Male Disclosure of Sexual Abuse and Rape

Jennifer C. Yeager, MSc; Joshua Fogel, PhD

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

Conclusions and Implications for Advanced Practice Nurses

Identifying and facilitating a history of sexual abuse can be emotionally and cognitively strenuous for the patient and for the advanced practice nurse or other clinician. This strain can be alleviated with proper training to recognize the red flags, and by having an established procedure for identification, referral, and treatment of male rape victims.

Acknowledging the link between a possible history of sexual violence and a host of adult mental and physical illnesses is essential. Not only does this knowledge allow for an understanding of the impact on adult male rape victims, it also promotes treating survivors with compassion and understanding and providing essential treatment and support options. Furthermore, treating the "underlying condition" as the reason behind a host of physical and psychological problems may result in fewer medical visits for these male patients.

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Cite this: Male Disclosure of Sexual Abuse and Rape - Medscape - Apr 10, 2006.

Abstract and Introduction
Rape Myths
Homosexual Individuals
Healthcare Professionals' Responses to Male Disclosure of Rape
Rape Indicators
Case Example: Tom Presents With Sleep Disturbances
Conclusions and Implications for Advanced Practice Nurses
References

Possible Behavioral Indicators of Undisclosed Sexual Abuse or Rape Among Men
Depression
Uncontrollable crying
Aggression (trouble controlling temper)
Sexual acting out
Sexual problems (low sex drive/sexual overactivity)
Eating disturbances
Insomnia/nightmares
Posttraumatic stress disorder
Flashbacks
Panic attacks
Feeling isolated from others
Avoiding eye contact
Fears of an intruder
Low self-esteem
Headaches
Loneliness
Self-harm
Overly frequent washing
Obsession with neatness/cleanliness
Weight loss
Alcohol/drug abuse
Psychological regression

Possible Behavioral Indicators of Undisclosed Sexual Abuse or Rape Among Men
Depression
Uncontrollable crying
Aggression (trouble controlling temper)
Sexual acting out
Sexual problems (low sex drive/sexual overactivity)
Eating disturbances
Insomnia/nightmares
Posttraumatic stress disorder
Flashbacks
Panic attacks
Feeling isolated from others
Avoiding eye contact
Fears of an intruder
Low self-esteem
Headaches
Loneliness
Self-harm
Overly frequent washing
Obsession with neatness/cleanliness
Weight loss
Alcohol/drug abuse
Psychological regression

Possible Behavioral Indicators of Undisclosed Sexual Abuse or Rape Among Men
Depression
Uncontrollable crying
Aggression (trouble controlling temper)
Sexual acting out
Sexual problems (low sex drive/sexual overactivity)
Eating disturbances
Insomnia/nightmares
Posttraumatic stress disorder
Flashbacks
Panic attacks
Feeling isolated from others
Avoiding eye contact
Fears of an intruder
Low self-esteem
Headaches
Loneliness
Self-harm
Overly frequent washing
Obsession with neatness/cleanliness
Weight loss
Alcohol/drug abuse
Psychological regression

Semistructured Interview Guidelines to Inquire About Sexual Abuse or Rape in Men
Step 1	Ensure these questions are asked privately where the patient cannot be overheard. Give the patient as much control as you can over the situation during the disclosure. Ask how he wants to be treated, especially when doing anything that may violate his personal space. Begin by stating that "I have some private questions" and ask the following: Where would you be comfortable talking? Is there any place that you would prefer to sit? Would it be okay if I... ?
Step 2	A history of sexual violence can be detected via the following screening questions: Incidents involving forced or unwanted sexual acts are often difficult to talk about. Have you been forced or coerced to engage in unwanted sexual activity by: Has anyone attacked or threatened you in any of these ways: any rape, attempted rape, or other type of sexual attack?
Step 2	If a patient begins to answer but shuts down, gentle prompts can be used, such as: Can you tell me more about that? Do you have an example of that?
Step 3	If yes, communicate these points: I'm glad you survived. It's not your fault. I'm sorry that it happened. You did the best you could.
Step 4	Ascertain, if appropriate, whether the patient's symptoms/issues are linked to this sexual violence. Some men do not make the link between their current issues and past history, so it can be traumatic when they finally do make that link. Ensure that there is a list of accessible emergency contacts in case the patient becomes traumatized.

List of Self-Help Books for Helping Men Cope With Sexual Abuse or Rape
Book Title	Author(s)	Publisher/Year
Everything You Need to Know When You Are the Male Survivor of Rape or Sexual Assault^[15]	John La Valle	Rosen Publishing Group; 1995
If He Is Raped: A Guidebook for Partners, Spouses, Parents and Friends^[16]	Alan W. McEvoy, Jeff D. Brookings, Debbie Rollo	Learning Publications; 2003
Male on Male Rape^[17]	Michael Scarce	Perseus Publishing; 2001
Male Victims of Sexual Assault^[5]	Gillian C. Mezey, Michael B. King	Oxford University Press; 2000
The Sexually Abused Male: Prevalence, Impact, and Treatment^[18]	Mic Hunter	Lexington Books; 1990
The Courage to Heal Workbook^[19]	Laura Davis	Harper Collins; 1994
Male Rape: Breaking the Silence on the Last Taboo^[20]	Richie J. McMullen	GMP Publishers; 1990
Male Victims of Same-Sex Abuse: Addressing Their Sexual Response^[21]	Suzanne M. Sgroi, John M. Preble, A. Nicholas Groth	Sidran Press; 2002
Allies in Healing^[22]	Laura Davis	Harper Collins; 1991

List of Web Sites That Provide Support for Men in Coping With Sexual Abuse or Rape
Web Site	Link
Male Survivor	http://www.malesurvivor.org/
Pandora's Aquarium	http://www.pandys.org/
The National Center for Victims of Crime	http://www.ncvc.org/ncvc/main.aspx?dbName=DocumentViewer&DocumentID=32361
Male Survivor Issues and Resources	http://www.xris.com/survivor/
Rape, Abuse, and Incest National Network (RAINN)	http://www.rainn.org/

Semistructured Interview Guidelines to Inquire About Sexual Abuse or Rape in Men
Step 1	Ensure these questions are asked privately where the patient cannot be overheard. Give the patient as much control as you can over the situation during the disclosure. Ask how he wants to be treated, especially when doing anything that may violate his personal space. Begin by stating that "I have some private questions" and ask the following: Where would you be comfortable talking? Is there any place that you would prefer to sit? Would it be okay if I... ?
Step 2	A history of sexual violence can be detected via the following screening questions: Incidents involving forced or unwanted sexual acts are often difficult to talk about. Have you been forced or coerced to engage in unwanted sexual activity by: Has anyone attacked or threatened you in any of these ways: any rape, attempted rape, or other type of sexual attack?
Step 2	If a patient begins to answer but shuts down, gentle prompts can be used, such as: Can you tell me more about that? Do you have an example of that?
Step 3	If yes, communicate these points: I'm glad you survived. It's not your fault. I'm sorry that it happened. You did the best you could.
Step 4	Ascertain, if appropriate, whether the patient's symptoms/issues are linked to this sexual violence. Some men do not make the link between their current issues and past history, so it can be traumatic when they finally do make that link. Ensure that there is a list of accessible emergency contacts in case the patient becomes traumatized.

Possible Behavioral Indicators of Undisclosed Sexual Abuse or Rape Among Men
Depression
Uncontrollable crying
Aggression (trouble controlling temper)
Sexual acting out
Sexual problems (low sex drive/sexual overactivity)
Eating disturbances
Insomnia/nightmares
Posttraumatic stress disorder
Flashbacks
Panic attacks
Feeling isolated from others
Avoiding eye contact
Fears of an intruder
Low self-esteem
Headaches
Loneliness
Self-harm
Overly frequent washing
Obsession with neatness/cleanliness
Weight loss
Alcohol/drug abuse
Psychological regression

Semistructured Interview Guidelines to Inquire About Sexual Abuse or Rape in Men
Step 1	Ensure these questions are asked privately where the patient cannot be overheard. Give the patient as much control as you can over the situation during the disclosure. Ask how he wants to be treated, especially when doing anything that may violate his personal space. Begin by stating that "I have some private questions" and ask the following: Where would you be comfortable talking? Is there any place that you would prefer to sit? Would it be okay if I... ?
Step 2	A history of sexual violence can be detected via the following screening questions: Incidents involving forced or unwanted sexual acts are often difficult to talk about. Have you been forced or coerced to engage in unwanted sexual activity by: Has anyone attacked or threatened you in any of these ways: any rape, attempted rape, or other type of sexual attack?
Step 2	If a patient begins to answer but shuts down, gentle prompts can be used, such as: Can you tell me more about that? Do you have an example of that?
Step 3	If yes, communicate these points: I'm glad you survived. It's not your fault. I'm sorry that it happened. You did the best you could.
Step 4	Ascertain, if appropriate, whether the patient's symptoms/issues are linked to this sexual violence. Some men do not make the link between their current issues and past history, so it can be traumatic when they finally do make that link. Ensure that there is a list of accessible emergency contacts in case the patient becomes traumatized.

List of Self-Help Books for Helping Men Cope With Sexual Abuse or Rape
Book Title	Author(s)	Publisher/Year
Everything You Need to Know When You Are the Male Survivor of Rape or Sexual Assault^[15]	John La Valle	Rosen Publishing Group; 1995
If He Is Raped: A Guidebook for Partners, Spouses, Parents and Friends^[16]	Alan W. McEvoy, Jeff D. Brookings, Debbie Rollo	Learning Publications; 2003
Male on Male Rape^[17]	Michael Scarce	Perseus Publishing; 2001
Male Victims of Sexual Assault^[5]	Gillian C. Mezey, Michael B. King	Oxford University Press; 2000
The Sexually Abused Male: Prevalence, Impact, and Treatment^[18]	Mic Hunter	Lexington Books; 1990
The Courage to Heal Workbook^[19]	Laura Davis	Harper Collins; 1994
Male Rape: Breaking the Silence on the Last Taboo^[20]	Richie J. McMullen	GMP Publishers; 1990
Male Victims of Same-Sex Abuse: Addressing Their Sexual Response^[21]	Suzanne M. Sgroi, John M. Preble, A. Nicholas Groth	Sidran Press; 2002
Allies in Healing^[22]	Laura Davis	Harper Collins; 1991

List of Web Sites That Provide Support for Men in Coping With Sexual Abuse or Rape
Web Site	Link
Male Survivor	http://www.malesurvivor.org/
Pandora's Aquarium	http://www.pandys.org/
The National Center for Victims of Crime	http://www.ncvc.org/ncvc/main.aspx?dbName=DocumentViewer&DocumentID=32361
Male Survivor Issues and Resources	http://www.xris.com/survivor/
Rape, Abuse, and Incest National Network (RAINN)	http://www.rainn.org/

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