title: The Association Between Unwanted Sexual Experiences and Early-Onset Cervical Cancer and Precancer by Age 25: A Case-Control Study.
abstract: We examined the association between unwanted sexual experiences and cervical cancer, cervical intraepithelial neoplasia 3, adenocarcinoma in situ, diagnosed ≤25 years of age.
  
  
  
  A case-control study of women ≤55 years who attended gynecological hospitals in Australia between 1983 and 2007. Cases were ≤25 years when diagnosed with disease, control group 1 were "older women" >25 years at diagnosis; control group 2 were "well women" ≤25 years attending preventive health clinics. A self-administered postal survey was utilized. The main outcome measures were prevalence of childhood sexual abuse (<16 years) and unwanted adolescent sexual experiences (between 16 and 18 years) in cases compared to controls.
  
  
  
  Of 400 contactable subjects, 251 participated (62.8%). Prevalence of childhood sexual abuse in cases (26.6% [25/94]) was similar to other groups. Prevalence of childhood genital contact abuse in cases with cervical cancer was 45.5% [5/11], compared to older women (20% [10/50], p = 0.08) and well women (13.8% [8/58], p = 0.01), and was marginally more common compared to well women when adjusted for other lifestyle factors (odds ratio [OR]: 4.7 [1.0-22.6], p = 0.05). Prevalence of unwanted adolescent sexual experiences in cases was 28.9% [33/114]. Prevalence of adolescent penile-genital contact experiences in cervical cancer cases was 46.7% [7/15], compared to older women (9.4%, [6/64], p < 0.001) and well women (13.7%, [10/73], p = 0.003), and was more common compared to well women when adjusted for lifestyle (OR: 5.9 [1.4-24.9], p = 0.02) and sexual health risk factors (OR: 5.6 [1.4-22.1] p = 0.01).
  
  
  
  Unwanted sexual experiences with genital contact were a risk factor for invasive cervical cancer ≤25 years, likely due to a complex interplay of biological and environmental factors.
authors.affiliation: 1 Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne , Melbourne, Australia .|2 Department of Gynaecology, Royal Children's Hospital , Melbourne, Australia .
authors.forename: Yasmin Leela
authors.initials: YL
authors.lastname: Jayasinghe
authors.affiliation: 3 Department of Medicine, Austin Health , Heidelberg, Australia .
authors.forename: Victoria
authors.initials: V
authors.lastname: Sasongko
authors.affiliation: 4 Department of Internal Medicine, Singapore General Hospital , Singapore, Singapore .
authors.forename: Rachel Wenrui
authors.initials: RW
authors.lastname: Lim
authors.affiliation: 2 Department of Gynaecology, Royal Children's Hospital , Melbourne, Australia .|5 Murdoch Childrens Research Institute , Melbourne, Australia .
authors.forename: Sonia Regina
authors.initials: SR
authors.lastname: Grover
authors.affiliation: 5 Murdoch Childrens Research Institute , Melbourne, Australia .|6 Women's Centre for Infectious Diseases, Royal Women's Hospital , Melbourne, Australia .
authors.forename: Sepehr N
authors.initials: SN
authors.lastname: Tabrizi
authors.affiliation: 6 Women's Centre for Infectious Diseases, Royal Women's Hospital , Melbourne, Australia .
authors.forename: Elya E
authors.initials: EE
authors.lastname: Moore
authors.affiliation: 5 Murdoch Childrens Research Institute , Melbourne, Australia .|7 Clinical Epidemiology & Biostatistics Unit, Royal Children's Hospital , Melbourne, Australia .
authors.forename: Susan
authors.initials: S
authors.lastname: Donath
authors.affiliation: 1 Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne , Melbourne, Australia .|5 Murdoch Childrens Research Institute , Melbourne, Australia .|6 Women's Centre for Infectious Diseases, Royal Women's Hospital , Melbourne, Australia .
authors.forename: Suzanne Marie
authors.initials: SM
authors.lastname: Garland
keywords: cervical cancer; human papillomavirus; sexual abuse; young women