Longitudinal study on the impact of childhood sexual abuse on sexual assertiveness: The mediating role of sexual fantasy.

Background: One of the devastating long-term outcomes of childhood sexual abuse (CSA) is its effect on sexual assertiveness, manifested by the limited ability to initiate desired sexual interactions, express one's sexuality, and refuse unwanted sexual activities.

Objective: This study examined a model in which the relation between CSA and sexual assertiveness was mediated by survivors' subjective experience of their sexuality, as reflected by their subjective experience of sexual fantasy.

Participants And Setting: Three-hundred-and-sixty-three adults participated in this longitudinal study.

Methods: Participants filled out questionnaires assessing CSA history and subjective experience of sexual fantasy at T1. Sexual assertiveness, manifested as sexual initiative and proactivity, expressing one's sexuality, and sexual refusal, was assessed 14 months later (T2).

Results: The higher the severity of CSA, the higher the tendency to experience sexual fantasy as functional, intrusive, shameful, and limitless. In addition, the association between severity of CSA and sexual assertiveness was mediated by the experience of sexual fantasy. That is, the association between severity of CSA and sexual initiative and proactivity was mediated by experiencing sexual fantasies as shameful (B = -0.80, SE = 0.34, p = .01); the association between severity of CSA and expressing one's sexuality was mediated by experiencing sexual fantasies as intrusive (B = -0.53, SE = 0.24, p = .01); and the association between severity of CSA and sexual refusal was mediated by experiencing sexual fantasies as intrusive (B = -0.23, SE = 0.06, p = .006).

Conclusions: These findings emphasize the need to address shame and intrusiveness in adult survivors' sexuality to promote sexual well-being.