialog” [ 34 , 35 ].

Strategic communication is characterized by a series of techniques that lead people to discover new ways of perceiving and managing problematic situations. Therefore, strategic dialogue leads to an experience of changing one’s own feelings and perceptions, modifying one’s perspective. Strategical problem solving is one of the most common techniques, which we could define as the “technology” to find solutions because of its effectiveness in finding alternatives [ 36 , 37 , 38 ].

Finding alternative solutions to a problem is not easy and leads to implementing the usual solutions, the so-called “attempted solutions”, but which turn out to be unsuccessful, only increasing the sense of inadequacy and dissatisfaction [ 39 ]. The attempted solutions have the function to maintain the problem and to create a vicious circle in which the person is psychologically trapped.

Strategic problem solving modifies the dynamics of rational linear thinking to find the solution, through stratagems of non-ordinary logic. This allows finding a solution in the present rather than an explanation in the past [ 38 ].

Therefore, strategic counseling is characterized by its flexibility and adaptability to the problem presented, since it makes use of strategies and techniques conceived and adaptable to the established purpose. Indeed, as the counseling intervention proceeds, it can be reoriented based on the observed effects. This intervention method guides clients to change their behavior, their feelings about the problem, and the perception of events, changing their perspective of observation and feelings connected to the problem. Clients experience new perceptions and discover different ways to manage and overcome difficulties. These sensations and perceptions become actions and behaviors that lead to higher individual awareness. According to this perspective, behavior change derives from a modification of perceptions that simultaneously generate a different way of conceiving and relating to reality or “to change to know” [ 35 ].

1.4. Strategic Behavioral Prescriptions

Prescriptions are tasks and indications that the therapist provides during the sessions. The patient must perform these tasks between sessions or during the session itself. In strategic counseling, behavioral prescriptions represent an important function, since to bring about a change one must go through concrete actions, acting on the problem even in the absence of the therapist [ 40 ]. This absence allows patients to demonstrate that they can change their situation from a concrete experience. Prescriptions can be direct, indirect, and paradoxical [ 41 ].

In the first case, these are clear indications about the actions that the patient should perform. These aim at achieving a specific and shared goal in the session. Collaborative patients with low resistance benefit from this type of prescription.

Indirect prescriptions are behavioral injunctions that hide their true goal and circumvent the individual’s resistance. These prescriptions are best suited to those who resist changing. They act persuasively through linguistic and hypnotic suggestions. The therapist shifts the patient’s attention from the problem to other elements that reduce the tension linked to the discomfort, allowing the individual to neutralize the problem.

The paradoxical prescriptions, on the other hand, provide for the use of the symptom of resistance to therapy, as actions to be voluntarily implemented or exasperated to increase the level of control perceived by the patient about a previously spontaneous situation [ 41 ].

The therapist reinforces the results obtained by the patients, redefining the situation and gratifying them [ 42 ]. Prescriptions play a key role in strategic counseling and are part of the change process as they create a bridge between the patient’s reality and the therapeutic setting.

2. Materials and Methods

2.1. procedure.

This case report illustrates the story of Sara, an Italian girl of 17 years of age. Sara suffers from BDSM-type sexual addiction, self-aggressive behavior, and alcohol abuse because she was a victim of sexual harassment when she was a child. Sara was involved by her mother in a strategic counseling program. The strategic counselor (SC) was a young woman, and the therapeutic process was divided into 15 weekly sessions which were 60 min long, as described in Table 1 :

Strategic counseling sessions and objectives.

2.2. Ethical Statement

Sara and her mother were informed by the strategic counselor that the therapy will be part of a scientific publication. The aims, the methods, and the procedure were explained to the minor and her mother in verbal and written forms. The SC obtained the informed consent of the participants to publish the therapy in online and paper journals. The participants were aware that their sensitive data (names, places, etc.) would be subject to change to protect privacy.

The informed consent was redacted according to the Italian Deontological Code of Psychologists of the National Council of the Order of Psychologists 2020 ( www.psy.it ) (accessed on 10 May 2021) and was based on the following Italian legislative references: Law 633/1941 Article 96 (Protection of copyright and other rights related); Civil Code Article 10 (Abuse of the image of others); Civil Code Article 23 (Consent for personal data processing); Legislative Decree n. 196/03 Article 13 and EU Regulation 2016/679 (GDPR) Article 13 (Information on the processing of personal data).

The collected materials are kept confidential under the responsibility of the SC.

3. Case report: Sara’s Story

3.1. assessment and therapeutic alliance.

Sara goes to art school, she is an only child and has lived alone with her mother since her father left home when she was 10. Sara was involved in the strategic counseling process by her mother, worried about her daughter’s high-risk behaviors, such as engaging in sex with several occasional partners and binge drinking.

Although it is not her direct request, Sara immediately demonstrates a good motivation to undertake the therapeutic path. Moreover, despite her young age, Sara shows good awareness of her psychological, physical, and cognitive state, expressing her feelings and thoughts.

During the first session, the strategic counselor invites Sara’s mother to attend. However, Sara shows considerable difficulty in talking about herself in the presence of her mother, so the SC decides to be alone with Sara. In the absence of her mother, Sara discloses with the SC, although with slight difficulty, describing her problem in relations with other, especially males, and telling the SC about the trauma she experienced when she was six, namely a sexual assault by a man of 20. Sara expresses embarrassment and shame in telling of her traumatic experience, holding her head, avoiding the therapist’s gaze, and never using the word “rape”. Sara also affirms that since she was 12, she has had violent sexual intercourse and bondage relationships with peers. Furthermore, when she decides to have sex with someone, she also binge drinks alcohol. Sara’s mother is unaware of her daughter’s trauma and believes that her daughter’s destructive attitudes are part of her adolescence. Sara describes her mother as a “normal, slightly apprehensive housewife”. She considers her childhood quite happy. However, when she was very young, her mom went through a particularly intense moment of emotional distress due to numerous conflicts with her father, which is why she often had to care for her ailing mom. For this reason, Sara decided to avoid telling her mother about the sexual violence.

The SC uses the techniques of active listening and lets all the elements emerge that the girl is ready to share. At the end of the session, the SC thanks Sara for the trust and courage shown and gives the girl a task, called “my objectives”. According to the prescription, she is required to describe the personal goals which she wants to obtain by means of the therapy.

During the second session, Sara comes alone. She sits and starts to read the task without any encouragement from the SC. Sara identifies her sex life as a source of discomfort. Her sexuality is characterized by strong and uncontrollable impulses, which lead her to seek out sexual acts and physical violence. When she has these impulses, she often contacts some friends who practice BDSM, namely bondage (not professional), and she asks them to have violent sexual intercourse, after binge drinking. Her mother discovered her activity when Sara came home one night with marks and bruises all over her body. On that occasion, Sara admitted to her mother that she has a problem managing her sexuality and that she explicitly asks her partners to practice bondage and to inflict upon her asphyxiation and physical violence. The girl explains that this kind of suffering gives her the feeling of control, as she is the one who decides to feel pain and the level to which she does so. An aspect that Sara realizes in completing the prescription is that when she had homosexual intercourse, she never felt the need to suffer violence. With boys, however, she sought violence during penetration and, in particular in practicing bondage. Sara realizes that her sexual impulses never allowed her to have a relationship and she describes sex as a punishment that she uses because she thinks she does not deserve to be loved.

The SC and the patient identify the main objectives of the therapeutic process as elaborate on the trauma deriving from sexual abuse suffered in childhood, exploring sexuality without the use of alcohol or violence, and structuring a new self-image considering her desires and resources.

During the third session, the SC describes to the patient the process of trauma processing, explaining the role of repressed emotions and memories. Despite the fear of reliving her trauma, Sara shows a strong motivation to continue the process, saying that she stopped her sexual impulses after her mother discovered them. Additionally, Sara admits that during those nights in which she practiced bondage, she felt that she could have suffocated. That event impacted the perception of Sara towards her sexuality, leading her to relive the same fear she felt during the abuse she suffered. Sara is not ready to tell her mother the truth. However, she does not exclude the possibility of doing this in the future.

It appears immediately functional for Sara to have a young female figure as a therapist to project and analyze some dynamics of her behavior without fear of being judged and to gradually acquire confidence.

3.2. Sexual Violence-Trauma Processing and Positive New Identity Structure

The second part of the therapeutic process was focused on trauma-processing and on the possible evaluation of the dysfunctional coping strategies used by Sara to manage her negative feelings connected to the traumatic experience. First, Sara was instructed to explore the dynamics of her trauma, learning how to change the memories linked to the experience. Sara explored her body’s reaction during her processing of trauma, and she also understood what happens in talking about her sexual violence. She analyzed her physical and emotional reactions, living and exploring the situation in the therapeutic setting. The second step of the trauma-processing was to lead Sara to tell her traumatic story from multiple points of view, exploring it as if she could relive it but from the outside, as an observer. The goal was to teach Sara, progressively, how to understand the emotions connected to the trauma and be able to face them, and then live the experience as a story that is part of her life but that can no longer hurt her because it belongs to the past. To reach this goal, the SC gave to Sara a specific prescription: “imagine that you can do something to make your current condition worse, imagine the worst fantasy on your traumatic experience”. This prescription leads the patient to realize that she has control over the decision-making process about her malaise and to analyze all the attempted solutions she has implemented and continues to implement even though they are dysfunctional, to solve her problem.

At first, Sara expressed difficulty in imagining how her traumatic experience could have been worse; however, later she created alternative scenarios that saw her capable of worsening her fantasy about the past and about the present. Sara gained more control over her choices and realized that self-harm related to extreme sexuality and alcohol abuse stems from this idea of not having control over her body, as someone else has it instead. When she carries out these harmful behaviors, she allows another person to harm her, and this removes her responsibility and reduces her sense of guilt for not having protected herself during the aggression suffered as a child.

Sara analyzed her relationship with alcohol and stated that what she appreciates most is the sense of relaxation and the absence of tension. However, once this effect is over, Sara suffers a psycho-physical breakdown, sadness, and a sense of emptiness. The substance, therefore, mitigates the anxiety of the girl, who slowly undertook to reduce its use to monitor the effect that these changes in behavior have on well-being. Additionally, Sara practices bondage during sexual intercourse, and she feels very protected and accepted and can share an aspect of herself that is more complex to externalize. Sara does not share this aspect of her life with her mother and feels it is not understood. After she started the therapeutic path, however, Sara became more confident in her relationship with her body, asking her mother for advice and support.

The SC explained to the patient that she should not aim to reach a socially shared normal range, but the goal is to understand its functioning and progressively reduce everything that causes her discomfort. Bondage-related BDSM experiences are denial and defense mechanisms that Sara uses, along with alcohol, to avoid dwelling on her suffering. The two thematic areas, bondage and alcoholic binging, are intertwined during the sessions. These draw a parallel between the desire, the effects, and consequences of alcohol and the violent sexual experiences Sara sought. These two conditions have in common the associated emotions and the subsequent intense sense of emptiness and sadness. Sara now hypothesizes that she can do without the search for risky or self-harming situations and for the first time she reflects on the meaning that these actions have for her, as she said: “I thought I was in control by drinking and doing violence to me, but it was my addiction to violent sex and alcohol that had control over me”.

The SC explained to the patient the theory of the “self-fulfilling prophecy”, asking her to reflect on how she could change this prophecy. The last four sessions before the therapeutic restitution and closing phase were focused on the building of a new positive identity structure. Sara was required to learn and apply strategies to (a) monitor her psycho-physical sensations related to self-harming behaviors, alcoholic binges, and bondage, understanding the relationship with her emotions; (b) learn to respect her body more and to assume control of her decisions, passing from a passive to an active role; and (c) find alternatives to violent sexual behaviors.

To achieve these aims, the SC gave to Sara the following prescriptions:

• (a) A diary of emotions, structured to analyze the type of emotion, the antecedent, thoughts, actions, strategies, and consequences and to become more curious and attentive toward her feelings and reactions.
• (b) The use diaphragmatic breathing once per day, to get in touch with her body, focusing on physical needs.
• (c) Dedicating some time to her sexual pleasure, identifying new activities and modalities as alternatives to violent bondage, associated with alcohol abuse.

Regarding the first prescription, during the sessions, Sara reported having monitored her emotions related to negative feelings and the need to self-harm through sex and alcohol as her coping strategies. She described some events in which she felt alone and misunderstood by her mother or friends. However, analyzing the situations, she found inconsistencies between her interpretation and the reality, understanding how often she tends to blame others for her malaise. Doing this exercise every day and illustrating to the SC all the reported events and emotions, Sara progressively recognized that she has mental patterns that lead her to perceive others as threats and to feel misunderstood and alone. Her strategy is always to make others abuse her to confirm her attribution of guilt.

Sara is now more aware of the way she uses violent sex and alcohol and the psychophysical consequences that come with it. This careful analysis of her behavior, together with the other two prescriptions, allowed the girl to get in touch with the needs of her body, to focus on physical and sexual well-being, without feeling negative emotions and guilt or punishing herself sexually with bondage. In fact, during the weeks between sessions, Sara learned to dedicate herself to the well-being of her body and explored other activities related to sexual pleasure that did not involve the use of violence, such as masturbation and petting, only with people of who she trusts. Additionally, Sara progressively talked with her mother, telling her about her progress.

The emotions during the task related to the exploration of sexuality were positive, as Sara was able to give herself something satisfying. A very interesting and adaptive sensation for the patient’s functioning is that she felt pampered and protected by herself during masturbation and by her sexual partner during petting. Sara also decided to no longer engage in sexual activities that result from negative emotions. Bondage for her will always be an aspect of her sexuality but she wants to be able to decide and not let her trauma take over.

The new ways of exploring sexuality that Sara learned required considerable effort. Sara was very brave and found a personal space in which to find her own new identity. These sensations are new for her, as Sara has never explored her body or recognized her sexual needs, if not mediated by violence. The contact with the body, now experienced positively, reduces the sense of shame.

The SC positively reinforces Sara’s need to find herself, reflecting on her resources. Sara has already found her inner space, she just has to keep feeding it in order to not fall back into the old dysfunctional strategies. To do this, Sara needs to continue with the prescription for another two weeks, in which she will explore her autonomy from the SC. Sara can contact the professional if she needs to, but she does not come to the counselor’s office for two weeks. In addition, the SC gives Sara another prescription, to add to the previous ones: “What I want when I want”. According to this behavioral task, Sara will do something that she desires to do, just to experiment with the pleasure of doing this. Sara can do more than one thing, but she must do at least one per day.

3.3. Therapeutic Restitution and Follow-Ups

This conclusive part of the therapeutic process aims to reinforce the positive outcomes obtained by the patient and to restitute feedback on the acquired strategies for the future. To reach these goals, the SC used the suitcase metaphor, comparing the therapeutic experience to a journey during which Sara learned some coping strategies useful to manage stressful events and to better organize her new life and identity. The patient imagines having a suitcase in which she can collect and take these strategies with her, to cope with difficulties and to maintain her outcomes.

During the last session, the SC asked Sara to describe her therapeutic process, looking to herself as an observer and pointing out the main changes and results obtained. Sara was enthusiastic to describe her improvements. She reported some actions done for the “What I want when I want” prescription, such as spending time with friends, reading books, and taking long walks. Sara did not show any negative feelings, such as shame or embarrassment, in admitting her old habits and in recounting the trauma experienced in childhood. She now is more aware and less afraid of her impulsive and destructive behaviors and aims to build a “true” identity, not being influenced by the violence suffered. Sara, however, expresses her fear of falling back into the dysfunctional behaviors and harming herself again.

The SC explains therefore that the therapy foresees two follow-up sessions, one after one month and one after three months. These sessions are aimed at monitoring Sara’s progress and helping her to maintain them over time. This perspective reassures the patient, who greets the SC with affection and gratitude. The SC also explains to Sara that in the month in which they will not see each other, she will have the sole task of using the tools learned in therapy, metaphorically opening her suitcase, and pulling out the ones that best suit the situation she must deal with.

After one month, the SC meets Sara and she tells the professional about her progress. During the month, the teenager often confronted her mother, explaining her problems and asking for help when she felt aggressive impulses. The mother responded adequately to her daughter’s requests, showing herself to be present and welcoming. Sara also tells of having opened her suitcase on several occasions and having used some strategies learned in therapy. Sara decided to continue to explore her sexuality through masturbation and petting and only with people she trusts. She did not experiment with compulsions regarding sexuality or binge drinking, and she started to practice sport (running) to take care of her body. During the session, the SC reinforced the prescription of the suitcase, adding the task to identify other tools and strategies to add to it.

Three months later, the SC conducted the last follow-up with the patient. During the session, Sara was excited to tell the SC her improvements. Indeed, she was selected to participate in a competitive run, and she also had her first sexual intercourse without the use of violence or bondage. Sara felt satisfied with her progress and she also added a tool in her suitcase: get in touch with her physical sensations. Sara started to concentrate more on her body and her physical needs. The SC compliments Sara and positively strengthens her progress. The counselor asks her to continue filling her suitcase with useful strategies and tools for her future.

4. Discussion

According to the definition of child sexual abuse, sexual harassment can be described on a continuum of power and control from non-contact sexual assault to contact sexual assault [ 4 ].

This phenomenon is widespread among children; indeed, one out of two children per year worldwide suffers some form of violence [ 43 ].

The recent scientific literature on sexual abuse shows that the consequences of this traumatic event jeopardize both the physical and psychological health of the individual and cause lifelong distress. The gradual emergence of symptoms following exposure to traumatic events represents a conceptual challenge for psychology and psychiatry. Indeed, child sexual abuse is associated with mental health issues, drug or alcohol addiction, and post-traumatic stress disorder [ 4 ].

This work aims to explore the possible relationship between experiences of childhood abuse and the development of pathological compulsive sexual behavior, sexual addiction and BDSM conducts. These pathological sexual behaviors are characterized by inappropriate or excessive sexual acts or cognitions that lead to subjective distress or impaired functioning.

Sadomasochistic sexual practices are receiving greater attention from the scientific community than in the past. The acronym BDSM identifies a wide range of erotic practices between two or more consenting partners who share sexuality based on games of power, dominance, and submission from which they derive satisfaction and pleasure. Risk factors are thought to include family history and childhood abuse, and it seems that compulsive sex and BDSM practice represent a functional behavior to compensate for the traumatic experiences of abuse [ 44 ].

The case report illustrated herein shows an association between sexual violence and risky behavior in adolescence. Sara is a 17-year-old adolescent who suffered sexual violence when she was six and developed a sexual addiction relating to BDSM (bondage) and binge drinking. The mother of Sara, worried about her daughter, introduces Sara to the strategic counseling process. The SC sessions were divided into 15 sessions with specific goals and prescriptions. At first, Sara revealed her story, talking of the sexual abuse and of the tendency to have violent sexual intercourse, to practice BDSM, specifically bondage, and to drink alcohol before sex. The first step of strategic counseling’s process (three sessions) was to focus on the assessment and on establishing a therapeutic alliance. Specifically, the SC created a therapeutic alliance with the patient, who learned to manage negative emotions related to the abuse. Sara associated herself with the counselor, a young woman, and established a strong relationship of trust. The patient and the counselor used this positive relationship to co-build objectives for the other steps of the therapy.

The second (five sessions) and the third steps (four sessions) were focused on sexual violence-trauma processing and had the aim of elaborating the memories related to the trauma and on building a new identity. In this phase, Sara analyzed her relationship with alcohol and BDSM. She understood the role of substance abuse and violent sex in her life. Indeed, on the one hand, alcohol and sex mitigate the feeling of anxiety and she feels invincible, but on the other hand, Sara perceives a sense of shame and guilt. During this process of evaluation of her coping strategies, Sara started to communicate with her mother, asking for support. The SC guided Sara to discover more functional strategies for her well-being. The counselor explained the theory of the “self-fulfilling prophecy” and encouraged Sarah to make a positive prophecy about herself come true. At the end of this phase of counseling, Sara learned to monitor her psycho-physical sensations related to self-harming behaviors, alcoholic binges, and bondage, understanding the relationship with her emotions, and to respect and explore her body more, assuming the control of it and being active, as well as in her sexuality. These skills led Sara to find alternatives to violent sexual behaviors.

The final step (one session) was based on the therapeutic restitution and the SC positively reinforced the outcomes of the therapeutic process and restituted feedback on the acquired strategies for the future. To do so, the SC used the metaphor of the suitcase, according to which Sara can collect the strategies she learned into this suitcase and she can open it and use them anytime she feels the need.

The SC performed the first follow-up one month after the end of the therapy and a follow-up after three months. During both follow-ups, Sara demonstrated having maintained the positive outcomes of the therapy and using her suitcase to cope with difficulties. Sara practiced sport and stopped using BDSM, violent sex, and alcohol. Today, her relationship with sexuality is based on self-eroticism and petting with people she trusts.

5. Conclusions

The review of the literature and the case report presented highlighted the importance of exploring the possible connection between childhood sexual abuse and the development of compulsive sexual behavior and BDSM practices in adulthood. The recognition that comes from relationships with others (partner, sexual interest, work) confirms the value of our existence. Consequently, some individuals could undertake their search for contact through the forced transition from the passive to the active role, displaying risky behavior concerning fears and life experiences.

Hypersexuality and sadomasochistic practices might compensate for the missing part of the subject’s ego. The pain of self-esteem’s loss, parental affection, or childhood omnipotence is anesthetized through perverse action and fantasy. Sexual practices based on violence and coercion in some cases allow individuals to act out their fantasy of perfection. In this act, the sadist is reunited with his/her lost omnipotent self and the masochist abandons himself/herself in the other, rediscovering the fusion condition of childhood.

This division between reality and fantasy, between loss and the denial of grief, is also reflected in the thinking of these subjects as an inability to accept different views, without considering nuances or a middle ground.

Author Contributions

Conceptualization, V.S.; writing—original draft preparation, V.S., E.Z., S.E., M.P.; writing—review and editing, S.E., V.S.; supervision, V.V.; funding acquisition, V.V. All authors have read and agreed to the published version of the manuscript.

This research was published thanks to the contribute of the Institute for the Study of Psychotherapies, Rome, Italy; and the Department of Human, Social and Health Sciences of the University of Cassino and Southern Lazio, Cassino, Italy.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the Institute for the Study of Psychotherapies, Rome on 26 April 2018.

Informed Consent Statement

Written informed consent has been obtained from the patient(s) to publish this paper.

Conflicts of Interest

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

EssayEmpire

Sexual violence essay.

No universal definition of sexual violence exists because cultural and social norms and laws define the act; however, many professionals agree on several underlying concepts of sexual violence. Sexual violence includes any unwanted or unlawful behavior perpetrated with the use of coercion and/or force against one’s sexuality by a person either known or unknown to the victim. Sexual violence is a global problem with many consequences for the individual(s) involved, the larger community, and society as a whole.

Although sexual violence is often perceived as an extreme form of violence, a wide range of behaviors constitutes sexual violence, from harassing verbal comments and gestures to physical touching and penetration. While the act of sexual violence is often characterized by physical and verbal behaviors, a large component of sexual violence is mental. Sexual violence is a display of subordination whereby an asymmetrical balance of power and control is present between the perpetrator and the victim. Power may be attributed to one’s physical properties, such as a person’s body size and strength, or it may be attributed to social, financial, or political properties. The perpetrator uses this imbalance of power to coerce or force the victim to surrender to the perpetrator’s control.

A majority of sexually violent incidents occur between acquaintances, contrary to the common belief that strangers often perpetrate sexual violence. Sexual violence is one of the most under-reported incidents for a number of reasons, depending on individual factors, belief systems, and cultural expectations. Many victims may fear retaliation from the perpetrator, may be too embarrassed or humiliated by the episode(s) to report the incident(s), may not feel the authorities can ameliorate the situation, may not perceive themselves to be victims of sexual violence, or it may be socially and culturally unacceptable to inform others about the incident(s), potentially bringing shame to their families. Because sexual violence is grossly under-reported and has no single definition, it is a difficult subject on which to compile accurate statistics.

Women and children are at greatest risk for sexual violence victimization, but other groups are vulnerable, such as the elderly, the disabled, and inmate populations. Other vulnerability factors have been correlated with sexual violence victimization, including a prior history of sexual violence, drug and alcohol use, high-risk sexual behaviors, and poverty. Individuals with lower socioeconomic status typically lack economic and educational resources for survival and for responding to sexual violence, thus placing them at greater risk for victimization. Women living in poverty are also at risk for intimate partner violence, in which sexual violence is a component. Many such vulnerability factors are often consequences of sexual violence, too.

Males are at greater risk for perpetrating sexual violence. No single explanation for the cause of sexual violence exists, but there are many factors associated with the perpetration of sexual violence. Individual factors placing a male at risk for perpetration include drug and alcohol use, hostility toward women, and childhood sexual and physical abuse. Relationship factors placing a male at risk for perpetrating sexual violence include association with delinquent and aggressive peers, unstable and violent family environments, and patriarchal family and community structures.

Other community factors that increase the likelihood of sexual violence include weak sanctions against, and tolerance for, perpetrators of sexual violence; a lack of economic means, such as employment; and a lack of support from law enforcement. Larger social factors affect the likelihood that males will sexually violate others, including poverty and a lack of policy addressing gender inequality. A tolerance for the subjugation of women and male superiority and sexual entitlement continue to influence sexual violence perpetration in many countries.

The consequences of sexual violence for victims are widespread, including immediate and long-term costs for the victim, the community, and society. Consequences may be physical, psychological, social, and health related, depending on the victim and perpetrator relationship and the type, frequency, and severity of violence endured.

Physical injuries may be sustained during the incident of sexual violence. For example, bruising and lacerations may result from the perpetrator’s use of force or use of weapons. Injuries to the victim’s sexual organs may also result from forced penetration. Sexually transmitted diseases and unwanted pregnancies are also potential physical repercussions of sexual violence.

Psychological injuries will vary among victims depending on various factors. Short-term problems include shock, denial, anxiety, and a loss of trust of others. Long-term consequences include post-traumatic stress disorder, depression, and a fear of revictimization. Health-related consequences, including engaging in risky sexual behaviors and drug use and abuse, not only are potential short-term and long-term consequences of sexual violence but also place the victim at risk for being revictimized.

Many other crimes, such as prostitution and sex trafficking, entail the potential for sexual violence to occur, particularly rape. Increased use of technology, particularly the use of the Internet, provides new domains for sexual violence and propaganda to occur, such as pedophilia and stalking. Female genital mutilation is a cultural practice that has been outlawed or restricted in several countries. Finally, rape has been used as a tool of warfare against women in countless wars spanning countless periods of time. All these implications entail a different perspective of a global problem.

Sexual violence is a complex phenomenon with a wide range of risk factors and consequences for all individuals involved, particularly the victim. Regardless of the victim’s culture and background, the consequences of sexual violence lend insight into why such violence is a social problem on numerous levels, leaving a host of problems to be mitigated and overcome.

Bibliography:

• National Sexual Violence Resource Center. 2004. “Global Perspectives on Sexual Violence: Findings from the World Report on Violence and Health.” Geneva, Switzerland: World Health Organization. Retrieved March 30, 2017 ( http://www.nsvrc.org/sites/default/files/Publications_NSVRC_Booklets_Global-perspectives-on-sexual-violence.pdf ).
• Paludi, Michelle A., ed. 1999. The Psychology of Sexual Victimization: A Handbook. Westport, CT: Greenwood.

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