Childhood sexual abuse and early menarche: The direction of their relationship and its implications

Purpose: A relationship between childhood sexual abuse (CSA) and early menarche previously has been proposed and psychobiological mechanisms for the association have been suggested. Because it has serious implications for many disciplines, we attempted to confirm that association and explore its direction, first with hypothesis 1: the negative relationship between pubertal age and CSA is based on victims' increased target gratifiability at ages of high target vulnerability, and then with hypothesis 2: CSA and circumstances surrounding it are related causally to early menarche. Methods: African-American and multi-ethnic Caucasian women (N = 323) were interviewed at several women's clinics at Johns Hopkins Bayview Medical Center; 64 women reported premenarcheal abuse. We assessed (1) ages of CSA and menarche to determine their relationships, (2) household characteristics and their relationships with CSA, (3) variables associated with CSA, to determine the independent effect of CSA and explore potential dose response (i.e., effects of increased stress). Results: CSA and menarcheal age are related negatively (p < .05). Hypothesis 1 need not be rejected totally, but with most CSA events occurring long before puberty, hypothesis 2 is supported. Theoretically, stressful CSA characteristics increase victim/nonvictim differences in menarcheal age. Stress may derive from household characteristics often related to CSA but, even controlling for them, CSA has independent effects on menarcheal age. Conclusions: Hypothesis 1 may apply when CSA occurs within 2 years premenarche but, because hypothesis 2 is supported, continuing psychobiological effects and stress engendered by CSA are underscored. Mechanisms through which they impact the developing child require further exploration, and medical and psychological attention.