Male Disclosure of Sexual Abuse and Rape

Jennifer C. Yeager, MSc; Joshua Fogel, PhD

Disclosures

Topics in Advanced Practice Nursing eJournal. 2006;6(1) 

In This Article

Healthcare Professionals' Responses to Male Disclosure of Rape

It is widely acknowledged in the literature that male victims tend not to disclose abuse for reasons such as being labeled homosexual, weak, or feminine.[4,5,6] However, an additional reason why there are such few disclosures of male rape may be explained by healthcare professionals' responses to disclosures.

Healthcare professionals may believe that male rape victims are not psychologically damaged by the experience; there might be agreement that the experience was an exercise in experimentation, or the healthcare professional might accept the assumption that the experience was not rape. As a result, it may also be reasonable to assume that some healthcare professionals believe that rape is less damaging for men than for women, particularly if the abuser is a woman.

There is also an argument that women may have received more support and counseling to deal with their abuse and have therefore developed better coping strategies. By contrast, men may be more likely to assent with social expectations that men pursue and enjoy sexual experiences and are emotionally strong.[10] Men may therefore be much less motivated to actively seek out support and counseling, as these actions are likely to be viewed as "unmanly."

Because male victims are socialized to be dominant, to be in control, and to enjoy sexual experiences, being placed in the role of victim and accepting and disclosing abuse are often extremely problematic for men, as the rape experience undermines their concept of masculinity, which may be further threatened by the prospect of disclosure.[3]

As Mulkey[6] (p 9) explains:

Research has shown that men who have been sexually assaulted suffer not only a degrading loss of masculine identity at the hands of their perpetrators, but also through the words and actions of friends and professionals to whom they turn for help. In a culture that attempts to neutralize the severity of this shattering crime through jokes and innuendo, men who have been victims can re-experience their trauma on a daily basis.

For example, research findings indicate that men who disclose to friends and/or professionals after being raped or abused are not taken seriously upon disclosure. In an interview study involving 30 rape crisis centers, male rape myths were revealed by counselors and rape crisis workers, who often said they felt male rape was not a problem because they were never contacted by male patients.[11] However, some centers did admit this may be because they were unresponsive to male victims.

In a study of adult women, among all of the women in the sample who had presented to an emergency department in crisis seeking help with suicidal thoughts or attempts, not even one was ever asked about a history of sexual violence.[12] In addition, these women say they may have disclosed if they had been asked. This study illustrates that being asked about a history of sexual violence is rarely performed for women, and on the basis of what was stated above, this would be even more unlikely among men. Additionally, the women in this sample were unanimous about the embarrassment, humiliation, and lack of privacy they experienced from "nosy" and "voyeuristic" professionals. Confidentiality and respect are essential to promote disclosure.

As men who are raped or sexually abused do not often come to the attention of healthcare professionals, the probability that they are receiving appropriate referrals for counseling and treatment is drastically reduced. Men are generally considered to be less likely to seek treatment due to the social belief that it may be unmanly to seek help and that this would further threaten a man's self-concept of masculinity.[3] Dealing with this improbability that men will willingly come forward to seek help requires healthcare professionals to actively facilitate disclosure. This may be problematic in that the majority of organizations do not provide specifically male-oriented assault services (or are only beginning to do so), or are generally perceived by society to not do so, as the establishment of services was originally based on the understanding that women are victims and that men are perpetrators.

Holmes and colleagues[3] also write that healthcare professionals have come to view disclosure as a positive and empowering experience for patients. However, the authors also report that those patients who have reasons for being reluctant to disclose (eg, fear of being disbelieved, fear of being seen as homosexual), and who also see the prospect of disclosure as negative and disempowering, are not considered or addressed by healthcare professionals in terms of how disclosure might be encouraged from these patients.

Men in particular have not experienced the encouragement and support for disclosure and may not understand that they are not "alone" and unique in their experiences. In fact, it seems likely that only men in long-term counseling, who have built a trustworthy relationship with their therapist, are likely to disclose assault, particularly when perpetrated by a female.

Additionally, Ratner and colleagues[4] argue that homosexual or bisexual male rape victims are even less likely to disclose. They suggest that the stigma and isolation often associated with sexual minority status may cause professionals to overlook, or even minimize, key etiologic factors associated with mental health problems in these populations (eg, alcohol abuse, suicidal ideation and attempts, mood disorders, and poor self-esteem). This, in turn, contributes to limited social support, poor mental health, and inadequate therapeutic interventions.[13]

Notably, in Ratner and colleagues'[4] Canadian study of 358 homosexual and bisexual adult male rape victims, less than one half of the sample received any counseling to deal with the sexual abuse issues. Clearly, this has profound implications for the health and well-being of the victimized sexual minority men.

Why are healthcare professionals' responses to adult male rape disclosure often unsupportive and insensitive? Pediatric healthcare practitioners surveyed about addressing sexual abuse in the primary care setting report that they were not trained in their residency programs to recognize the historical, behavioral, and physical red flags for sexual abuse. Also, they were told that there was no consensus about how to manage identified cases of sexual abuse. These practitioners did not know the types of questions they should be asking when they suspected abuse. Additionally, while they believed it was their responsibility to inquire about the abuse, they felt discomfort inquiring about sexual topics, primarily due to a lack of training.[14]

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