Whilst there are many similarities in women's and men's reported experiences, impacts and responses to childhood sexual abuse, research and practice evidence is beginning to identify some particular differences. In detailing some of these gendered differences, it is recognised that there is considerable diversity of experience amongst men and amongst women and that in many respects the similarities amongst those who have survived sexual abuse outweigh the differences (sometimes it is more a matter of degree, the particular clustering of effects, interpretation and meaning, than unique difficulties). Masculine stereotypes impact on how men experience, understand and respond to sexual abuse and its effects (Crome, 2006; Easton, Renner & O'Leary, 2013; Holmes & Slap, 1998; Hunter, 1991; Lisak, 1994; Easton, 2014; O'Leary, Easton & Gould, 2015). For example, whilst men also experience depression, this occurs in a gendered social context, where men struggle to privately and publicly acknowledge they are not coping and less likely to access health services.

For a detailed discussion of gender, see the Gender and Sexuality module.

Men report:

Childhood sexual abuse challenges gender identity.

“I recognise culturally for women to talk about sexual abuse was a risk of them appearing to others as damaged goods and so on; but for men I think it was different because it gets mixed up with gender identity and not so much for the women the self-image of a man being sexually physically able to look after yourself and the necessity of doing that and so on and so forth….I know you’ve got males who have been sexually assaulted and, because of stigmas of society, are still unwilling to get counselling and help for it.” Teram, E et al. (2006). Towards malecentric communication: sensitizing health professional to the realities of male childhood sexual abuse survivors. Issues in Mental Health Nursing, 27 (5), 499-517.

Being sexually abused or sexually assaulted can challenge men's gender identity. Identifying 'as a man', with all the expectation and understanding of how men are and relate to the world, is a primary social identity by which people make sense of and function in the world. Many men identify that the experience of sexual assault can leave them feeling that they have to continually prove their masculine identity. Some men speak of how being sexually assaulted robbed them of their masculine identity.

Confronting questions of sexual identity

“It makes you wonder when you’re being raped. You know, some guy just had anal sex with me. You know, who am I? Am I gay or am I hetero? You know, you wonder?” (Butler, 1994).

"[T]he realisation dawned on me for the first time that what Father Duggan had done was actually abuse. I had appreciated up until then only that I had felt ashamed, embarrassed and uncomfortable about the sexual contact with Father Duggan. However, that was because I had thought that my behaviour was wrong or abnormal and that I was homosexual or bisexual. I had also recognised the sexual contact as something which I had kept secret." (John Ellis, The Royal Commission Final Report, Vol 3. Impacts, p. 45)

Men who have been sexually abused report being confronted by questions about their sexual identity, sometimes throughout adulthood. Women do not report the same set of questions as an effect of the sexual abuse. Partly this question comes from the fact that the majority of sexual assault of males is committed by males (80% in Dube et al. 2005), and that the abuse involves a same sex act (96% of sexual abuse of females is committed by males, a heterosexual act). It also both highlights a community concern with establishing sexual identity, and how acts of abuse or assault can become subsumed or overshadowed by questions relating to sexual identity, rather than the coercion, manipulation, or assault that occurred.

Like gender, sexual identity is an influential identity category by which people make sense of themselves and the world. Some men report a "struggle with confusion/anxiety over sexual identity, [and] inappropriate attempts to reassert masculinity" (Crome, 2006, p. 5). Some men report 'homophobia', external and internal, as an effect of the sexual abuse. This homophobia can be produced when sexual assault is misrepresented as a 'homosexual offence', presuming that the offender identifies as 'homosexual', when in fact the vast majority of men who commit sexual abuse of males identify as heterosexual or straight.

Externalised distress

There is evidence that some men who have been sexually abused are more likely to express distress through problematic or 'externalised' behaviours such as drinking, reckless sexual activity, gambling, and these can 'cloud' the more typical abuse related symptoms (Crome, 2006, p. 3). Romano & De Luca (2001) report that men exhibit greater propensity for externalising behaviours such as aggression and excessive risk taking, whereas women who have been sexually abused exhibit internalising behaviours such as guilt and depression. O'Leary (2009) found that men who have been subjected to child sexual abuse report increased substance misuse.

Barriers to help seeking

“Yes, I think it’s that shame, that weak, you know, if I need help I’m weak, those are the things that would have stopped me years ago getting help, even though people told me I needed help, I avoided it” (Rapsey et al., 2017, p. 7).

Men who have been sexually abused report being very much aware of established gendered expectations that as a man you are meant to be strong, to be self reliant and able to cope with and resolve difficulties alone and this along other barriers to disclosure (see Disclosure Module) reduces their help seeking behaviour. One of the difficulties with diminished help seeking, is that it delays dealing with effects, and can support the prolonged use of unhealthy and avoidant coping strategies. It can also add to men's sense of shame, failure, self blame and self loathing for not 'manning up' and addressing difficulties.

The difficulty is that these men not only have to overcome the issue specific barriers related to being sexually abused, but that they are living in a culture where men report:

• Lower knowledge and awareness of health issues.
• Less likely to access GP, health care practitioners.
• Lower mental health literacy.
• Poorer diet and nutrition.
• Higher consumption of alcohol and illicit drugs.
• Greater use of tobacco.
• Increased negative impact of unemployment.
• Higher likelihood of being a victim of assault, robbery and homicide.
• Higher likelihood of perpetrating violence.
• Higher likelihood of committing suicide.

Confronting vulnerability

In addition to the above gendered differences and constraints, men who have been sexually abused report that help seeking is difficult, because they have to confront and overcome vulnerability.

“The experience of vulnerability and helplessness that makes up part of the core of the abuse experience violates the fundamental tenets of masculinity as it has been culturally elaborated” (Lisak, 1996).

According to the 'masculine code', the one thing a man is not meant to be is 'vulnerable', yet vulnerability is central to the experience of sexual abuse and in some cases in addressing its impacts.

• Sexual abuse is an experience of vulnerability.
• According to the 'masculine code', males are not meant to be vulnerable.
• To recognise that you have been sexually abused is to acknowledge to yourself that you have been and can be personally 'vulnerable'.
• To access support typically requires a person to acknowledge current vulnerability (not coping) and historical vulnerability (having been abused), to someone else.
• There is a suggestion/concern that in order to 'cope better' and 'get on', victim/survivors need to revisit/process the experience of vulnerability.
• If we think of this about what we know about trauma and the brain, present day experiences of vulnerability are very likely to trigger sexual abuse flashbacks and trauma responses.

Confronting vulnerability, as described above, produces an almost impossible bind of men who have been sexually abused. It can be useful, therefore, for those working with men to acknowledge this almost impossible bind and hence the strengths, resilience, courage, problem solving skills it takes to confront the experience of vulnerability and address the impacts of abuse.

The effects of vulnerability may also vary throughout the lifespan. Within The Royal Commission Final Report, Dr Philomena Horsley stated the particular issues related to vulnerability for those in aged care facilities:

“As people age and become older, particularly those in their 70s and 80s and 90s, there’s a physical frailty, there’s often a cognitive impairment of some kind, or moving into that space, as well as, in a social sense, greater isolation from networks, particularly if one is in care or going into care, and so lack of support. I think what can happen is as those feelings of vulnerability and lack of safety occur in someone’s life, it can re-trigger memories, either specific memories or just a more generalised sense of feeling vulnerable, not feeling safe, feeling a lack of control about their physical surroundings, whether they’re in a family home or whether they’re in an aged-care facility or whether they’re in a prison, for instance, which I think is a really under-recognised area. People become less physically mobile, so [have] less [of] a sense of empowerment in themselves [...] What happens particularly in aged care settings and in many cases hospital settings where a lot [of] older people spend significant periods of time, is they lose their privacy. They often have intrusive physical examinations, they may be catheterised, they may  have a range of UTIs [urinary tract infections], which is really common in older people, all of which involve other people touching their genitals or their body generally, who  they don’t know or have a relationship with.”  (p. 28, Vol. 3: Impacts)

Suicidal ideation and attempts

“At 19, I lost my driving licence because I had been drinking and driving. One day I drove very fast down Eureka Street in Ballarat. I drove about halfway, hit a telephone pole, lost control of the car and crashed through the front fence of a house. The ambulance and police could not believe that I lived through such a crash. The only injury that I got was some glass in my head. They said the only thing that saved me was that I didn’t have my seatbelt on and was thrown into the back seat. The front of the car was crushed. It took me a long time to realise that these accidents were actually suicide attempts. I think I was trying to be heard. My mum said to me, ‘BAP you’ve got nine lives, you must be a cat’. I couldn’t even tell her why I was doing these things.” ("BAP", p. 103, The Royal Commission Final Report, Vol. 3: Impacts)

The risks of suicide are increased for both men and women who have experienced sexual abuse. One large scale study of 17,337 participants found that "compared to reporting no sexual abuse, a history of suicide attempt was more than twice as likely among both men and women who experienced CSA" (Dube et al., 2005). O'Leary and Gould (2009, p. 950) found in their Australian research, that "sexually abused men were up to ten times more likely to report suicidal ideation" than men in the broader community sample. In noting high rates of suicidal ideation/attempts and substance misuse by men sexually abused in childhood compared to the general male population, this occurs in a context where between 1994 and 2004 men accounted for 80% of the deaths by suicide in Australia (O'Leary, 2009).

Factors influencing increased suicidal thoughts/actions following experiences of sexual violence for men are:

• Feeling isolated and alone.
• Acting violently and aggressively.
• Blaming themselves for the abuse.
• Feeling fearful and anxious.
• Using alcohol and drugs (O'Leary & Gould, 2009).
• Loss of hope (Spokas et al., 2009).
• Investment in masculine norms (O'Leary & Easton, 2014).

In a study of 487 men with a history of CSA, five variables were related to an increased risk of suicide attempt in the past year:

• frequency of the sexual abuse;
• use of force during the sexual abuse;
• high conformity to masculine norms;
• level of depressive symptoms; and
• suicidal ideation (Easton et al., 2013, p. 6).

Easton and colleagues (2013, p. 6) stated that:

“...in this study, men who met criteria for high conformity to masculine norms had an increased risk of attempting suicide in the past year... those who adhere to gender norms may restrict their emotional expression and refuse to discuss their feelings with others” (Easton et al., 2013, p. 6).

In light of the findings of the research conducted by Easton and colleagues (2013, p. 6), the authors advised that:

“...although it may be emotionally difficult for men to recount details of CSA when seeking clinical services, the findings in this study suggest that knowledge of CSA characteristics could be important in suicide assessment and prevention.”

Beware of uncritical promotion of the victim to offender discourse

“It is important to emphasise that most sexually abused children do not become sexual offenders. Additionally, many individuals who have committed child sexual abuse do not report having themselves experienced sexual abuse” (Richard, 2011 in Proeve, Malvaso & DelFabbro 2016 p. 28).

It is important to develop awareness of research evidence in relation to the possible relationship between a man being sexually abused in childhood and later offending. No causal link has been established. Rather research has identified some increased risk factors.

A review 7 studies did not suggest that there is a straightforward relationship between being abused and offending. Factors identified as increasing risk of offending of males sexually abused in childhood:

• Masturbation, fantasy, and pleasure connected to abuse.
• Physically abused (in addition to sexual abuse) in childhood.
• Witnessed high/severe levels of violence in childhood family home.
• Sexually abused by both family and non-family abusers. Thomas (2009, pp. 382-387).

A recent prospective study (Widom & Massey, 2015 in Proeve, Malvaso & DelFabbro, 2016, p. 29) indicated that, whilst histories of physical abuse and neglect significantly predicted arrest for a sexual crime, history of child sexual abuse did not. In addition, evidence suggests age at time of the sexual abuse can increase risk of offending. Rates of conviction for sexual offending for males sexually abused under 12 years 2.9%, for those abused 12 years and over 9.2%. Over 90% are non offending and highly protective.

The victim to offender discourse profoundly troubles men who have experienced childhood sexual abuse or sexual assault, stopping them from talking about what was done, seeking help, having relationships, being engaged with their children. It can make men hyper vigilant: constantly worrying, monitoring and checking their own behaviour for any possible signs of being a ‘perpetrator' or 'paedophile'. This fear is distinct from actually offending or having thoughts or plans of offending, whereas those who offend have little fear of their own offending behaviour and their thoughts are occupied with ways they can offend and conceal or justify their abuse.

Issues relating to offending will be dealt with in more detail in the future in a separate module on Addressing sexual offending.

Personal stories

The sharing of men's experiences and their survival can be useful in developing understanding of the effects of sexual abuse, as well as empowering, as it provides a means to overcome isolation and build solidarity. Hearing men's stories can help professionals to understand the context and meaning attached to effects. It helps practitioners better understand how sexual abuse effects can be expressed everyday life.

Below are links to videos of men speaking about their experiences, the meaning they have made of the sexual abuse and what is important to them in their lives.

We encourage you to take care that incidents of sexual abuse are discussed, which can be triggering and distressing for those impacted by sexual abuse.

As you watch and listen to the video segments, you might reflect on the themes and points that stand out most to you. Take written notes of these themes. There are a series of questions and points of reflection below.

Video: Les's Story

Shatterboy: Men Surviving Sexual Abuse

If you would prefer to read men’s reflections and comments see Excerpts from "It happened to us: Men talk about child sexual abuse".

"It happened to us: Men talk about child sexual abuse"

This booklet, developed by the Victorian Department of Human Services [VDHS] (2000), provides an opportunity for adult male survivors of child sexual abuse to speak out about their own experiences and what they felt was important in helping them. By presenting their feelings, views and experiences, they hoped that other survivors, the community and professionals who work in the area, will learn more about child sexual abuse and its effects.

Download this booklet [191 kB ] or visit the web page about the booklet.

Social and relational impacts

Men and women subjected to sexual abuse are 40-50% more likely to report relationship difficulties, including difficulties with trust, intimacy and sex (Dube, Anda et al., 2005). Common relationship and parenting problems, work stressors, and traumatic events can trigger childhood trauma and produce fear of abandonment, hypersensitivity to criticism, challenges with trust and intimacy, and problems dealing with conflict (Bateman, Henderson and Kezelman, 2013, p. 20).

One of the particular challenges men subjected to sexual abuse report is limited support from friends, family and service providers. Damage to trust and a lack of sense of safety in relating with others associated with the abuse may contribute to limited support and relational networks. This sits within a context where men typically have smaller social support networks than women, and are less likely to have a close confidant other than a spouse (Flood, 2005; Breckenridge, Cunningham & Jennings, 2008; Washington, 1997).

When working with men, support for partners is a priority. Noting that a partner's distress and isolation is often amplified by the pressure men feel to keep the abuse secret. At the time of telling his partner, the man will typically ask them not to tell anyone else, thereby cutting them off from their own important supportive relationships.

Impacts on sexual relationships

The impacts on sexual relationships can be complex and difficult for men to talk about. Research with couples where the male partner had experienced sexual abuse has identified the following impacts:

• Increased confusion during sexual and emotional intimacy.
• Difficulties when the man 'checked out' and emotionally disengaged.
• Increased emotional engagement and communication were correlated with improvements in the sexual relationship.
• Feeling distress, shame or guilt about a sexual response.
• Engaging in sexually compulsive behaviour.
• Aversion to sex or specific sexual activities.
• Difficulty trusting sexual partners.
• Experiencing, panic attacks, disassociation or flashbacks during sexual activity (Anderson & Veach, 2005; Hall 2008).

Sexual abuse can lead to difficulties in relationships, and to confusing sex with love, care-giving, abuse, pain, being powerless or being powerful. These difficulties may surface and then dissipate for long periods, or be an ongoing source of tension in the relationship. Some men report confusion regarding sexual identity and intrusive sexual thoughts and images during intimacy.

It is not unusual for men to present at services when relationship difficulties have arisen. This can be an opportunity for practitioners to work with the man and capitalise on his motivation to improve his relationships and address difficulties. More about working with relationship difficulties, intimacy and sexuality is discussed in the module Men and Relationships (coming soon).

 

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