Sexual violence and sexual health outcomes among women in the Democratic Republic of the Congo: a multicenter cross-sectional study

Background and Objective Sexual violence has severe and long-lasting repercussions on women’s sexual and pelvic health, particularly in conflict-affected settings. This study aimed to evaluate sexual function and pelvic floor outcomes among survivors of sexual violence in the Eastern Democratic Republic of the Congo (DRC). Methods This cross-sectional study was conducted in Goma and Bukavu between 2022 and 2024. Female Sexual Function Index (FSFI) scores and pelvic floor parameters (tone, PERFECT, and pain) were compared between survivors of sexual violence and non-exposed women. Bivariate analyses and logistic and linear regressions were used to identify factors associated with sexual inactivity and sexual dysfunction. Key Findings and Limitations Among 328 women (176 survivors, 152 controls), sexual inactivity was significantly more common among survivors (78% vs. 42%, p < 0.001), and sexual violence remained independently associated with sexual inactivity in multivariable analyses (adjusted OR 4.37; 95% CI 2.42 to 7.88). Survivors also reported lower FSFI pain scores, indicating more pain during and following sexual intercourse (β –0.91; 95% CI –1.59 to –0.24). Pain intensity at the 6 o’clock position during vaginal palpation was significantly higher among the survivors (p = 0.004). Pelvic floor functionalities and tone were comparable across groups. Results are limited by the study's cross-sectional design. Conclusions and Clinical Implications Sexual violence is strongly associated with sexual inactivity and pelvic pain. These findings underscore the need for multidisciplinary, trauma informed rehabilitation strategies. Further longitudinal research is needed to guide culturally adapted interventions.