title: Sexual and physical abuse and gynecologic disorders.
abstract: Is sexual and/or physical abuse history associated with incident endometriosis diagnosis or other gynecologic disorders among premenopausal women undergoing diagnostic and/or therapeutic laparoscopy or laparotomy regardless of clinical indication?
  
  
  
  No association was observed between either a history of sexual or physical abuse and risk of endometriosis, ovarian cysts or fibroids; however, a history of physical abuse was associated with a higher likelihood of adhesions after taking into account important confounding and mediating factors.
  
  
  
  Sexual and physical abuse may alter neuroendocrine-immune processes leading to a higher risk for endometriosis and other noninfectious gynecologic disorders, but few studies have assessed abuse history prior to diagnosis.
  
  
  
  The study population for these analyses includes the ENDO Study (2007-2009) operative cohort: 473 women, ages 18-44 years, who underwent a diagnostic and/or therapeutic laparoscopy or laparotomy at 1 of the 14 surgical centers located in Salt Lake City, UT, USA or San Francisco, CA, USA. Women with a history of surgically confirmed endometriosis were excluded.
  
  
  
  Prior to surgery, women completed standardized abuse questionnaires. Relative risk (RR) of incident endometriosis, uterine fibroids, adhesions or ovarian cysts by abuse history were estimated, adjusting for age, race/ethnicity, education, marital status, smoking, gravidity and recruitment site. We assessed whether a history of chronic pelvic pain, depression, or STIs explained any relationships via mediation analyses.
  
  
  
  43 and 39% of women reported experiencing sexual and physical abuse. No association was observed between either a history of sexual or physical abuse, versus no history, and risk of endometriosis (aRR: 1.00 [95% confidence interval (CI): 0.80-1.25]); aRR: 0.83 [95% CI: 0.65-1.06]), ovarian cysts (aRR: 0.67 [95% CI: 0.39-1.15]); aRR: 0.60 [95% CI: 0.34-1.09]) or fibroids (aRR: 1.25 [95% CI: 0.85-1.83]); aRR: 1.36 [95% CI: 0.92-2.01]). Conversely, a history of physical abuse, versus no history, was associated with higher risk of adhesions (aRR: 2.39 [95% CI: 1.18-4.85]). We found no indication that the effect of abuse on women's adhesion risk could be explained by a history of chronic pelvic pain, depression or STIs.
  
  
  
  Limitations to our study include inquiries on childhood physical but not sexual abuse. Additionally, we did not inquire about childhood or adulthood emotional support systems, found to buffer the negative impact of stress on gynecologic health.
  
  
  
  Abuse may be associated with some but not all gynecologic disorders with neuroendocrine-inflammatory origin. High prevalence of abuse reporting supports the need for care providers to screen for abuse and initiate appropriate follow-up.
  
  
  
  Supported by the Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (contracts NO1-DK-6-3428, NO1-DK-6-3427, and 10001406-02). The authors have no potential competing interests.
authors.affiliation: Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, Rockville, MD, USA karen.schliep@utah.edu.
authors.forename: K C
authors.initials: KC
authors.lastname: Schliep
authors.affiliation: Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, Rockville, MD, USA.
authors.forename: Sunni L
authors.initials: SL
authors.lastname: Mumford
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Erica B
authors.initials: EB
authors.lastname: Johnstone
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: C Matthew
authors.initials: CM
authors.lastname: Peterson
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Howard T
authors.initials: HT
authors.lastname: Sharp
authors.affiliation: Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Stanford
authors.affiliation: Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, Rockville, MD, USA.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Uba
authors.initials: U
authors.lastname: Backonja
authors.affiliation: Mary Amelia Women's Center, Tulane University, New Orleans, LA, USA.
authors.forename: Maeve E
authors.initials: ME
authors.lastname: Wallace
authors.affiliation: Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, Rockville, MD, USA.
authors.forename: Germaine M
authors.initials: GM
authors.lastname: Buck Louis
mesh_terms: D000293:Adolescent; D000328:Adult; D004715:Endometriosis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D000066550:Physical Abuse; D012742:Sex Offenses; D055815:Young Adult
keywords: endometriosis; epidemiology; pelvic adhesions; physical abuse; sexual abuse