"The Unheard Voices": Lived Experiences of Sexual Abuse in Male Survivors.

Background: Victims of sexual abuse face unique emotional challenges. Among them, the male survivors of sexual assault have largely been neglected in the literature, being traditionally considered "against the norm" and symbolic of reduced masculinity.
Methods: Qualitative approach was used to study the lived experiences of five (three heterosexual and two homosexual) male survivors of sexual abuse. In-depth interviews were conducted with consent, transcribed verbatim, and analyzed using interpretative phenomenological analysis (IPA).
Results: Commonality in the experiences of abuse (the identity of the abuser, nature of agony), perspectives of sharing the abuse history (lack of acceptance of "male" victimhood, the openness of the opposite gender, family reactions), and the long-term impact of abuse (withdrawal/change of interest as coping, sexual identity issues) emerged as the main superordinate theme (and subthemes).
Conclusion: Society, with its patriarchy, often turns apathetic to male victimization in sexual abuse. Beliefs about masculinity and resultant trauma can cause a chronic social and psychosexual impact on the victims. More systematic research is needed to understand their perceptions, unmet needs, and experiences of recovery.

Key Messages:

Sexual abuse in males is a known but neglected phenomenon. This qualitative study explores the lived experiences of young male survivors of sexual abuse. Lack of social acceptance, commonality in the identity of the abuser, abuse being antagonistic to masculinity, and long-term impacts of abuse emerged as the main themes. Understanding sexual abuse in males beyond “traditional social roles” can help interventions for their psychosocial well-being.

The phenomenon of male sexual assault has largely remained undiscussed and ignored in society and the academic community, even though failure to address this issue has profound and detrimental psychosocial consequences for the victim. According to the United States (US) Centers for Disease Control and Prevention (CDC), 16% of males reported being sexually abused by 18 years. In their 2010–2012 survey, the CDC further documented that 1 in 17 men reported being forced to have penetrative sex at some point in their lives. In India, a study conducted by the Ministry of Women and Child Welfare (2007) found that 53.22% of children faced one or more forms of sexual abuse, among whom the percentage of boys abused was 52.94. Such situations might be attributed to the patriarchy induced and misconstrued masculinity, that is, a belief that “maleness” induces an immunity to sexual transgression. Patriarchy and gender stereotypes have tried to project masculinity as incongruent with victimhood, “men cannot be raped.” Also, as espoused by “radical feminism,” patriarchal systems are structured around making women subservient and the objects of male sexual satisfaction. Subramanian et al. found that stakeholders often have a misplaced belief in male children’s resiliency and ability to overcome adverse effects of sexual abuse and, thus, do not address or report occurrences of abuse. Such a system inevitably rules out the possibility of males being sexually violated. Thus, male survivors of sexual violence face unique challenges—the foremost being lack of recognition of the devastating experience of abuse as a “reality.” Thus, in addition to the inevitable experience of trauma associated with sexual transgression, the male victim also has to resolve “de-masculinization” issues. To add to the challenges experienced by these male survivors of sexual abuse is the fact that in many countries, including India, the legal definition of rape and sexual assault is not gender-neutral and is framed keeping a woman as a victim into consideration. A recent amendment to the Protection Of Children from Sexual Offences Law (2012), which provides for the death penalty for aggravated sexual assault on children, is a welcome change; it is now gender-neutral, thus legally and socially acknowledging sexual victimization of not only girls but boys as well. In India, several nongovernment organizations working in human rights have recently advocated that it is imperative to consider that men and people belonging to the LGBTQIA+ (lesbian gay bisexual transgender queer intersex asexual) community are expropriated from their right to seek justice against sexual assault. However, a change in the Indian Penal Code, despite an imminent need for the same, is still a long way to come. It needs to be mentioned that one of the recommendations of the Justice Verma Committee (2013) was to make rape laws gender-neutral. However, that proposal was vehemently opposed by numerous women groups and was ultimately dropped from the Criminal Law Amendment Act, 2013. Thus, male survivors of rape are also forcefully exempted from taking judicial recourse. Sometimes, the health care system itself acts as a barrier to their psychosocial and legal needs in the aftermath of abuse. Keeping this in the background, the present study attempted to understand the unheard tribulations of some male survivors of sexual abuse in their own voices.

Material and Methods

Participants

The study participants were three heterosexual males and two homosexual males of the age range 18–30 years and with a minimum educational qualification of Class 12 (Higher Secondary in India). Snowball sampling was used. Because victims of sexual abuse generally prefer not to disclose their tribulations due to social antipathy toward them, the only way of getting access to this population was through the researcher’s acquaintance. The first participant was known to one of the researchers. He introduced the researchers to another participant with a similar experience. In this manner, the researchers got acquainted with all their participants. Two more individuals, who fulfilled selection criteria, were approached. However, they expressed discomfort in revisiting or recounting their abuse experience and, hence, were not included.

Procedure

The purpose of the study and goals were explained to the consenting participants. Written informed consent was obtained from all of them, after assuring them of anonymity and complete confidentiality of the obtained data. The study received appropriate ethical clearance. Data were collected between October and December, 2019.

Sexual abuse was defined as either of the following experiences: severe sexual assault, including completed or attempted anal, vaginal, or oral intercourse; penetration with objects; and sexual activity without penetration. This definition was adopted from other similar qualitative studies.[7, 8] The current study aimed to explore the participants’ experience of abuse and their way of coping with or “making sense” of the experience. An interview guide (given later) was prepared. It encompassed probes regarding their experience of the abuse, idiosyncratic ways of coping, experience of re-telling abusive encounters to others, its long-term impact on life goals, relationships, etc., and how or if it was related to their sexual orientation. The primary researcher was vigilant regarding the sensitivity of the topic under consideration. She conducted several practice interviews with other researchers, in order to hone her interviewing skills and learn the art of getting maximum information/knowledge with minimum probes. The participants were reminded that they were free to leave at any point, should they feel any discomfort. However, they were encouraged to vocalize/share their experience of discomfort so that it could be addressed in the safe space of sharing.

Tools Used

Sociodemographic datasheet. This was prepared for the study to elicit relevant sociodemographic information from the participants, such as age, sex, education, etc. This information schedule also contained questions related to the focus of research, that is, the experience of sexual abuse, sexual orientation, etc. These questions were framed in a nonintrusive and nonthreatening manner. The purpose was to make the participant feel at ease with the issues before proper interviewing was initiated.

In-depth personal interview. This was conducted using a semistructured “Interview Schedule/Guide” (Box S1), with each participant, in person, the average duration of the interview being 45 minutes. The interviews were conducted in private settings that the participants were comfortable with and only in the researcher’s presence. The specifics are not being disclosed to maintain confidentiality. The interview guidelines were constructed based on a literature review and the tenets of interpretative phenomenological analysis (IPA) and also drew upon the researchers’ prior work with survivors of child sexual abuse. The first author (postgraduate student in psychology) conducted and transcribed the interviews. Open-ended questions and appropriate prompts were used to obtain rich data during the interview. Memo writing was done to maintain notes and prompts during the interviews.

The interviews were audiotaped with the participants’ consent and transcribed verbatim. The transcripts were returned to the participants for cross-checking and correcting. This ensured the validity of their information. The interview transcripts were numbered to anonymize data, and no specific names or identities were used. The complete transcript was cross-checked with each of the participants for their agreeableness on the content. To ensure confidentiality, only the researchers accessed the data.

Analysis. IPA was used to interpret the data. It was done manually. In accordance with IPA’s tenets, interpretation of the participants’ lived experience of sexual abuse and the meaning they attach to those experiences was done in two levels (double hermeneutics). Initial open frame-by-frame coding of the transcripts was done, followed by selective and then axial coding to organize the superordinate theme and subthemes. The themes were identified through sustained engagement with the text and a process of interpretation. The analysis was done manually without the use of any software. Considering that the content of the analysis was sensitive, manual analysis was chosen for the researchers to familiarize and engage themselves with the participant data. Each interview was conducted until no new theme emerged from the interview/participant. The average duration of interviews was about 45 minutes, with the shortest being 37 minutes while the longest lasted 1 hour 20 minutes.

Thematic saturation was achieved with five participants. The reason for data saturation with such a small number could be that this is a highly specific and less-studied population.

The first level interpretation is derived based on the interviewee/the participant’s perspective and their subjective view on their experiences.

The second level interpretation is derived from the basis of the interviewer’s exegesis formed based on first level interpretation

The trustworthiness of the data. To enhance the rigor of the research, the analyst triangulation technique was used. Second, third, and fourth authors simultaneously and independently performed the interpretation, and only those parts of the interpretation that were derived based on mutual consensus were accepted. This helped in reducing selective perception and guiding through the blind spots in an interpretative analysis. As this is a gender-sensitive topic, both male and female genders were involved in the analysis, to ensure content rigor. To prevent the researchers’ personal biases from influencing the data analysis, the analysis involved rigorous discussion among the authors and frequent engagement with the text and the emergent themes. Respondent validation was done with all the participants after obtaining the initial results. Certain facets of the interview were repeated in brief, following the responses obtained from them on specific issues.

Results

The sociodemographic details of the participants are summarized in Table 1. As mentioned before, all were males. The occupational details are not mentioned at the request of the participants.

Table 1.

Sociodemographics of the Participants

Participant No.	Age	Socioeconomic class	Religion	Literacy	Sexual Orientation
P1	22	Middle	Hindu	Class 12	Same sex
P2	18	Lower	Hindu	Class 12	Heterosexual
P3	28	Middle	Muslim	Graduate	Heterosexual
P4	20	Lower	Hindu	Graduate	Heterosexual
P5	30	Middle	Christian	Postgraduate	Same sex

The results of the phenomenological analysis are tabulated as the main superordinate themes, the subsequent subthemes, and the supporting verbal excerpts from the participants (Table S1). The predominant themes were centered around the sexual abuse experiences, challenges in expressing the same, the perception or significance attached with the abuse, and its long-term impact on the victims. All of the participants had experienced some degree of physical violence associated with the abuse. While facing and living through the abuse involved the relationship with the perpetrator and emotional agony of the process, barriers in expressing the distress were the lack of societal acceptance of male victimhood, perceived deficits in familial support, and being considered “feministic.” Finally, the ways of coping varied from change of jobs and hobbies to modifications of sexual identity and preferences. Feeling that their lived challenges were “unheard” was an overarching theme, which was reflected in the participants’ keenness to be involved in the study. They welcomed the initiative as they perceived an “audience” to their “life-stories,” which helped their psychological distress. Their excerpts are presented in Table S1.

Discussion

As seen from the results section, our participants encountered/experienced violation/abuse at familiar settings such as school or university, at neighbor’s house, at friend’s house, and even in their own houses, on multiple occasions. It is evident from the participants’ testimonies that such encounters left them feeling confused, distraught, and vulnerable. Several participants echoed the statement that there was no place where they felt “safe”; rather, they had to be on their guard at all times. The noteworthy aspect was the commonality of their experience, a rather difficult one, of sharing accounts of abuse with others. Participants hardly ever disclosed their dreadful experience to others. The primary reason cited for that was the lack of social cognizance about male victimhood. As one of the participants reported, a man, if or when abused, is taken to be “less of a man.” This feeling has been resonated even in a recent study by Mgolozeli and Duma, where the victims of penetrative sexual assault felt deprived or “robbed” of their masculinity, which subsequently reflected on the social identity. Another participant bore the brunt of his friends’ ridicule when he disclosed his abuse to them. Yet another participant did not disclose about his abuse due to fear of disbelief of the same. This has been identified as a sociocultural barrier to disclosure by Sorsoli et al., that is, victimization of males is an unacceptable premise in a conventional patriarchal society, and, in “rare” cases when it actually occurs, it is not to be discussed. One study revealed that 15%–39% of males reported negative responses when they disclosed sexual abuse experience to others, especially more so when the perpetrator was older and had forcibly violated a younger victim.

One of our participants recounted that although his mother believed him, she did not confront the abuser. While he did not address the issue with her, it created long-lasting feelings of resentment within him. This has been reported as a frequent occurrence where parents acknowledge abuse and neglect but conceal them to protect the child from further occurrences. Disclosure could also be prevented by personal reasons such as fear of negative consequences, fear of being blamed, or being viewed as abnormal or deviant.[16-18]

The participants in our study were open to discussion. They had conceptualized the “abuse” through their own framework, unlike difficulty in conceptualizing the sexual trauma and conflicting feelings that emerged as a main theme of another similar study.

Another important finding of our study was that the participants reported acceptance, compassion, and empathy when they shared their traumatic experiences with their female friends or partners. As one participant reported, his partner was supportive and would be present as a pillar of support in situations where he might feel threatened. Another participant attributed this to the higher prevalence of sexual abuse in females and the societal acceptance of the same. This, in his view, made it easy for them to acknowledge and be sympathetic toward fellow victims of abuse. Although this finding could not be found in other studies, what was noted in several studies was that males often opened up about their tribulation for the first time when they went to therapy. It is widely accepted that it might be the therapist’s nonjudgmental attitude, unconditional positive regard, and feelings of warmth and compassion that help clients feel “safe” and open up about their vulnerabilities. The participants found this atmosphere or environment in the company of their trusted female friends rather than male ones. This could be rooted in care ethics, as mentioned by Gilligan. Additionally, the experience of complete powerlessness and victimization, which is opposed to the conventional masculine notion of pride and independence, is a sad and often-repeated reality of women’s lives, which helped them truly empathize with fellow survivors.

Though it was expected that reliving the “traumatic experience” might be difficult for the participants during the interview, all five expressed relief and emotional comfort for being able to discuss their experiences and challenges in a nonjudgmental setting. This once again emphasizes the importance of empathetic gender-neutral ventilation for victims of sexual abuse.

The current study also explored the longstanding and far-reaching impact of the abuse on the participants. One of the long-term impacts was permanent withdrawal from their choices of career or hobby. While one of them changed his career after being abused by a potential employer, another gave up on his hobby (he was abused by his teacher after class) and has not pursued it to date. For both of these individuals, they were, in fact, putting up a “wall” or distance between them and the abuser as well as the experience of abuse. This could be seen as evasion coping, which is higher in male victims of sexual abuse.

Another impact of abuse was significant dents in identity it rendered and the idiosyncratic journey taken by each individual to re-establish or newly establish their self while incorporating the trauma in the conception of themselves. One participant expressed dilemma and confusion over the reason behind his sexual orientation and wondered if it was the abuse that made him choose homosexuality. This has been recurrently reported as a consequence of sexual abuse in quite a few studies.[21-23] Re-experiencing vulnerability with sexual identity as a part of the emotional response has also been reported by a recent qualitative study. Another participant believed that his non-normative sexual orientation made him more vulnerable to nonconsensual sexual overtures. This has also been reported in earlier studies.[24, 25] However, the same participant acknowledged that accepting his sexual identity enabled him to redefine the power dynamic and establish the sexual boundaries.

One participant reported that he had developed a mechanical approach toward sexual intimacy and did not derive any pleasure. This has been reported as a frequent occurrence in males who have experienced sexual abuse; they often undergo a journey of renegotiating sexuality, which involves espousing a conventional feminine narrative of prioritizing emotional intimacy and trust. One of the participants reported about developing homophobia as his abuser had same-sex orientation.

Conclusion

Formal literature and various sociopolitical discourses have a significant dearth of research and dialogue on sexual abuse of males. Society, rather, patriarchy, turns a blind eye to anything that threatens the traditional view of masculinity, and thus, males can only be seen as powerful, active, initiating, and invincible. This, in turn, robs the victims of language or place in such settings, and their experiences go unacknowledged, undocumented, and invalidated. In the present study, a few abuse survivors refused to participate as they felt uncomfortable about discussing their tribulations. As Alaggia and Millington pointed out, recounting “confusing, threatening, disempowering experiences” can be more threatening to men. Research suggests that a confiding relationship helps one overcome the negative effects of abuse, and therapeutic space seems to provide one with the same. However, in India, individuals seeking professional services for mental health are frowned upon. Compounded furthermore is the silence around the vulnerability of the traditional “masculinity” that makes this subject a social taboo. There is, thus, a dire need to create a “safe” space for men where they can renegotiate the boundaries of masculinity in a receptive environment, can open up about their experiences, process the trauma, make meaning out of it, live a fuller and more enriched life, and, perhaps, even pursue the hobbies they left due to trauma. This might ensure a better process of recovery and social integration.

The current study is with a small sample size, but nevertheless, an in-depth qualitative analysis that provides rich data in terms of lived experiences in the participants’ own voices, where each voice is important. It helps take a social glance at this unacknowledged violence and throws light on the magnitude of systematic research that needs to be done in this field to estimate the risks, social outcomes, and unmet needs of male sexual abuse victims. This might help in shaping policies, interventions, and methods to prevent the social evil of abuse.

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Supplemental material for this article is available online.