Violences sexuelles entre partenaires intimes : caractéristiques et enjeux cliniques

Abstract

IntroductionIntimate partner sexual violence is identified as a common form of intimate partner violence. It is also the most widespread form of sexual violence in the world, with one woman in four affected during her lifetime. In France, couple relationships appear to be the area of life most at risk of sexual victimization in adulthood. However, our understanding of this phenomenon is limited, with few targeted studies in the international literature and very little data in France. Most studies tend to focus on sexual violence in general or intimate partner violence in general, without exploring in depth the characteristics and issues of sexual violence when committed by a partner. While intimate partner violence is a major public health issue, what do we know about intimate partner sexual violence and how can we use this information to provide a better support for victims? ObjectivesThe aim of this article is to summarize the current state of the art about intimate partner sexual violence, along two major lines: a descriptive line, focusing on the nature, extent, and expressions of sexual violence in couples, as well as its clinical effects; and a food-for-thought line, focusing on the identification of issues likely to contribute to the harmful power of intimate partner sexual violence. Materials and methodsArticles were selected from referenced databases, such as PubMed, PsycInfo and Web of Science. The terms “intimate partner sexual violence” and “intimate partner rape” were used as first choice, and then the keywords “intimate partner violence; domestic violence; domestic abuse; intimate partner; relationship; battered women; spouse; wife; marital” were cross-referenced with the terms “rape; sexual violence; sexual abuse; sexual coercion; unwanted sex; forced sex”. The search for articles was carried out between February 2021 and May 2021. ResultsThe literature tends to indicate that intimate partner sexual violence develops mainly in relationships already marked by violence. It appears to be co-occurring with physical and psychological violence by the partner elsewhere in the relationship, but also simultaneously with the abuses. Intimate partner sexual violence is repetitive and has multiple expressions: their reality extends beyond intimate partner rape. They seem to be associated with unique deleterious effects for the victims, and could be an indicator of the severity of the overall situation of intimate partner violence, with increased post-traumatic and depressive symptomatology, as well as a greater number of deaths by suicide and homicide. However, they are still perceived as less serious than sexual violence by a non-partner or a stranger, both by society and by the women affected. This discrepancy between the seriousness of sexual violence between partners and its global and individual perception is to put into perspective with the dysfunctional dynamics of sexual consent in violent relationships. However, the research is scarce, and more studies are needed to provide a better understanding of the numerous aspects of intimate partner sexual violence. ConclusionsThe clinical reality of intimate partner sexual violence is both worrying and poorly understood. It must be recognized and addressed in treatment because of its traumatic potential and its power regarding psychological confusion for the victims. The current state of knowledge indicates that asking women who have experienced violence from their partner about sexual violence is an essential part of practice. The professionals in contact with this public must be properly trained to be able to provide adequate responses.