“I don’t think I ever leave my house without feeling some fear. Even if I don’t consciously think about it, there’s that sense within me that I’m at risk. I still wake up in the middle of the night terrified. I wake up with that taste in my mouth. I can taste it again. Sometimes at night I wake up and the pain – it feels like a knife going through me to where I almost jump straight up. When that happens the nights are still pretty hard. I usually don’t go back to sleep.”¹ 

These are the words of Andrew, who was raped by multiple assailants. His reaction and feelings are similar to many who are raped, but still male rape remains an extremely under-reported crime. 

Men are generally portrayed as being strong and not as a vulnerable population. Internationally male rape and sexual assault is still a taboo subject. There is a dearth of research and literature available on it. A seminal piece of work carried out in 2002 in Ireland revealed the true nature of rape and sexual assault in both males and females. Some 28% of men reported having experienced some form of sexual violence in their lifetime. Of these, 3% experienced penetrative assault, 18% experienced attempted penetration or contact abuse, and 7% experienced non-contact abuse.²

In 2011 there were 351 attendances for forensic examination at the Rotunda Sexual Assault Treatment Unit (SATU); 93% were female and 7% were male.³ The SATU service is offered to patients aged 14 years and older, both male and female, for acute or historic cases of sexual assault and rape.

The law

There are a number of different laws in relation to rape and sexual assault, depending on the type of sexual activity and the age of the victim. 

The Criminal Law Amendment Act (Rape), introduced in 1990, states: “Rape under section 4 means a sexual assault that includes:

• Penetration (however slight) of the anus or mouth by the penis, or
• Penetration (however slight) of the vagina by any object held or manipulated by another person.”³

Perceptions

In society there are perceptions and stereotypes prevalent with regard to gender roles, in rape in particular. Male rape has negative connotations with regard to heterosexual and homosexual behaviour, and as a result some male victims have considerable difficulties when seeking care following a rape. Some men experience some forms of psychological/emotional distress but the effect on men’s sense of sexuality, masculinity and sexual identity may encourage them to suppress the event and delay disclosure. How we care for these men has a huge impact on their future lives. Society expects men to display traits such as toughness, independence, aggressiveness and dominance, whereas qualities such as submissiveness, emotionality and compliance are not consistent with social norms.⁴

The SAVI Report: Sexual Assault and Violence in Ireland stated that 41% of men thought that men who were sexually assaulted must be gay. A study carried out on attitudes to male rape found that there was a pecking order for suffering, in which heterosexual men were perceived to suffer more after rape as they had been exposed to a different form of sexual practice; while anal intercourse was perceived to be more acceptable to homosexual men and thus they were perceived to be less deserving of sympathy and assistance.⁵

Societal issues

The issue of male rape continues to be the most under-reported crime of sexual violence and health problems in our society, thus it is incumbent on clinicians to educate the general public to cause individual changes but also changes in societal norms. Providing education can help to increase awareness of male rape and also help to dispel myths. Education can be delivered not only to adolescents but to religious clergy, the military, prison officers and legal professionals involved with victims of rape. 

The media also needs to be influenced in the way they portray male rape. Sensationalising it only adds to the myths and stereotypes, thus there is a social responsibility to portray rape in an unbiased fashion, regardless of the gender of the victim.⁴

Physical and emotional effects of rape

Men and women go through similar levels of distress following a rape, although feelings of intense anger are more common among men. Sexual assault on men is likely to be more violent than cases involving women, potentially leading to more general body than genital trauma.⁶ Most common injuries may be abrasions to the throat and abdomen, bruising, broken bones and black eyes. 

Penile penetration is less common in male victims than in female victims, whereas digital, object and anal assault is common in males.⁷ If there is genital trauma it most likely takes the form of rectal injury, including tears to the anus, abrasions, haematoma, bleeding and fissures.⁷

There is no typical response following a rape or sexual assault. Emotions range from calm, composed, relaxed to a complete emotional breakdown. Sleep difficulties, depression, alcohol, drug and tobacco misuse, and suicide attempts are some of the issues experienced by men. They may feel shame, embarrassment, stigma and hostility following the assault. 

Some 70% of men reported long-term sexual identity problems and 68% a damaged masculine identity.⁴ They think that being raped makes them gay or that they have given off signals so that people perceive them as gay. One reason that makes them question their sexual orientation is that they may have experienced sexual arousal during the rape. Erections are a common involuntary response in times of extreme pain, anxiety, panic or fear. This can cause a lot of insecurities in their sexual lives and may lead to impotence. A prevalent theme that emerges is men’s inability to form close and trusting relationships following a rape. Extensive sensitive and effective counselling has shown to be beneficial to men.⁷

Barriers to reporting

Just 5-10% of male victims report a rape or sexual assault to An Garda Síochána; as a result there is a significant number who do not seek help or assistance from any authority or organisation.³ Erectile response during a rape lessens a man’s response to seek help or even to acknowledge the assault.² Men fear rejection and disbelief from authorities if they report an assault. Society views male rape as rare because there may be a perception that men should be able to resist.⁷ One man said of his rape:“I don’t think a lot of people believe it could happen. I am 6’2” and weigh 220lb.”¹

Due to the prevalence of female rape, most sexual assault services have a greater female focus; nevertheless all the Irish centres also care for male victims. Another issue which may deter men from reporting is that male victims stay in denial longer than female victims and don’t want anyone to know what happened to them. Male victims rarely seek care within 24 hours of an assault.

Services available for male victims

In Ireland there is no dedicated service for male victims. There are, however, six specialist SATUs strategically placed nationally to provide responsive care for men and women over the age of 14 years, who give a history of recent rape/sexual assault. The care is available 24 hours a day, seven days a week, and includes forensic clinical examination, treatment of any injuries sustained, provision of appropriate medication and immediate psychological support. These units are located in Dublin, Mullingar, Galway, Waterford, Cork and Donegal. There is also an out-of-hours service at Midwestern Regional Hospital Limerick.

A caring non-judgemental attitude is fostered in caring for victims of sexual assault. When a person reports a sexual assault to An Garda Síochána an appointment is made to attend one of the units where a forensic clinical examination will be carried out promptly. Forensic evidence should be obtained as soon as possible after an incident but may be collected up to a week after an assault. It is, however, rare to identify semen in the rectum more than 72 hours after an incident. Nevertheless, other forensic evidence, including injuries sustained during the assault, may be identified so prompt attendance at a SATU is encouraged. Risk assessment for post-exposure prophylaxis for HIV (PEPSE) should be performed on all patients who present within 72 hours of an incident. Factors specific to the assault (rectal penetration, multiple assailants, bleeding) or the assailant (known to be HIV positive) may increase the risk of HIV exposure and acquisition and prophylactic antiviral therapy should be initiated without delay.⁸

A support worker from the Rape Crisis Centre will attend the SATU and be available to support the victim should they so wish. All victims, whether male or female, receive care from committed, competent and caring professionals. 

Conclusion

The reporting of male rape is much lower than that of females although the volume of disclosure is increasing. Undoubtedly, raising awareness about attitudes towards care after male rape should be introduced into communities. The lack of data in this area hinders knowledge about prevalence of such assaults; there is a need for further scientific and epidemiological data and research. Male rape continues to be under-acknowledged, under-reported and under-managed, therefore it is up to us to challenge this dimension of Irish culture and to increase its unacceptability in society.  

References

1. Scarce M. Male on male rape: the hidden toll of stigma and shame. Persues Publishing, London: 1997 (pp2)
2. Mc Gee et al. The SAVI Report, Sexual Abuse and Violence in Ireland. The Liffey Press, Dublin: 2002
3. National SATU Guidelines Development Group, Recent Rape/Sexual Assault: National Guidelines on Referral and Forensic Clinical Examination in Ireland, 2010 (pp123)
4. Turchik J, Edwards K. Myths about Male Rape: A Literature Review. Psychology of Men & Masculinity 2012; 2: 211-226
5. Doherty K, Anderson I. Making sense of male rape: constructions of gender, sexuality and experience of rape victims. Journal of Community Applied Social Psychology 2004; 14: 85-103
6. Mc Lean I. The male victim of sexual assault, Best Practice & Research Clinical Obstetrics and Gynaecology 2013; 27: 39-46
7. Tewksbury R. Effects of Sexual Assaults on Men: Physical, Mental and Sexual Consequences. International Journal of Men’s Health 2007; 6: 22-35
8. Health Protection Surveillance Centre. Guidelines for the Emergency Management of Injuries (including needlestick and sharps injuries, sexual exposure and human bites) where there is a risk of transmission of bloodborne viruses and other infectious diseases). HSE, 2012