Abstract and Introduction
It is important for advanced practice nurses and other clinicians to be aware of indicators of rape and sexual abuse in men and to be able to detect them. This is particularly important as men are much less likely than women to spontaneously disclose abuse. Men who are raped or sexually abused do not often come to the attention of healthcare professionals, decreasing the potential for these individuals to receive appropriate referrals for counseling and treatment. Supportive responses from healthcare professionals mitigate the negative effects of abuse, whereas unsupportive responses appear to exacerbate the negative effects of abuse, and possibly increase secondary victimization. Dealing with this improbability that men will willingly come forward to seek help requires advanced practice nurses and other clinicians to actively facilitate disclosure, especially considering that the majority of men seen by clinicians have a disguised presentation when they present to a healthcare facility. Possible rape/sexual abuse indicators are discussed, along with sample interview questions to ask male patients who are potential survivors of abuse. Finally, a sample case vignette is provided.
According to the Rape, Abuse, and Incest National Network, about 1 in every 10 rape victims is male in the United States, and about 2.78 million men have experienced an attempted or completed rape in their lifetime. About 44% of rape victims are under 18 years of age, and 15% are younger than 12 years. The gender of a rape or abuse victim can be a very important contextual factor in examining the varying needs of victims, as it can affect whether or not a victim receives support after being sexually abused. Also, it can drastically affect the victim's likelihood to disclose rape and seek support from others.
Although there is an increasing awareness of male rape, there are a number of factors influencing under-reporting of cases and hindering disclosure for men. This contributes to an underestimation of the prevalence and severity of male rape. First, rape may emotionally or physically affect men to a lesser degree than women, therefore leading to a reduced need or referral rate for counseling or other treatment. Second, male rape victims may deal with their abuse in ways that are dissimilar to how women deal with it (ie, men are more likely to react with anger to their experiences in an attempt to re-establish their masculinity), resulting in the increased likelihood that they will be seen by services other than the helping professions (ie, the criminal justice system). Third, men may be much less likely than women to disclose experiences of rape.[4,5]
Some additional reasons exist that are not specific to every situation of male rape. Men may be less likely to label their experiences as rape if they have responded in a manner that suggests that they are enjoying the encounter (ie, ejaculation or erection), are not negatively affected by the rape experience, or fail to regard the experience as significant.[4,5] Another phenomenon is that people are more likely to attribute blame and pleasure to male victims than to female victims. Researchers theorize that it is an association of male rape with homosexual pleasure that contributes to an under-reporting of male rape. Men are generally socialized to label sexual experiences as desirable; however, this socialization may be reversed if there is the stigma of homosexuality associated with the experience (ie, disclosing rape by a man may insinuate that the victim is also homosexual). And finally, men may also feel shame and blame themselves for not being able to prevent the assault and/or to cope afterwards like a "real man."
Topics in Advanced Practice Nursing eJournal. 2006;6(1) © 2006 Medscape
Cite this: Male Disclosure of Sexual Abuse and Rape - Medscape - Apr 10, 2006.