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

Rape Indicators

The studies previously discussed are useful in promoting awareness of adult male rape. However, although the studies all conclude that programs or policies explicitly addressing male rape are needed to enhance coping and quality of life, they do not suggest how this might be practically implemented. To the authors' knowledge, there are no studies describing how advanced practice nurses in particular should screen, refer, or treat those who have a history of male rape.

All clinicians have a professional and ethical responsibility to respond in a sensitive and competent manner to male victims of rape. In order to do so, they must recognize that male rape does occur and be aware of the need to ask sensitive questions in their assessments.

Clearly, if there is physical evidence indicative of sexual abuse or rape, clinicians should inquire, counsel, treat and/or refer the male victim elsewhere to appropriate healthcare professionals. Quite often when there is an absence of physical rape-related injuries requiring men to seek medical attention, clinicians must be attentive to other behavioral indicators of rape. Such behavioral indicators of undisclosed rape that have been noted in both male and female rape victims are listed in Table 1 .

Although many of the indicators may also be easily linked to other issues (eg, depression), having a number of symptoms such as dissociation, anxiety following a trigger event, sleep disturbance and nightmares, fears of an intruder, inexplicable anger, sexual problems, drug or alcohol abuse, low self-esteem, and avoidant eye contact are profiles indicative of possible sexual assault.

What is important to consider here is that these indicators should be viewed as red flags for a possible history of sexual abuse (whether in childhood or adulthood) for males as well as females. Although the indicators in Table 1 will not conclusively signal the presence or absence of a history of sexual abuse, it is strongly suggested that clinicians can facilitate intervention and direct patients to appropriate aid if they recognize the survivor's "common story" among these indicators.[12] Every person's story will have unique aspects, but there are similarities that should cue advanced practice nurses to ask about a history of sexual violence, including the indicators listed in Table 1 .

If a clinician witnesses a number of these red flags in a male patient's behavior, it is essential to initiate a discussion with open-ended questions, followed by more direct follow-up questions, depending on the patient's response.[14] It may be appropriate to have an established interview schedule for use to encourage consistency and reduce the mental workload, such as the semistructured interview questions described in Table 2 .

It is also important to use appropriate terminology when specific questions are asked. Healthcare practitioners often find it difficult to use precise language when discussing sexual topics, despite acknowledging that this can be problematic.[14] For instance, instead of asking, "Have you had any negative relationships in the past?," it is much clearer and more accurate to ask the patient, "Have you had any sexually violent experiences in the past?"

Besides being a more accurate question, this takes the burden off the male patient to both interpret what was meant and also to initiate the sexual abuse issue. It is also essential to ensure that neutral, non-blaming language is used at this point. For instance, asking, "Why did you not get help?" suggests a judgment on the part of the healthcare professional. Rephrasing the question as, "Can you tell me more about that?" suggests the patient's story is believed and supported.

At this stage, it is also essential to realize that although healthcare professionals must create an environment to facilitate disclosure, they must not bombard the patient into disclosing. It may take some patients a few visits to build up trust or to feel safe enough to talk; healthcare professionals must allow this to happen naturally rather than pressuring patients into revealing something that they are not ready to reveal. Disclosure and trust can be promoted by explaining to patients how their medical information will be used, transcribed, and interpreted. Also, it is also helpful to explain who will have access to their history and for what reasons and to emphasize that they are in a confidential and safe environment where a wealth of support and treatment options are available.

Options for referral of the male patient are essential, as these psychosocial issues can often be beyond the scope of practice of a clinician who is not trained in psychiatry. At the minimum, there must be a list of sexual abuse counselors with experience and sensitivity to the needs of a male patient. It is also appropriate to ask at this point whether the patient would prefer to see a male or female counselor, as the patient's trust level with men or women may be a psychological issue. Cost and ease of access/location of the counselor must also be conveyed to the patient at this time, so a list of affordable and accessible professionals is essential.

Additionally, a list of support groups, Web sites, or self-help books can be instrumental in showing the patient that he is not alone and that there is support out there for him (eg, see Table 3 and Table 4 ). Also, as suggested in step 4 of Table 2 , it is important to have a list of emergency on-call counselors or support hotlines that can be used if necessary. Research has shown that healthcare professionals are often not confident broaching sexual topics with patients; it is therefore important to have a support system in place for the patient and for the healthcare professional, if necessary. Below is a case example detailing how an advanced practice nurse would be likely to encounter and approach this sensitive issue of encountering a male sexual abuse or rape victim in clinical practice.

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