BASED on an exhaustive review of existing literature, researchers at Penn’s School of Medicine have determined that the sexual abuse of boys in the United States has been dramatically underreported and undertreated, with possibly devastating consequences. Some eight to 16 percent of the overall male population has a history of sexual abuse, concluded Dr. William Holmes, the assistant professor of medicine who served as lead author of the study, which appeared in the December 2 issue of the Journal of the American Medical Association. Those found to be at highest risk for sexual abuse were younger than 13 years, nonwhite, of low socioeconomic status, and not living with their fathers.
“Perpetrators tended to be known, but unrelated, males,” said Holmes. “Abuse frequently occurred outside the home, involved penetration, and occurred more than once.”
Holmes’s attention was drawn to the problem several years ago when he studied the sexual histories of a group of HIV- positive men — and was stunned to find that “25 percent of them reported having sexual-abuse histories.” That led him to examine the literature on the subject, focusing on 166 studies conducted since 1985. Holmes, who is also a senior scholar in the Department of Biostatistics and Epidemiology, found that unclear definitions of “sexual abuse” in the literature had contributed to the lack of attention to the problem. While some studies used objective questions to determine whether abuse had taken place, others had employed more subjective questions, and others used no questions at all — relying instead on unstated methods of documentation.
The best level of questioning, he said, “is objective questioning, whereby they actually either defined what sexual abuse is, or they actually talked about different kinds of things that can happen to somebody — and then asked whether that had ever happened to the participant.
“The breadth of any given problem cannot be accurately measured until there is agreement of the definition of the problem,” he concluded. “Objective questioning should be the norm, with terms for sexual organs clearly used (e.g., ‘penis’) and acts described in simple, graphic language.”
The consequences of sexual abuse in adolescent boys can be devastating, noted Holmes, citing higher rates of borderline personality-disorder, depression, and suicide attempts in men who have been victims of sexual abuse compared to those who have not. They also begin using drugs earlier, and tend to use multiple substances. “Perhaps, for these men, substance-abuse is a way of self-medication,” he suggested, “a way to blunt that side of reality.” He added that boys who are sexually abused may become adult perpetrators, though cautioned that one has to be careful about inferring a causal relationship between earlier events and later, adult behavior.
Holmes hopes to study these and other aspects of male sexual abuse soon in greater detail. In fact, the review of the existing literature is serving as the background section of a grant application to the National Institute of Mental Health. If that grant comes through, he intends to study a group of men with histories of sexual abuse, culled from a randomly-selected urban population, and compare that group with a random sample of men who do not have a history of sexual abuse.
In the meantime, he warned that parents need to be as vigilant with boys as with girls, and create an environment “that allows their sons to feel safe talking about any sexual abuse or potential abuse they may have suffered.” And all medical professionals, “especially mental-health experts,” should ask “specifically of new male patients about any history of childhood sexual abuse” — and steer that patient to “some form of counseling.”
