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A groundbreaking study published in Social Science & Medicine has shed new light on the enduring impact of child sexual abuse (CSA), revealing how survivors experience not only profound psychological distress but also persistent physical pain that can last for decades. Led by Dr. Noga Tsur of Tel Aviv University, the research examines how pain—both during and long after abuse—becomes an inescapable reality for many survivors, influencing their daily lives and relationships in profound ways.
The Overlooked Role of Pain in Child Sexual Abuse
While extensive research has explored the psychological trauma of CSA, the experience of physical pain during and after abuse has received far less attention. Tsur and co-researchers analyzed 29 testimonies submitted to the Israeli Independent Public Inquiry on CSA, using qualitative thematic analysis to identify three critical themes: pain as a distress signal, the internalization of pain, and the intermingling of physical and emotional suffering.
Pain as a Distress Signal
The study found that many survivors reported experiencing intense physical pain at the time of the abuse. This pain often served as an involuntary distress signal—not only alerting the survivor to their own suffering but, in some cases, making it apparent to others around them. However, perpetrators frequently ignored or dismissed these expressions of pain, further deepening the trauma.
One survivor described the ongoing nature of this pain, recalling: “It happened every day. Since I can remember, until age 14, there in that shower, and every time it hurt, when the body contracted, when the tears wanted to come out, I heard: ‘You have to be clean, and there is the most dirt down there.’”
For some, their body’s automatic responses—flinching, tensing, or crying—became an unspoken plea for the abuse to stop, only for their pain to be disregarded by their abuser. One participant recounted: “He was not interested in pain. He usually tried not to hurt, but if it did hurt, it did not interest him.”
In a few cases, repeated complaints of headaches and stomach pains led caregivers to intervene. But for many, their signals of distress were ignored, leaving them to suffer in silence.
Chronic Pain and the Internalization of Trauma
The study also found that pain does not end when the abuse stops. Instead, for many survivors, it becomes a chronic presence—an internalized wound that lingers for years or even a lifetime.
Survivors in the study described their pain as an invisible yet persistent force, affecting their relationships, mental health, and even their physical well-being. One participant likened it to an incurable disease: “The external scars have long since passed […] but on the inside, everything is painful and stormy, just like it was 23 years ago.”
Others expressed frustration over the lack of understanding from society, feeling as though their trauma-related pain was dismissed or minimized: “My colleague has migraines, so she gets to take sick leave. What do I say? That my body harbors memories of trauma?”
The Blurring of Physical and Emotional Pain
One of the most striking findings of the study was how survivors struggled to separate physical pain from emotional anguish. Many described how their bodies reacted to triggers—certain smells, touches, or environments—bringing back the pain of their abuse as if it were happening again.
Some turned to coping mechanisms such as substance use to dull the pain, though this provided only temporary relief. One participant shared: “Cannabis doesn’t make the pain go away. It just lowers the intensity so I can breathe a little.”
The study also highlights how some survivors developed a complicated relationship with pain, even intertwining it with sensations of pleasure or guilt. This troubling phenomenon has been explored in other research, which suggests that CSA survivors may struggle with boundaries in intimate relationships, sometimes engaging in behaviors that mimic the abuse they endured.
A Call for Recognition and Better Treatment
Tsur and her colleagues emphasize that pain should be recognized as an essential part of the CSA survivor experience—one that is often overlooked in trauma treatment. The study calls for a more holistic approach to survivor care, integrating physical pain management with psychological therapy to address the full scope of their suffering.
Additionally, the researchers highlight the need for further study on the link between CSA and chronic pain, particularly the biological and neurological mechanisms at play. Their findings suggest that many survivors live with what amounts to “pain flashbacks,” in which their body re-experiences the agony of abuse through chronic conditions such as fibromyalgia, irritable bowel syndrome, and tension headaches.
Breaking the Silence
This study offers a sobering look at the hidden scars of CSA—ones that may not always be visible but are deeply felt. By amplifying survivor voices and shedding light on their experiences, researchers hope to push for better support systems, medical care, and social recognition of the true toll of CSA.
For survivors, the message is clear: their pain is real, and it deserves to be acknowledged. No one should suffer in silence.
