Abstract
Background
Non-contact sexual violence (NCSV) and its trauma remain understudied, limiting prevention and legal protection. This national study examined NCSV patterns and compared sexual, psychological, and social health among women with and without NCSV experiences globally.
Methods
A controlled cross-sectional study recruited 540 married women aged 18–76 years from all 31 provinces of Iran between November 2022 and June 2023 using online and in-person convenience sampling. Participants were categorized into NCSV + and NCSV− groups. Demographic data, NCSV patterns, and standardized measures of sexual, psychological, and social health were collected. Data were analyzed using independent t-tests, chi-square tests, and backward logistic regression.
Results
Overall, 16.9% of women reported experiencing NCSV, with a mean age of victimization of 12.3 (5–32) years. Nearly half were under 13, 36.6% were 13–18, and 13.8% were over 18 at exposure. Exhibitionism was reported by 86.1%. Most incidents (44.8%) occurred once and were mainly perpetrated by strangers (68.4%). 74% of survivors never disclosed the experience. While univariate analyses showed negative associations between NCSV and multiple sexual and psychological variables, backward logistic regression identified higher risks of depression, sexual dysfunction, sexual avoidance, and lower religiosity.
Conclusion
The reported prevalence and severity, the wide age range of survivors, and the silence of three in four women highlight that NCSV occurs across diverse groups and warrants attention. These findings also suggest the potential harm associated with NCSV and underscore the importance of raising awareness, providing education on sexual self-care, and ensuring access to support services.
Trial registration
Not applicable.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s12905-026-04655-0.
Keywords: Non-Partner Sexual Violence, Sexual Abuse, Sexual Aversion, Sexual Dysfunction, Sexual Distress, Depression
Introduction
Sexual Violence (SV) refers to any sexual acts occurring without consent or in situations where the victim cannot provide consent or resist. SV includes non-contact, contact, and penetrative subtypes of behaviors [1]. The non-contact sexual violence (NCSV) subtype involves sexual acts carried out without physical contact, which can occur in various settings, such as schools, workplaces, public spaces, or through technological platforms. The NCSV subtype is one of the least studied areas, despite its high prevalence [2].
Survivors of NCSV may be subjected to mandatory exposure to sexual situations, such as being forced to view pornographic content, the perpetrator’s genital area, or explicit sexual behavior. They may also experience verbal or behavioral sexual harassment, including receiving inappropriate sexual comments, unsolicited sexual messages or images, or being targeted by sexual gossip and rumors. Furthermore, victims may face threats of SV or coercion to fulfill specific objectives. Additional violations include forced undressing, unauthorized filming or photographing, and the distribution of nude images and videos without the victim’s consent. These actions collectively create a hostile and distressing environment, both in person and online [2].
The prevalence of the lifetime NCSV among women under the age of 18 is alarmingly high. According to the WHO, NCSV has only been reported in one country: the Netherlands, with a prevalence of 15.8% [3]. A global survey by UNICEF indicated that approximately 650 million individuals, equivalent to one in five worldwide, have experienced NCSV, including online or verbal abuse [4]. In the United States, the lifetime prevalence was estimated at 32.1% [2]. Despite NCSV’s higher prevalence compared to other forms of SV, it remains one of the least-studied areas globally, particularly in Iran.
Data on the associated factors of this phenomenon are limited, but existing studies suggest it can negatively contribute to women’s sexual and psychosocial health, often alongside other forms of sexual abuse, including contact SV and penetration. Additionally, NCSV is associated with high-risk sexual behaviors, such as unprotected sex and having multiple sexual partners, engaging in compulsive sexual behavior disorder, and pornography use [5], or even sexual avoidance [6], sexual distress [7], sexual dysfunction, and sexual [8] and relationship dissatisfaction [9]. Additionally, unhealthy behaviors such as smoking, alcohol and drug abuse, and reliance on prescription drugs have also been observed in relation to NCSV [10]. NCSV may have psychological effects, including feelings of shock, phobias, and anxiety [11], low self-esteem, depression [12], and obsessive-compulsive disorder [13]. Lack of social support may aggravate the outcomes of NCSV. Previous work indicates that insufficient social support is associated with greater severity of psychological symptoms, including anxiety and depression [8], a reduced ability to cope with the consequences of SV due to limited access to emotional and psychological resources, and an increased risk of re-experiencing SV owing to diminished capacity to recognize and avoid high-risk situations [14].
Furthermore, research indicates that the complications of NCSV are closely tied to the severity of victimization, though there is still no consensus on which characteristics best define this severity. Vaillancourt-Morel and colleagues proposed three critical factors for assessing severity [15] the chronicity of abuse, the type of act perpetrated, and the relationship with the perpetrator. Severity tends to increase with more frequent abuse, more violent acts like rape, and closer relationships between the victim and the offender. Although this tool was originally designed for assessing child abuse severity (under the age of 18) [15], we believe that it could also be informative in adults, in the absence of an appropriate scale for measuring severity among adults.
NCSV is one of the hidden forms of SV against women, often underreported for various reasons [16]. From an individual perspective, many women remain silent due to fear of being blamed, lack of awareness of protective laws, fear of social rejection, and economic dependence on their spouse or family [17]. At the family level, factors such as fear of losing a spouse or child, concerns about the children’s future, and poverty and economic hardships force women to endure violence [18]. From a social perspective, conservative cultural and social structures, traditional pressures, lack of effective support systems, fear of notoriety, the need to preserve reputation, and the absence of effective legal mechanisms perpetuate the cycle of violence and hinder women’s safety [19].
In the context of Iran, these challenges are further compounded by limited awareness and education regarding sexual self-care, especially among children and adolescents. This lack of necessary knowledge may increase vulnerability to NCSV [20, 21]. Considering the nature of NCSV and its significant contribution to women’s sexual, mental, and social health, further research in these areas is essential, especially in contexts where cultural and religious factors may be associated with the reporting and addressing of such issues. This paper, as part of a larger project on SV, focuses on the NCSV Iranian women. The overall prevalence of sexual violence has been published previously [22].
Aims
Comparison of the demographic and sexual characteristics between women with NCSV + and without NCSV-.
Comparison of the sexual health between women with NCSV + and without NCSV-.
Comparison of the psychological health between women with NCSV + and without NCSV-.
Comparison of the social support between women with NCSV + and without NCSV-.
Examination of factors associated with the experience and severity of NCSV+.
Methods
Study design
A controlled cross-sectional study was conducted among Iranian married women between November 2022 and June 2023, following the principles outlined in the Declaration of Helsinki.
AI-Assisted Language Editing: ChatGPT (version 3) was used solely for language editing and improving the fluency of the manuscript. All scientific content, data analysis, and conclusions are the sole responsibility of the authors.
Procedure
In this study, both face-to-face and online sampling methods were utilized to minimize selection bias and ensure the inclusion of individuals without access to smart devices. For the online sampling, invitations to participate, along with the inclusion criteria, were shared nationwide across various groups on Telegram, WhatsApp, and Instagram, which were linked to universities, health centers, sports, and arts organizations from different regions. The research team closely monitored the sample distribution across provinces based on participants’ reported locations and increased promotional efforts in areas with lower participation until the desired sample size was reached. The invitation included ethical codes, assurances of data confidentiality, and a note that the study covered topics related to sexual life. Interested participants received the questionnaire along with an informed consent form. To minimize labeling concerns and potential underreporting, participants were told only that the survey assessed private sexual experiences and behaviors. No explicit mention of sexual abuse was made at the outset. Questions about sexual satisfaction, functioning, frequency of intercourse, pornography use, and other sensitive topics appeared before the sexual violence items. The data were hosted on a secure online platform, where completed responses were initially stored and then sent to the researchers anonymously. Completing the questionnaire took approximately 15 min, and the design required all questions to be answered before submission. While this extended the sampling period, it ensured a 100% completion rate. Participants were incentivized with a chance to win free internet access through a raffle. Additionally, 10% of the participants were recruited through in-person visits to health centers affiliated with Tehran University of Medical Sciences, which serves a heterogeneous population of over three million in approximately one-third of the Tehran region. Participants were randomly selected from an existing electronic list at each center and contacted by phone to explain the study objectives and entry criteria. Eligible individuals were invited to the health center, where the paper version of the questionnaire was provided in a private setting with a research team member present.
Participants
A total of 540 women, representing all 31 provinces of the country, completed the survey. In the online version, out of 400 individuals who met the study criteria, 350 completed the survey (online response rate of 87.5%). In the face-to-face sampling, 220 individuals were eligible, and 190 participants completed the paper version of the survey, with a response rate of 86.3%. The inclusion criteria for the study required participants to be over 18 years old and married, in accordance with the guidelines set by the Ethics Committee for research on sexual health, which mandated the inclusion of only married women.
Outcome measures
NCSV was assessed using a single screening item. Among participants who reported NCSV, five additional questions evaluated the pattern of victimization and three questions assessed its severity. Furthermore, demographic characteristics, sexual history, and variables related to sexual, psychological, and social health were assessed using the following standardized questionnaires.
Detection of NCSV
In the original project, participants were screened using a single item: “Have you ever experienced sexual violence?” Four response options were provided: “No,” “Yes, non-contact sexual violence,” “Yes, contact sexual violence,” and “Yes, penetrative sexual violence.” Multiple selections were permitted. In the present study, we compared the sexual and psychosocial characteristics of participants who reported non-contact sexual violence (NCSV+) with those who reported no history of sexual violence (NCSV−).
Perpetrators were defined as any individual, regardless of gender or relationship to the participant, including family members, acquaintances, and strangers, but excluding intimate partners. Limiting the sample to non-partner perpetrators allowed for a cleaner assessment of NCSV by separating it from the distinct category of intimate partner violence (IPV).
NCSV was defined as being coerced into unwanted sexual experiences without physical contact. This included threats of sexual abuse, exposure to another person’s genitals, being forcibly stripped of clothing, being made to view pornographic material, or having nude photographs taken without consent. To improve response accuracy, the terms “coerced” and “without physical contact” were underlined in the questionnaire. Participants who reported NCSV were automatically directed to additional questions assessing the pattern and severity of their victimization.
Patterns of NCSV
Those identified as NCSV+ were directed to five follow-up questions exploring abuse patterns: age at first incident, specific acts, frequency, offender-victim relationship, and reporting status.
Severity of NCSV
NCSV severity was measured covering three aspects: experience, frequency, and relationship with the perpetrator. Experience was coded by intrusiveness (0 = non-victim, 1 = without direct contact). Frequency was categorized as 0 (non-victim), 1 (once), 2 (two to five times), or 3 (more than five times). Relationship closeness was coded from 0 (non-victim), 1 (stranger), 2 (acquaintance), 3 (relative), to 4 (parent/stepparent) [15].
Demographic and sexual information
The demographic section included seven items: age, years of education (from primary school onward), religiosity, residence (city or village), employment status (unemployed, part-time, full-time), economic status, daily internet use, and substance use. Religiosity was assessed with a single item—“I consider myself a religious person”—from a three-item scale, rated on a seven-point Likert scale (1 = strongly disagree to 7 = strongly agree), with higher scores indicating greater religiosity [23]. Economic status was measured by asking participants to rate their situation as “undesirable,” “average,” or “desirable,” instead of reporting income. Substance use was evaluated with a question about use in the past six months. Sexual history was assessed through ten items: age at first consensual sex, frequency of sexual intercourse in the past three months, monthly masturbation frequency, number of extramarital partners per year, conflict over sex frequency (rated on a five-point Likert scale from 0 = no argument to 4 = yes, even with divorce demand), monthly pornography use, ease of sexual communication with partners (1 = very hard to 5 = very easy), and yes/no questions on pornography use and paraphilic behaviors.
Sexual health
Compulsive sexual behavior disorder
Compulsive Sexual Behavior Disorder (CSBD) was assessed using the short CSBD-7 scale, which covers five dimensions: control, salience, relapse, dissatisfaction, and negative consequences—the latter measured with three items. Each item has a four-point Likert scale (1 = completely disagree to 4 = completely agree), yielding a total score between 7 and 28. A score of 18 or higher indicates CSBD risk. This tool demonstrates acceptable reliability and validity in both its English [24] and Persian [25, 26] versions.
Sexual aversion
The ten-item Sexual Aversion Questionnaire (SAQ) used a four-point Likert scale (1 = not at all like me to 4 = very similar to me). Total scores ranged from 10 to 40, with higher scores indicating greater sexual aversion [27].
Sexual distress
Sexual distress was assessed using the Sexual Distress Scale-1 (SDS-1), a single-item measure on feeling “disturbed about sexual life.” Responses ranged from 1 (never) to 5 (always). SDS-1 strongly correlates with full-scale scores of the Female Sexual Distress Scale-Revised (FSDS-R). This instrument has shown acceptable reliability and validity in both its original [28] and Iranian [29] versions.
Relationship satisfaction
The Relationship Satisfaction Scale was condensed into a single-item measure (RAS-1) assessing emotional intimacy and overall partner satisfaction: “In general, how satisfied are you with life with your spouse?” Responses ranged from 1 (not satisfied at all) to 5 (very satisfied), with higher scores indicating greater satisfaction. This tool demonstrated satisfactory reliability and validity in both the original [30] and Persian [31] versions.
Sexual satisfaction
A single-item question, “During the last two months, how satisfied are you with your life with your spouse?” assessed sexual satisfaction. Responses ranged from 1 (not at all satisfied) to 5 (very satisfied), with higher scores indicating greater satisfaction. The scale ranged from 1 to 5 [32].
Sexual function
The Arizona Sexual Experience Scale assesses sexual dysfunction through five questions on sex drive, arousal, vaginal lubrication, orgasm ability, and orgasm satisfaction, with scores above 18 indicating potential dysfunction. Higher scores reflect greater impairment in each domain. The tool has shown acceptable validity and reliability in both its English [33] and Persian [34] versions. As it lacks a dyspareunia item, this study added a separate question—“Do you experience pain during sexual intercourse?”, which was rated on a five-point scale.
Psychological health
Depression
The PHQ-2 [35], a brief version of the PHQ-9, assessed depressive symptoms over the past two weeks. It includes two items on decreased interest and feelings of depression. Responses range from 0 (not at all) to 3 (nearly every day), with total scores from 0 to 6, where higher scores indicate greater depressive symptoms. This tool demonstrated good validity and reliability in international studies [36] and in an Iranian study as well [37].
Anxiety
The six-item Spielberger State-Trait Anxiety Inventory (GAD-6) assessed anxiety symptoms on a four-point Likert scale (1 = not at all to 4 = very much). Scores classified participants into no/mild [6–11], moderate [12–17], and severe [18–24] anxiety levels. Previous investigations, both international [38] and Iranian [29], have supported the validity and reliability of this questionnaire.
Self esteem
Self-esteem was measured using the Rosenberg Self-Esteem-Single Item (RSE-1), a shortened version of the RSE-10 [39]. Participants rated “I have high self-esteem” on a five-point Likert scale (1 = not very true to 5 = very true), with higher scores indicating greater self-esteem. The validity and reliability of this tool have been verified in earlier research, encompassing both Iranian [40] and international [41] contexts.
Obsessive compulsive symptoms
The Compulsive Personality Assessment Scale (CPAS-8) includes 8 items with responses on a five-point Likert scale (0 = Absent to 4 = Very severe). The total score ranges from 0 to 48, with higher scores indicating more obsessive-compulsive symptoms. Previous studies have corroborated the questionnaire’s validity and reliability [42]. This study uses the term “Obsessive Compulsive Symptoms (OCS)” instead of “OCD” due to reliance on self-reports.
Social health
Social support
Perceived social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS), developed by Zimet et al. This 12-item tool assesses support across three dimensions: family, friends, and significant others. An example item is, “There is a special person who is around when I am in need.” Items are rated on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree), with total scores ranging from 12 to 60. Higher scores reflect greater perceived support. Previous studies, including foreign [43] and Iranian [44] research, have confirmed the good validity and reliability of this tool.
Statistical analysis
The study’s optimal sample size of 500 women was based on NCSV incidence reported by Basile et al. [45]. Independent t-tests compared mean scores of continuous variables between NCSV + and NCSV- groups, while chi-square or Fisher’s exact tests analyzed categorical variables presented as frequencies and percentages. Comparisons included demographic, sexual, psychological, and social health factors. Effect sizes were calculated using Cohen’s d, with thresholds of 0.2 (small), 0.5 (medium), and 0.8 (large). Regression analyses included backward logistic regression to identify factors associated with NCSV presence and linear regression to examine factors related to NCSV severity. The backward method was chosen to eliminate redundant or collinear variables, enhancing model clarity and robustness [46]. Variables with p-values ≤ 0.05 were retained in the final models. Although paraphilic behaviors were statistically significant, they were excluded from regression due to limited sample size.
Results
Pattern and severity of NCSV
Out of 540 participants, 16.9% (n = 101) of women reported experiencing NCSV; consequently, 83.1% were added to the NCSV- group. At the time of victimization, 49.5% of women were under 13 years old, 36.6% were between 13 and 18, and 13.8% were over 18, with a mean age of 12.3 years. The average severity of NCSV was moderate (M = 4.06), with exhibitionism being the most common type of NCSV (86.1%). In most cases (44.8%), NCSV occurred only once, and the majority of perpetrators were strangers (68.4%). Notably, 74% of victims did not report it to anyone (Table 1).
Table 1.
Pattern and severity of NCSV among women (N = 101)
| Variables | Women (N = 101) |
|---|---|
| Age range of NCSV+ (year) | 5–32 |
| Mode of Age of NCSV+ (year) | 12 |
| Mean (SD) of age at first NCSV | 12.39 ± 6.19 |
| Mean (SD) of Severity of NCSV (Score Range: 0–11) | 4.06 ± 1.09 |
| N (%) | |
| Age Distribution in NCSV+ women | |
| Non-contact > 18 years | 14 (13.86) |
| Non-contact 13–18 years | 37 (36.63) |
| Non-contact < 13 years | 50 (49.51) |
| Type of NCSV | |
| Threat of sexual abuse | 29 (28.7) |
| Exposing their genital area to you | 87 (86.1) |
| Undressing you | 16 (15.8) |
| Forcing to watch pornography | 46 (45.5) |
| Taking nude photos of you | 33 (32.7) |
| Frequency of NCSV | |
| 1 time | 43 (44.8) |
| 2–5 times | 41 (42.7) |
| More than 5 times | 12 (12.5) |
| Relationship with the perpetrator | |
| Stranger | 67 (68.4) |
| Known person | 19 (19.4) |
| Relatives | 12 (12.2) |
| Parents or stepparents | - |
| Report | |
| No | 71 (74) |
| Yes | 25 (26) |
| If yes report to | |
| Parents | 13 (52.0) |
| Friend | 11 (44.0) |
| Police or legal authorities | 1 (4.0) |
Number, %: Percentage, M Mean, SD Standard deviation, Non-contact sexual violence (NCSV)
Sociodemographic and sexual characteristic differences between women with NCSV + and NCSV-
NCSV+ women reported lower levels of religiousness (P = 0.001, d = 0.3), poorer economic conditions (P = 0.05, d = 0.1), and a higher prevalence of substance use compared to the NCSV− group (12.9% vs. 5% of NCSV−; P = 0.004, V = 0.1) (Table 2).
Table 2.
Comparison of demographic information between women with NCSV (NCSV+, N = 101) and without NCSV(NCSV-, N = 439)
| Variable | NCSV + (N = 101) |
NCSV - (N = 439) |
P-value | Cohen’s D |
|---|---|---|---|---|
| M (SD) | M (SD) | ǂ | ||
| Age | 35.66 ± 8.45 | 36.07 ± 10.30 | 0.6 | 0.04 |
| Education (year) | 15.15 ± 3.30 | 15.26 ± 3.69 | 0.7 | 0.03 |
| Religiousness | 4.05 ± 1.89 | 4.77 ± 1.67 | 0.001** | 0.3 |
| N (%) | N (%) | £ | ||
| Residence | ||||
| City | 99 (98) | 423 (96.4) | 0.4 | 0.03 |
| Village | 2 (2) | 16(3.6) | ||
| Employment | ||||
| Jobless | 59 (58.4) | 272 (62.0) | 0.7 | 0.02 |
| Part-time | 17 (16.8) | 63(14.3) | ||
| Full time | 25 (24.8) | 104 (23.7) | ||
| Economics | ||||
| Undesirable | 19 (18.8) | 50 (11.4) | 0.05 | 0.1 |
| Average | 71(70.3) | 312 (71.1) | ||
| desirable | 11(10.9) | 77 (17.5) | ||
| Internet use (Daily hours) | 2.70 ± 1.92 | 2.87 ± 5.95 | 0.6 | 0.05 |
| N (%) | N (%) | £ | Cramer’s V | |
| Substance Abuse | ||||
| Narcotics | - | - | 0.004** | 0.1 |
| Stimulant | - | - | ||
| Hallucinogens | - | - | ||
| Alcohol | 13 (12.9) | 22 (5) | ||
| None | 88 (87.1) | 417 (95) | ||
N Number, %: Percentage, M Mean, SD Standard deviation, non-contact sexual violence (NCSV). ǂ Analyzed by the Independent t-test, £: Analyzed by the Chi-square, Cohen’s d: Indicates the standardized difference between means (for quantitative continuous variables). Ranges from 0 to infinity, with larger values indicating larger effect sizes
* p < .05, ** p < .01, *** p < .001
Sexual information differences between women with NCSV + and NCSV-
The NCSV+ group had a significantly higher mean age at first consensual sexual experience (21.2 vs. 17.6 years; P < 0.001, d = -0.4) compared to the NCSV- group. The NCSV+ group also felt less comfortable talking about sexual matters with their spouses (P = 0.01, d = 0.2) than the NCSV- group. Among survivors of NCSV, pornography viewing (P = 0.004, V = 0.1) and paraphilic behaviors (P = 0.001, V = 0.1) were more frequent compared to the NCSV- group (Table 3).
Table 3.
Comparison of sexual information between women with NCSV (NCSV+, N = 101) and without NCSV(NCSV-, N = 439)
| Variable | NCSV + (N = 101) |
NCSV - (N = 439) |
P-value | Cohen’s D |
|---|---|---|---|---|
| M (SD) | M (SD) | ǂ | ||
| Age at first consensual sexual experience (year) | 21.22 ± 7.23 | 17.58 ± 13.68 | < .001*** | − 0.4 |
| Sex frequency (3 months) | 13.94 ± 13.74 | 17.72 ± 36.62 | 0.09 | 0.1 |
| Masturbation frequency (Monthly) | 0.94 ± 2.78 | 0.44 ± 1.62 | 0.08 | − 0.1 |
| Extramarital affair (yearly partner numbers) | 0.12±0.45 | 0.06±0.37 | 0.2 | 0.2 |
| Conflict about sex frequency | 0.46±0.843 | 0.39±0.703 | 0.4 | − 0.08 |
| Pornography use (monthly) | 5.44 ± 16.63 | 2.86 ± 6.64 | 0.4 | − 0.1 |
| Sexual communication | 3.58 ± 1.13 | 3.90 ± 1.03 | .01* | 0.2 |
| N (%) | N (%) | £ | Cramer’s V | |
| Pornography use | ||||
| No | 70 (70.7) | 365 (83.1) | .004** | 0.1 |
| Yes | 29 (29.3) | 74 (16.9) | ||
| Paraphilia behaviors | ||||
| No | 96 (95) | 438 (99.8) | 0.001** | 0.1 |
| Yes | 5 (5) | 1 (0.2) | ||
N Number, %: Percentage, M Mean, SD Standard deviation, non-contact sexual violence (NCSV). ǂ Analyzed by the Independent t-test, £: Analyzed by the Chi-square, Cohen’s d: Indicates the standardized difference between means (for quantitative continuous variables). Ranges from 0 to infinity, with larger values indicating larger effect sizes. Cramer’s V coefficient (for nominal variables) ranges from 0 to 1, where 0 indicates no association between variables and 1 indicates a perfect association
* p < .05, ** p < .01, *** p < .001
Sexual health differences between women with NCSV + and NCSV-
Survivors of NCSV reported higher levels of CSBD (P < 0.001, d = 0.5), sexual aversion (P < 0.001, d = 0.4), and sexual distress (P < 0.001, d = 0.4), as well as lower sexual satisfaction (P = 0.02, d = 0.2) and relationship satisfaction (P = 0.009, d = 0.2), compared to the NCSV- group. The NCSV+ women also showed higher sexual function problems (P = 0.008, d = 0.2), including problems with sexual drive (P = 0.002, d = 0.3), orgasm (P = 0.02, d = 0.2), orgasm dissatisfaction (P = 0.02, d = 0.2), and dyspareunia (P = 0.04, d = 0.2), than the NCSV− group (Table 4; Fig. 1).
Table 4.
Comparison of sexual health factors between women with NCSV (NCSV+, N = 101) and without NCSV(NCSV-, N = 439)
| Variable | NCSV + (N = 101) |
NCSV - (N = 439) |
P-value | Cohen ʼs d |
|---|---|---|---|---|
| Sexual Health Factors | M (SD) | M (SD) | ǂ | |
| Compulsive Sexual Behaviour Disorder | 11.52 ± 4.26 | 9.67 ± 2.97 | < .001*** | 0.5 |
| Sexual Aversion | 16.48 ± 7.17 | 13.90 ± 5.36 | < .001*** | 0.4 |
| Sexual Distress | 1.33 ± 1.141 | 0.86 ± 1.08 | < .001*** | 0.4 |
| Sexual Satisfaction | 3.60 ± 1.26 | 3.92 ± 1.13 | 0.02* | 0.2 |
| Relationship Satisfaction | 3.45 ± 1.28 | 3.82 ± 1.12 | 0.009** | 0.2 |
| Sexual Function Problems | 12.60 ± 4.11 | 11.37 ± 4.34 | 0.008** | 0.2 |
| Drive Problem | 3.49 ± 1.17 | 3.08 ± 1.27 | 0.002** | 0.3 |
| Arousal problem | 3.02 ± 1.26 | 2.83 ± 1.30 | 0.1 | 0.1 |
| Orgasm problem | 3.09 ± 1.226 | 2.78 ± 1.29 | 0.02* | 0.2 |
| Orgasm dissatisfaction | 3.01 ± 1.30 | 2.68 ± 1.27 | 0.02* | 0.2 |
| Lubrication problem | 2.58 ± 1.04 | 2.54 ± 1.15 | 0.7 | 0.03 |
| Dyspareunia | 2.06±0.97 | 1.82±0.86 | 0.04* | 0.2 |
N Number, %: Percentage, M Mean, SD Standard deviation, non-contact sexual violence (NCSV), ǂ Analyzed by the Independent t-test, £: Analyzed by the Chi-square, Cohen’s d: Indicates the standardized difference between means ( for quantitative continuous variables). Ranges from 0 to infinity, with larger values indicating larger effect sizes
* p < .05, ** p < .01, *** p < .001
Fig. 1.
Comparison of sexual health factors between women with NCSV (N=101) and without NCSV(N=439). Non-contact sexual violence (NCSV), Compulsive sexual behavior disorder (CSBD)
Psychological health differences between women with NCSV + and NCSV-
Women in the NCSV+ group had significantly higher levels of depression (P = 0.002, d = 0.4) and OCS (P = 0.02, d = 0.2), as well as lower self-esteem (P = 0.04, d = -0.2), compared to the NCSV- group (Supplementary Table 5; Fig. 2).
Fig. 2.
Comparison of psychological health factors between women with NCSV (N=101) and without NCSV(N=439). Non-contact sexual violence (NCSV), Obsessive-compulsive symptom (OCS)
Social health differences between women with NCSV + and NCSV-
No significant difference was found between the two groups in the level of social support (P = 0.9, d = -0.1) (Table 5).
Table 5.
Comparison of psychological and social health factors between women with NCSV (NCSV+, N = 101) and without NCSV(NCSV-, N = 439)
| Variable | NCSV + (N = 101) |
NCSV - (N = 439) |
P-value | Cohen ʼs d |
|---|---|---|---|---|
| Psychological Health | M (SD) | M (SD) | ǂ | |
| Depressive symptoms | 2.52 ± 2.07 | 1.83 ± 1.59 | 0.002** | 0.4 |
| Anxiety symptoms | 13.16 ± 2.42 | 13.65 ± 2.34 | 0.06 | 0.2 |
| Self-esteem | 2.61 ± 1.26 | 2.89 ± 1.25 | 0.04* | − 0.2 |
| Obsessive Compulsive Symptoms | 14.68 ± 5.37 | 13.33 ± 5.22 | 0.02* | 0.2 |
| Social Health | M (SD) | M (SD) | ǂ |
Cohen ʼs d |
| Social support | 42.85 ± 8.98 | 42.96 ± 10.24 | 0.9 | − 0.01 |
| Family | 15 ± 3.36 | 15 ± 3.62 | 0.9 | 0 |
| Friends | 13.34 ± 4.48 | 13.09 ± 4.32 | 0.6 | − 0.05 |
| Others | 14.43 ± 3.75 | 14.87 ± 4.05 | 0.2 | 0.1 |
M Mean, SD Standard deviation, non-contact sexual violence (NCSV). ǂ Analyzed by the Independent t-test, £: Analyzed by the Chi-square, Cohen’s d: Indicates the standardized difference between means (for quantitative continuous variables). Ranges from 0 to infinity, with larger values indicating larger effect sizes
* p < .05, ** p < .01
Factors related to the experience of NCSV
A backward logistic regression was conducted to assess associations between NCSV experience and demographic, sexual, and psychological variables, interpreted as reflecting long-term effects of early victimization. The model demonstrated a modest fit (Nagelkerke R² = 0.17). Individuals who had experienced NCSV were less likely to report religious beliefs later in life (Exp(B) = 0.83, 95% CI [0.72, 0.96], p = 0.016). NCSV+ survivors were more likely to report sexual function problems (Exp(B) = 0.92, 95% CI [0.85, 0.99], p = 0.04), depressive symptoms (Exp(B) = 1.19, 95% CI [1.02, 1.4], p = 0.024), and sexual aversion (Exp(B) = 1.08, 95% CI [1.03, 1.13], p = 0.001) (Table 6).
Table 6.
Factors associated with the experience of NCSV
| Associated factors | B | SE (B) | Wald χ² | df | P-value | Exp (B) | 95% C.I.for EXP(B) | |
|---|---|---|---|---|---|---|---|---|
| Lower | upper | |||||||
| Constant | -1.611 | 0.544 | 8.779 | 1 | 0.003 | 0.200 | ||
| Religiousness | − 0.178 | 0.074 | 5.824 | 1 | 0.016 | 0.837 | 0.725 | 0.967 |
| Sexual aversion | 0.079 | 0.024 | 10.954 | 1 | 0.001 | 1.083 | 1.033 | 1.134 |
| Sexual distress | 0.227 | 0.132 | 2.963 | 1 | 0.085 | 1.254 | 0.969 | 1.624 |
| Sexual function problems | − 0.078 | 0.038 | 4.215 | 1 | 0.040 | 0.925 | 0.859 | 0.996 |
| Depressive symptoms | 0.180 | 0.080 | 5.083 | 1 | 0.024 | 1.198 | 1.024 | 1/401 |
Results of logistic regression. Non-contact sexual violence (NCSV), Not: B = unstandardized coefficient; SE(B) = standard error of the coefficient; Wald χ² = Wald chi-square statistic; df = degrees of freedom; p = p-value; Exp (B) = odds ratio. -2 Log Likelihood = 357.733, Nagelkerke R² = 0.174, χ² [8] = 0.092, p < 0.001
Discussion
In the present study, 16.9% of Iranian women reported experiencing NCSV. Among these, the most common forms were exposure to exhibitionism (86.1%), forced viewing of pornography (45.5%), being photographed nude (32.7%), and threats of sexual abuse (28.7%). As one of the first surveys in Iran to address such sensitive topics, the potential for underreporting should be considered. Globally, a UNICEF survey found that nearly 20% of individuals—approximately 650 million people—have experienced NCSV [1]. A 2025 survey in Spain reported that one in three adults experienced childhood NCSV, with exhibitionism and forced exposure to pornography being the most prevalent forms, consistent with our findings [47]. Similarly, in Ireland, 33% of young adults reported experiences of genital exposure, forced pornography viewing, or receiving unwanted sexual messages [48].
The pattern of NCSV could be a critical element in designing effective prevention programs. In our study, the mean age of victimization was 12.3 years, consistent with global research findings [49], although the reported age range spanned from 5 to 32 years. This notable minimum range, alongside Maleki et al.‘s study in Iran [21], underscores the urgent need for early sexual self-care education by parents and the implementation of school-based programs to help children understand and recognize NCSV. Approximately 14% of NCSV cases occurred among individuals over 18 years, indicating that non-contact sexual violence can also occur in adulthood. The most commonly reported form of NCSV was exposure to exhibitionism (86.1%), highlighting the need for focused research on this paraphilic behavior in Iran. Previous surveys in Iran have similarly reported high prevalence rates [50–52], emphasizing the importance of policy attention and the formulation of deterrent laws. A study conducted in the United States also found that exhibitionistic behavior was more frequently perpetrated by men, reinforcing the need for gender-sensitive approaches in both research and policy [49]. The severity of NCSV was relatively low; in 45% of victims, it happened only once, and in 68% of the cases the offender was a stranger. The high proportion of stranger-perpetrated NCSV in our study may reflect the nature of non-contact sexual violence, which often occurs in public or opportunistic contexts (e.g., exhibitionism and voyeurism). In contrast, rape has more frequently been reported in contexts involving known perpetrators [22]. However, a deeply concerning finding was that three out of four victims remained silent, with very few reporting the incident to police or judicial authorities. This alarming finding has been reported in other worldwide studies. A 2025 survey [53] showed that more than two-thirds of NCSV victims never report the incident to the police or support centers. Key barriers to disclosure include fear of judgment from parents, friends, and society; lack of supportive health or legal services; and limited awareness of legal rights [54]. For the prevention of NCSV, family and community education to promote open, nonjudgmental conversations about sexual violence, dispelling harmful myths, and breaking the public and media silence surrounding sexual violence are crucial.
The univariate analyses showed that women with a history of NCSV had lower religiosity, higher substance use, delayed initiation of first consensual sexual intercourse, reduced sexual communication with their partners, and increased use of pornography and masturbation compared to women without such experiences. NCSV+ women reported a lower level of sexual health than the NCSV- group, including higher levels of CSBD, sexual aversion, sexual distress, sexual function problems, including problems with desire and orgasm, and dyspareunia, as well as lower sexual and relationship satisfaction. Concerning psychological variables, NCSV was related to higher depression, obsessive-compulsive symptoms, and lower self-esteem. However, in the backward logistic regression model, an association between NCSV and a higher likelihood of depressive symptoms, sexual function problems, sexual avoidance, and lower levels of religiosity was observed. Although the negative sexual and mental consequences of sexual abuse have been shown in previous studies [15, 55], little research exists on NCSV. A population-based study in Switzerland found that NCSV was associated with physical and mental health problems [56]. In the present study, the association of NCSV with sexual problems was more prominent than with mental health issues. Although the cross-sectional design limits causal interpretation, the findings remain important, particularly given that the observed negative associations pertain solely to the low-severity, non-contact form of NCSV. These findings suggest that even in the absence of direct physical contact, NCSV may induce fear and distrust in intimate relationships.
Several limitations should be considered when interpreting these findings. The study included only married heterosexual women because legal and religious restrictions limited the inclusion of unmarried women and other sexual orientations. The use of convenience sampling and partial online recruitment may have further reduced representativeness. In addition, some constructs, including NCSV, were assessed using single-item self-report measures. Underreporting of NCSV may have occurred due to cultural and religious factors, recall bias, and unacknowledged victimization, whereby participants may not have recognized or reported their experiences as sexual violence. Furthermore, severity was assessed using a composite index based on characteristics of the NCSV experience, adapted from the conceptual framework proposed by Vaillancourt-Morel et al. [15], which conceptualized severity as a latent construct. Finally, perpetrator gender was not assessed, limiting a more comprehensive understanding of perpetrator characteristics. Finally, perpetrator gender was not assessed, limiting a more comprehensive understanding of perpetrator characteristics.
Considering a control group (i.e., women without NCSV) and ability of variables comparison, anonymous data collection, online and in-person sampling to include those who do not access smart devices or are inactive on social media, including women from all provinces of Iran, working on a sensitive topic in an Islamic country, and providing data in a Middle East region where little information regarding NCSV exists, are among the study strengths.
Conclusion
The occurrence of NCSV in this study was slightly lower than that reported in Western studies, possibly due to partial gender segregation influenced by religious norms. However, underreporting remains a major concern. Although the relatively low severity of NCSV may seem reassuring, the wide age range of affected individuals and the silence of three out of four victims are deeply concerning. These findings suggest the need for early sexual self-care education, and efforts to understand the barriers to disclosure, likely rooted in societal and cultural myths and taboos surrounding sexual abuse.
The observed associations between NCSV and psychological and sexual health problems are noteworthy, particularly given that these negative outcomes were linked solely to a relatively low-severity, non-contact form of sexual violence. These findings suggest that policymakers should consider enforcing stricter laws and developing accessible, community-based support systems that include psychological counseling and safe reporting mechanisms, while clinicians should integrate prevention, early identification, and trauma-informed care into routine practice.
Supplementary Information
Acknowledgements
We sincerely appreciate the men and women who shared an important part of their private lives with us for the advancement of human knowledge. We truly appreciate all the effort and time that Dr. Rad has devoted to data analysis in this project. The authors acknowledge the financial support provided by Tehran University of Medical Sciences and RASA Midwifery Empowerment Center, for this research project.
Abbreviations
- SV
Sexual Violence
- NCSV
Non-Contact Sexual Violence
Authors’ contributions
The article’s conception, design, and final approval were by E. K, R. Z, B. B, and F. F. Data acquisition will be performed by E.K, R. Z, while data analysis and interpretation involve all authors. Final approval of the completed article is attributed to all authors.
Funding
This work was supported by the Tehran University of Medical Sciences under Grant number 1401-2-100-58606.
Data availability
The datasets generated during the current study are not publicly available due to the sensitivity of the subject in our country, but are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Tehran University of Medical Sciences under ethical code IR.TUMS.FNM.REC.1401.110. Informed consent was obtained from all individual participants included in the study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated during the current study are not publicly available due to the sensitivity of the subject in our country, but are available from the corresponding author on reasonable request.