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A new study published in the Journal of Brain Imaging Behaviour looked at sexual assault and white matter hyperintensities among midlife women.

“Adverse mental health implications of trauma and sexual assault have been studied extensively over the years, yet much of this research wasn’t spotlighted before the advent of the #MeToo movement several years ago,” study author Dr. Rebecca Thurston told us. “There has been some work, including my own research, which linked experiences of trauma and sexual assault to the underlying cardiovascular disease risk in women. However, much less is known about what these traumatic experiences may mean for a woman’s risk of serious brain disorders such as stroke and dementia.”

Guided by their previous findings about the association between sexual assault and increased cardiovascular disease risk, the researchers of the current study examined the relationships between sexual assault and the vasculature in the brain. Disease in brain vasculature places one at risk for stroke and dementia. 

“We discovered that not only do women live with the mental burden of the trauma, but that that trauma shows up in their brains,” Dr. Thurston told us. “Specifically, we discovered that women who have experienced sexual assault have greater white matter hyperintensities in the brain compared with women who did not report experiencing trauma earlier in life.”

White matter hyperintensities – which researchers could see using brain imaging -- are markers of small vessel disease in the brain linked to risk for stroke, dementia, and mortality. 

Sexual assault is very common. Some estimates are that up to 44% of women will experience sexual assault in their lifetime. Trauma places survivors at risk for most mental health disorders, yet there has been little research linking these experiences to physical health.  

Researchers launched the current study in 2017 by enrolling 145 middle-aged women who did not have clinically diagnosed cardiovascular disease, stroke, or dementia. They asked them to complete several questionnaires, assessing the degree of depression, trauma endured earlier in life, as well as post-traumatic stress measures. They also assessed participants’ sleep, body mass index, lipids, and blood pressure. In addition, all women received magnetic resonance brain imaging to assess the presence of white matter hyperintensities.

“We found that more than half of women (68%) reported experiencing at least one trauma, nearly a quarter of our participants reported experiencing sexual assault – which, again, emphasized how common it is,” Dr. Thurston told us. "We found that women with trauma exposure had a greater brain white matter hyperintensities than women without trauma.”

Of all the various types of trauma, however, sexual assault is clearly ranked as having the most significant association.

“I was surprised to see how pronounced the association was between a sexual assault history and white matter hyperintensities in the brain, even after controlling for a range of potentially confounding factors, such as age, race/ethnicity, education, BMI, blood pressure, lipids, preeclampsia, sleep, and depressive or post-traumatic stress disorder symptoms,” Dr. Thurston told us. “This finding suggests that sexual assault may place women at risk for poor brain health later in life.”

The study results have implications for both the women and for clinicians. 

Dr. Thurston wants survivors to know what happened to them is not their fault, they are not alone and help is out there. 

“If you have experienced a sexual assault, and have ongoing psychological symptoms, such as trouble sleeping, anxiety, or depression, please seek help,” Dr. Thurston told us. “If you feel comfortable sharing that you have experienced sexual assault with your healthcare provider, please do so. It really matters for your health.” 

Dr. Thurston wants clinicians to ask their patients about their trauma history and get trained in trauma-informed care. 

“And if you know that your patient has experienced a trauma like sexual assault, be sure to monitor their medical risk factors and treat them, since the sexual assault may place them at greater risk for brain disease later in life.”