behavioral

sciences
Review
Male Victims of Sexual Assault: A Review of the Literature
John C. Thomas 1 and Jonathan Kopel 2, *

1 Department of Counselor Education & Family Studies, Liberty University, Lynchburg, VA 24515, USA
2 School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
* Correspondence: [Link]@[Link]

Abstract: Compared to female rape victims, the literature addressing male rape victims remains
a growing area of interest for counselors and scholars. This article aims to review the growing
literature on male sexual assault victims. Specifically, the review will examine the literature on
male victims of sexual assault in nine sections: (a) an overview of male sexual assault, (b) male
rape myths, (c) prevalence, (d) responses to male victimization, (e) populations and perpetrators of
male victimization, (f) risk factors, (g) reporting, (h) the impact of sexual assault on men, (i) help-
seeking, and (j) implications for counseling. Empirical studies, case reports, and books are included
in the review.

Keywords: male rape; sexual assault; sexual trauma; rape myths; counseling

1. Introduction
Sexual assault, harassment, non-penetrative acts of sex, and attempted and committed
rape are all examples of violent sexual behavior. Sexual victimization, according to the
Centers for Disease Control and Prevention, is a sexual act that is conducted or attempted
by another person without the victim’s freely given consent or against someone who is
unable to consent or refuse. It is a significant public health issue that warrants significant
public, societal, and judicial attention [1]. According to current estimates, over 27% of
men and over 32% of women had been sexually victimized at some time in their lives [2].
Molestation is abusive sexual activity committed by one person against another [3]. It
is frequently committed with the use of force or by taking advantage of someone [3].
Molestation is a term used to describe a single incident of sexual assault on a young child,
Citation: Thomas, J.C.; Kopel, J. Male whereas sexual abuse is a term used to describe a pattern of repeated sexual assaults. Sexual
Victims of Sexual Assault: A Review abuse can have catastrophic and pervasive repercussions.
of the Literature. Behav. Sci. 2023, 13,
Victimization has a direct negative influence on the physical and mental health of those
304. [Link]
who experience it, leading to short- and long-term physical injury, fear, anxiety, despair,
bs13040304
post-traumatic stress disorder (PTSD), low self-esteem, social difficulties, and suicide
Received: 10 January 2023 ideation [4]. Together with other socioeconomic implications such as being unable to work,
Revised: 27 March 2023 dropping out of school, being stigmatized, and being shunned by their communities, it is
Accepted: 29 March 2023 also linked to an increased risk of sexual and reproductive health issues [5–7]. A sexual
Published: 3 April 2023 act that is conducted or attempted against a person who is unable to consent or refuse
by another without the victim’s free consent is known as sexual victimization. Men are
generally seen to be as less affected by sexual victimization. Yet, there is evidence to support
the idea that sexual victimization affects male victims mentally just as much as it does
Copyright: © 2023 by the authors.
female victims and may even be linked to worse results [8].
Licensee MDPI, Basel, Switzerland.
In ancient and modern societies, female sexual assault has remained a prevalent social
This article is an open access article
and public health challenge [9]. However, the infrastructure and support to allow reporting
distributed under the terms and
conditions of the Creative Commons
of sexual assault was extremely difficult [10]. Specifically, “Few women were willing to
Attribution (CC BY) license (https://
endure the damage to reputation and prospects for marriage that followed from bringing
[Link]/licenses/by/ a rape complaint, and if they did, the prospects for vindication of their complaint were
4.0/). remote indeed. The common law required a woman claiming rape to make a highly scripted

Behav. Sci. 2023, 13, 304. [Link] [Link]

Behav. Sci. 2023, 13, 304 2 of 22

showing that sexual relations were nonconsensual; she had to show that sex was coerced
by force and against her will -that she succumbed to overpowering physical force despite
exerting the ‘utmost resistance’” [11]. Despite the social stigma against sexual violence
perpetrators, female sexual assault was permitted in several cultures depending on the
victim’s social standing or violation of social taboos. For example, the sexual coercion of
enslaved African American women was permitted without any legal repercussions [12].
Furthermore, clinical investigations into the prevalence, psychological trauma, and therapy
for female sexual assault victims remained unknown until the 19th and 20th centuries [13].
Although the female victims of sexual assaults have garnered a great deal of nec-
essary attention, the body of literature examining men as victims of sexual violence is
lacking [14–18]. Consequently, what is known about adult male sexual victimization
(AMSV) is dwarfed by the knowledgebase on female victimization [19]. It is estimated that
the help and support for male victims is over 20 years behind that of female victims [20].
Furthermore, male victims have fewer resources and greater stigma with female sexual as-
sault victims [21]. Approximately 20–25% of female sexual assault incidents are reportedly
reported in the United Kingdom (UK) [22]. For instances of AMSV, it is anticipated that
this statistic is far lower. Prior to 1994, the United Kingdom’s legal definition of rape was
restricted to instances of forceful or unconsented vaginal penetration, thus excluding male
victims [23]. Instances of forced or unconsented anal penetration fell under the legal defini-
tion of “buggery”, which was punishable by a significantly lighter fine. Between 10–20% of
female sexual assault victims in the United States (US) are believed to have reported the
crime, and the number of male victims is likely to be far lower. All but three jurisdictions
in the United States now have gender-neutral rape laws, with Georgia, Mississippi, and
Idaho being the three exceptions.
During the 1980s, there has been a significant increase in the amount of literature on
the topic, indicating that AMSV is not as uncommon as the former paucity of material on
the issue suggested [4,24]. The incidence and prevalence of sexual assault against adult
men, the reasons behind it, and the psychology underlying victims’ involuntary sexual
reactions are all covered in this article’s examination of the literature. Due in part to
the misconception that the victim’s erection or ejaculation during the assault constitutes
permission, the legal system has been reluctant to offer male sexual assault victims a legal
redress, despite the increased awareness of these crimes [4,24].
Although the literature on sexual violence against women is laudable and although
it has provided a foundation upon which to explore male victimization [25,26], the latter
is an experience that is worthy of investigation. Even though adult male sexual violence
(AMSVo) is becoming more widely acknowledged as an issue, the literature unanimously
agrees that there is a dearth of information on the subject when compared to information
on female victims [27].
This article provides a review of the literature on AMSV. First, we provide the back-
ground for our literature search and criteria. Next, a discussion of the numerous definitions
is offered on AMSVo and related terms. We examine the literature related to prevalence
and barriers for men to report incidents of sexual violence. Biases and misconceptions
which impact both the reporting of an incident and response to men who are victims of
sexual violence are explored in depth. Research is provided on typical male responses to
sexual victimization, populations of men most at risk and risk factors to being violated, the
emotional impact on men, help-seeking by men, and implications for treatment to equip
counselors with required knowledge on AMSV and to empower them to address challenges
facing male victims. Finally, the limitations of this review and recommendations for future
directions in this research field are outlined.
As will be evident from this article, much of the literature is old, dating back to the
1970s when seminal research was taking place. Since that time, empirical investigations of
male sexual victimization have only been sparsely carried out over the course of nearly
50 years. Given the lack of research into adult male sexual victimization, we do not have
certainty regarding what is applicable to today’s victims and what is outdated. According
Behav. Sci. 2023, 13, 304 3 of 22

to this review, men frequently have erections or ejaculate uncontrollably during a sexual
assault; nonetheless, the victim’s response does not imply consent. This review also
supports the notion that anal rape might cause men to experience involuntary erections
or ejaculations.

2. Definition of AMSVo
Several terms describe sexual violence, including sexual victimization, sexual assault
and rape [28,29], although the literature often uses the terms interchangeably. Adult
sexual assault refers to all types of sexual assault, including rape, which is defined as the
penetration of the victim’s mouth or anus by a penile, digital, or foreign object while using
force, coercion, violence, threats of violence, or incapacitation. It covers oral-genital groping,
fondling, kissing, groping, and any other type of unwelcome sexual contact carried out in
similar ways [30]. The definition specifically mentions actions of unwanted female-initiated
sexual contact because there are still misconceptions about the subject. While determining
the issue of prevalence, it is crucial to be aware of the full range of sexual assaults, even if
it is acknowledged that non-rape forms of sexual assault could not have the same effect
on the victim as an attempted or successful rape. One in thirty-three men have reportedly
been the victim of an attempted or successful rape, but when the definition is expanded to
include sexual assault, the figure rises to one in five men [30,31].
Currently, there have been several definitions used to define sexual assault. Isely and
Gehrenbeck-Shim (1997) defined male sexual assault “as any non-consensual sexual acts
perpetrated against a man, 16 years or older, by a male or female” (p. 160) [32]. In 2020, the
Department of Justice’s (DOJ) definition of sexual assault included a range of victimizations
and was separate from rape or attempted rape. It includes attacks or threatened attacks
involving unwanted sexual contact between victim and offender, with or without force;
grabbing or fondling; and verbal threats. Additionally, they define rape as the “penetration,
no matter how slight, of the vagina or anus with any body part or object, or penetration
by a sex organ of another person, without the victim’s consent” ([Link]
gov/archives/opa/blog/updated-definition-rape; accessed on 28 March 2023) [33]. The
World Health (WHO, 2002) expands the definition beyond physical contact: “any sexual
act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to
traffic, or otherwise directed, against a person’s sexuality using coercion, by any person
regardless of their relationship to the victim, in any setting, including but not limited to
home or work” [27,34].
Before the 2003 act completely altered the legislation on sexual offenses, the rape of a
man was covered by the 1994 amendment to the Sexual Offences Act 1956 [35]. Until 1994,
there was no such thing as “rape of a male” in English law; instead, there existed a felony
called “buggery” (unconsenting penile–anal penetration), which had a lesser punishment.
The relatively recent recognition of rape of a male being possible and illegal is reflected in
how this issue is denied or misunderstood within society [35].
Although no definition is specific to men, we are satisfied that the DOJ’s definition of
sexual assault and rape provides the clearest distinction between sexual acts. The WHO’s
definition includes many acts not addressed in the DOJ’s definition, such as attempts
to obtain sexual acts, verbal comments, and advances. These are not considered sexual
violence as specified in the DOJ’s definition but are noteworthy for understanding the
experiences of men victimized by them. The WHO includes behaviors that would be
examined in sexual harassment and sex trafficking literature. Of importance, however, is
that the WHO captures the reality that all the identified behaviors can occur regardless of the
relationship between offender and victim. For research purposes, clearer operationalized
definitions are needed to focus on the unique aspects of each type of behavior and analyze
distinctions between them.
Behav. Sci. 2023, 13, 304 4 of 22

3. Prevalence of AMSVo
In Western nations, such as the UK, the US, and the Nordic countries, the prevalence
of male-on-male rape or sexual assault is believed to be between 5 and 10% of all sexual
assaults each year [35–38]. According to the Home Office crime statistics for England and
Wales, there were 9901 rapes of victims aged 16 and older in total during the 2010–2011
financial year, 9509 of whom were female (96%) and 392 of whom were male (4%). This
demonstrates the relative rarity of the problem and suggests why forensic doctors, thera-
pists, and other treatment providers would not see many male patients. The ratio of male
to female patients at the Saint Mary’s Sexual Assault Referral Centre in Manchester, UK,
illustrates that although this category is smaller than that of female victims, it is one that
has been expanding. The Centre saw fewer than 20 men who had been the victims of an
acute sexual assault (i.e., not past, or ongoing child sexual abuse) in the first five years of
its operation (1986–1991) [35,39]. By 2002, that number had increased to over 40 annually.
Fewer than 30% of men from those first five years were referred by the police, whereas
this number was over 70% in 2002. This surge in referrals was mirrored by a growth in
referral types [35,39]. Similar comparative hesitation was observed in Norway, Denmark,
Iceland, and Finland among men who reported anything at all, particularly to the police.
These statistics are a result of the frequency and sorts of assaults themselves, as well as the
various responses that men have when discussing what has happened to them [35,39].
Many studies have noted the difficulty of obtaining reliable and accurate statistics
on adult male victimization [40,41]. Several factors, including definitional limitations,
may cause different studies to have different prevalence findings. These include sampling
methods, how objects are written on scales, and the aforementioned “unrecognized as-
sault” [8]. Elliot and colleagues (2004) examined prevalence statistics for adult men as a
whole and found that it ranged from 0.6 to 8.3% [42]. This range of data is startlingly wide
and might not accurately reflect the population’s overall victimization rate. Although it
is acknowledged that some adult male subpopulations are more vulnerable to victimiza-
tion, none of these subpopulations—with the probable exception of those in correctional
settings—appears to have received enough attention in the research to paint a full picture.
However, even though there is a greater amount of research on male prisoners, the most
of it seems to be older, indicating that any attempt at synthesis would probably result in
outdated and unhelpful data [30]. Men attending college appear to be the second-largest
research group. Although the literature may be scant, it does seem to show indications
of a prevalence issue significant enough to motivate more study for this demographic.
According to some estimates, college-going men between the ages of 18 and 24 are five
times more likely to be assaulted than their non-college counterparts, placing them at the
greatest risk of victimization [30].
Furthermore, the prevalence reports of male sexual assault vary drastically depending
upon the study. Stemple and Meyer (2014) found high prevalence rates of male victimiza-
tion, approaching that of women, after reviewing five independent surveys by two federal
governments [43]. The national crime statistics show 10% of rape victims or 1 in 33 men
(3%) have experienced rape [28]. Although the rates of those reporting unwanted sexual
contact or pressured intercourse have been reported in the ranges of 38 to 48% for male
college students [44], incidence approximates 4% in most studies [42]. Based on the national
Criminal Victimization 2019 survey, the percentage of violent victimizations reported to
police was higher for female victims (46%) than for male victims (36%). This difference
can largely be attributed to reporting of simple assaults, as the percentages of violent
victimizations reported that excluded simple assaults were similar for women (47%) and
men (46%) [45]. Additionally, male victims reporting unwanted sexual contact or pres-
sured intercourse has been reported in the ranges of 36% to 46% [45]. Among male prison
inmates, 59% of male inmates reported some form of childhood sexual abuse. It is likely,
however, that the documented rate is likely an underestimation of the magnitude of the
problem. Studies also show mixed results regarding who is most at risk. For example,
Coxell et al. (1999) reported a higher prevalence in the homosexual male community [46],
Behav. Sci. 2023, 13, 304 5 of 22

whereas Isely and Gehrenbeck-Shim (1997) found that heterosexual men are more likely to
be victimized (71.4%) [32]. Further, Isely and Gehrenbeck-Shim found that most victims
were young (ages 16 to 30) and Caucasian (85%). Whether heterosexual or homosexual, the
literature suggests that any man can be a victim of rape [13].
Recently, other studies have estimated the prevalence of sexual assault among men
at college campuses [47,48]. In a study comparing students from sexual minorities and
non-sexual minorities, Edward et al. estimated the six-month incident rate of three types
of intimate partner victimization. This was a large-scale study (N = 6030) encompassing
eight New England universities, but only 34.1% (N = 2055) of the sample were male college
students. The respondents were distributed equally across years in school [47]. According
to their research, 7.4% of the male students (15.5% of sexual minority students and 6.5% of
heterosexual students) reported having been the victim of sexual victimization at least once
in the previous academic year.
In addition, Ford et al. aimed to address the dearth of information on sexual vic-
timization for groups other than heterosexual female victims [48]. The Online College
Social Life Survey dataset was used in this study to evaluate the victimization rates of
undergraduate college students (N = 21,000) from 21 four-year universities, 6581 of whom
were men. Three dichotomous questions that focused particularly on sexual encounters
that had occurred since they started college were used to measure sexual assault [48]. The
authors enquired as to whether someone had ever physically forced them into having sex,
attempted to physically compel them into having sex, or engaged in sex with them against
their will while they were physically incapacitated. According to their findings, roughly
13% of straight college men, 24% of homosexual undergraduate men, and 17% of bisexual
undergraduate men reported having experienced at least one of the three types of sexual
assault classified in this study [48]. The most frequent kind of attempted sexual assault
among straight and bisexual men was around 6% and 17%, respectively, but homosexual
men reported more instances of having sex while unconscious (around 14%) [48].

4. Barriers to Reporting AMSVo

Male and female victims may decide not to disclose information to protect a friend
or family member, out of concern of retaliation by their attacker, and out of concern that
they will be blamed personally for their victimization [42,49]. Men may also choose not to
report if they have issues with their sexuality. Men are more likely to encounter reporting
issues relating to their sexuality given that they are more likely to be victims of other men.
Men who have not publicly acknowledged that they are anything other than heterosexual
may choose not to report for fear of having to come out. In addition, heterosexual men
who were assaulted by other men might not come forward for fear of having their sexual
orientation revealed. Another specific rape distortion that affects men is the belief held by
the public and healthcare professionals that men cannot be raped [35]. Men may opt not
to complain if they are simply going to be informed that what occurred to them did not
occur—an invalidation of their experience. A lack of knowledge regarding the physiologic
reaction to attack and the fact that erection or orgasm can occur even in traumatic situations
may contribute to this belief. This false notion may not only prevent people from believing
that men may be abused, but it may also prevent men from recognizing victimization when
it does.
The literature strongly suggests that both adult men and women underreport sexual
violence to law enforcement and medical services, and research consistently conveys that
men are less likely to report [50–54]. Approximately 90 to 95% of all male sexual violations
are not reported [55]. Walker and associates reported that 12.5% never disclosed their
assault to anyone; among those who did, 54% delayed reporting for at least one year [56,57].
In their study, four of the five men who reported their assault to the police regretted their
decision. Victims said that not only were the police unsympathetic and disinterested, but
even more traumatic than the actual victimization. In fact, one victim described the legal
process as having “had a worse effect on him than the rape itself” (p. 75).
Behav. Sci. 2023, 13, 304 6 of 22

Underlying the failure to report are issues of stigma, shame, guilt, embarrassment,
fear of ridicule or not being believed, concern over confidentiality, and concern of having
their sexual orientation questioned [49,58]. Men tend to believe that authorities will not
believe them or will make light of their victimization. Graham (2006) and West (2000)
suggest that fear of homophobic reactions and a dissolution of their masculinity deters men
from reporting. Walfield (2018) argued that men fear being marginalized. Furthermore,
Page (2008) notes [59–61]:
“If police officers endorse stereotypical ideas about gender and rape only cases meeting
the characteristics of an “ideal” rape (i.e., the victim and offender are strangers, the victim
incurs physical injuries and there is a physical evidence of sexual assault) will be deemed
credible and will thus be investigated...the more a victim, or the characteristics of an assault,
deviate from this preconceived idea, the less likely police and prosecutors are to devote
extensive time and energy to processing the case” (p. 45).
Victims are also hindered by whether the act fits their own a priori definition of sexual
victimization. Warfield (2018) believes that men may use their perception of the act as a
defense mechanism from acknowledging their own victimization in the first place [59]. It
mitigates feelings of vulnerability and fear, whereas offenders use sexual stereotypes to
justify acts of sexual violence to minimize their own actions and the harm done [59]. Burt
and DeMello (2005) captured the bottom line of misconceptions when they asserted that
these are prejudicial, stereotypical, and false beliefs about rape, rape victims, and rapists.
Another reason for the lack of reporting is offered by Campbell (2008), who suggests that the
low conviction rates contribute to reluctance [62]. Mixed results have been found regarding
the extent of the violence as a factor in reporting. Frazier (1993) found that reporting
to medical services typically required extreme circumstances such as gang rape [63]. In
contrast, Monk-Turner and Light (2010) found that men who experienced penetration were
markedly reluctant and less inclined to report the assault [53].
Developing knowledge and understanding through empirical research to inform
support providers so that they are aware of what contributes to the blame attributions
of male victims is a necessity. The underreporting of sexual victimization by men has
served to limit the ability to competently research the topic. James (2018) noted that self-
incrimination, trepidation, and shame hinder adult male victims from disclosing their
experience to researchers [64]. Thus, the information available is from those who choose to
disclose their experience or from governmental organizations and other agencies that have
a connection to victims.
Although research affirms that male sexual violence is a legitimate problem [24,40,60],
its reality remains virtually invisible to the public [40]. Researchers found numerous
“myths” or misconceptions/biases that obfuscated male victims from being accepted and
understood [40]. The literature suggests there are several misconceptions associated with
AMSV. Kassing and colleagues (2005) noted four misconceptions: (a) it is rare, (b) women
cannot be perpetrators, (c) only happens in prison, and (d) men do not suffer psychological
consequences [65]. Additionally, Struckman-Johnson (1991) identified one additional mis-
conception [66]: men are too strong to be forced into unwanted sex. Pino and Meier (1999)
also noted the erroneous belief that male victims lose their manhood [67]. Stemple and
Meyer (2014) examined public misconceptions on male rape and identified three factors:
traditional gender stereotypes, outdated conceptions of rape, and methodological sampling
biases that exclude inmates [43]. The Center for Disease Control and Prevention (CDC) and
the Federal Bureau of Investigation (FBI) found that men and women reported a similar
prevalence of nonconsensual sex (women: 1.270 million; men: 1.267 million).
Furthermore, the idea of the “ideal victim” is still widely used within this gender-
based assumption of sexual victimization research [4]. In this conception, the perfect victim
of sexual assault is conceived to be one who society is most likely to label as a victim.
Within this framework, a person must fulfill five requirements in order to qualify for this
status: (1) be weak; (2) be engaged in a respectable activity; (3) be somewhere she could not
possibly be “blamed” for being; (4) the offender must be big and bad; and (5) the offender
Behav. Sci. 2023, 13, 304 7 of 22

must be unknown to the victim and have no personal relationship with her. The emphasis
in this depiction is on men as sexual offenders and women as victims. In addition, some
individuals think that rape is an act of dominance and control towards women, which
prevents men from declaring themselves to be sexual victims. Nonetheless, there is a
serious issue regarding male sexual victimization, which takes place in a variety of venues,
such as homes, workplaces, schools, on the streets, in the military and in times of conflict,
as well as in jails and police custody [4].

4.1. Blaming the AMS Victim

Male victims are perceived to carry a level of blame for not resisting their attacker.
Others may question how a man can achieve and maintain an erection and sexually perform
if the sexual encounter is a coercive situation. Smith and colleagues (1988) a assess 77 men
and 89 women who made a series of judgments about two randomly cases as if they were
on a jury [68]. A MANOVA analyzed a 2 (sex of victim) × 2 (sex of assailants) × (sex of
subjects). The attributions of victim responsibility found that men were more likely to be
assigned blame than female victims. They also found that when the assailant was a female
less impact was reported than a male-to-male act. It is hypothesized that if men become
aroused and sexually respond to the perpetrator, they wanted and enjoyed it. Given the
strong feminist theoretical paradigm and feminist ideology [69], women are classified as
victims and men as offenders. Javaid et al. highlight this point by noting some feminists
reject male rape to validate women’s experience of sexual violence by viewing men as
solely offenders [51]. The perceived minimal force needed to overpower female victims
mitigated the perceived impact on men. Male victims note that the implication is that “the
use of force determines concern about victimization” (p. e20).
Male victim bias perpetuates victim blaming. Specifically, the acceptance of male
rape was a strong predictor of victim blaming, suggesting that acceptance of stereotypical
ideas about male rape means that a person is more likely to engage in male victim blaming
behaviors. This is of concern, particularly as it is likely that these falsehoods regarding
male rape are accepted widely [70], as confirmed within this study with high levels of
acceptance of certain misconceptions or false beliefs on male rape. This finding is supported
by Kassing et al. (2005) and Johnson et al. (2006) [65,66].

4.2. Accusations of Homosexuality against Adult Men

Another masculine-related misconception is that men are sexually assaulted by homo-
sexuals, perpetuating the false belief that sexual violence is about sex and only committed
by homosexual men and victims are primarily homosexual [51,71,72]. Similarly, it is often
thought that women do not assault men, leaving the perpetration of male sexual vic-
timization to men. Accepted stereotypes that homosexuals solely assault men and only
gay men are victims facilitate the inaccurate understanding and poor handling of male
victims [51,71,72].

4.3. Female Perpetrators of AMSVo

The first systematic report on adult male victims was by Sarrel and Masters (1982) who
interviewed men who reported women perpetrating sexual assault [24]. The researchers
noted psychological distress, post-trauma reactions, and impaired sexual functioning. Later
studies found that gay men are more likely than women to have pro-victim judgements
and endorse male rape falsehoods, including victim blaming [56,57,66].

4.4. Toxic Masculinity, Macho Imagery, and Their Consequences on Men’s Health and Life Habits
Stereotypical ideas about men calls into question a man’s masculinity when sexu-
ally victimized [40]. The incongruity between historic beliefs of masculinity linked to
strength and AMSV maintains the bias of invulnerability. Not only do adult male victims
believe that they will be viewed as gay, but they also question it themselves [40,58,73].
For heterosexual men, being assaulted by another male is likely their first same-sex en-
Behav. Sci. 2023, 13, 304 8 of 22

counter. The horror of doubting their own sexuality leads to self-loathing and hatred
of homosexuals [40,51,71,72,74]. As a result, men are more likely to express anger than
women. Several studies suggest that adolescent men who strongly adhere to masculine
norms may be more likely to commit violence [75–79]. The social perception of men’s
actions, emotions, thoughts, and behaviors, as well as their rights and responsibilities in
society, is described by traditional masculine standards. According to several sociocultural
and psychological theories, socially constructed masculinity may help to explain why men
commit violence. Nonetheless, not all men who strongly uphold these archaic masculine
ideals will resort to violence against female partners. These results imply the necessity for
a sophisticated approach to comprehend the function of conventional masculine standards
and men’s use of AMSVo [75–79].
One of the most common sociological theories to describe toxic masculinity or the
macho personality constellation was through the script theory by Tomkins [75–79], which
comprises three behavioral dispositions supported by the following beliefs: (1) entitlement
to callous sex, (2) violence as manly, and (3) danger as exhilarating. The scene serves
as the fundamental analytical unit in script theory. Specifically, the theory references an
occurrence in a life that has already been lived, ordered by at least one affect and its object,
and designated by a beginning and an end, and a series of interrelated events form the
narrative of a life that we refer to as a personality. A script uses a set of guidelines for
understanding, reacting to, defending, and producing comparable scenarios to connect and
organize the information in a family of related scenes. According to the set of guidelines in
the macho script, the macho man generates, interprets, and reacts to circumstances that
threaten, challenge, or provide chances for him to play out his role as a macho man [75–79].
These scenes were arranged according to their effects and the rules for reading, compre-
hending, making, and justifying situations that they developed while being socialized into
hypermasculine scripts. The effect is the main driver in people. Tomkins defines affect as
a collection of facial-specific muscle and glandular responses that are widely dispersed
throughout the body and produce sensory feedback that is either essentially “acceptable”
or “unacceptable”. Innate and kept in subcortical areas are the programs for discrete affects.
Affects are originally organized and activated by innate scripts, but learnt scripts are what
create the dynamic complexity of human experience and motivation. The freedoms of
affect in time, intensity, the density of investment, the choice of objects, and investment in
possibilities, as opposed to drives, are what allow humans to worry about nearly anything
with varying levels of urgency [75–79].
According to Tomkins, the psychological processes occurring within the scene itself,
such as perception, cognition, and action, are amplified by affect. Yet, strong emotion
may only have a fleeting impact, with little or no influence on personality. Scenes must be
psychologically exaggerated to cause an urgent search for a system of rules to organize
their emotionally compelling content [75–79]. When a narrative review of scenes occurs
in the consciousness, psychological magnification is the further amplification of the set
of already magnified scenes by fresh emotion. The rules for understanding, producing,
anticipating, and manipulating the scenarios as well as the scenes themselves are magnified
psychologically. For the macho man, it is the effect of interest–excitement that psycholog-
ically increases the affectively urgent search for guidelines on how to be a “true man”,
experienced when he consciously evaluates memories and thoughts of possibly dramatic
scenes [79]. If he is brave enough to take on its challenges, this dangerous world might even
thrill him. Similar to language, personality can be seen from a synchronic or diachronic
perspective. Personality can be seen as a posture or position that describes a group of
potentialities that are currently unrealized. The macho is gradually conducting his life
according to his macho script. The macho script must be lived out to honor the machismo
philosophy [75–79].
The macho man is the nomadic warrior’s cultural offspring; the macho philosophy is
a warrior’s philosophy. The macho warrior rules over whatever he has taken, serving as
patriarch and ruler. His wives, children, and slaves are his property and owe him devotion
Behav. Sci. 2023, 13, 304 9 of 22

and respect. The macho man must be willing to take significant risks to preserve that domi-
nance [75–79]. He must also be willing to use violence to subdue rival men and callous sex
to subjugate female foes. Being a male within a macho culture socially inherits the ideologi-
cal script of the macho man. Affects are categorized in American society as either “superior
and masculine” or “inferior and feminine”, which are antagonistic contrasts [75–79]. To
establish the ideologically desired gender-stereotypic contrasts of masculine and feminine,
the act of assigning to the male or female sex tends to bias the socialization of affects into
gender scripts that separate and stratify men and women through this division of human
emotions. Macho ideology denigrates those who demonstrate “inferior, feminine” affects
while honoring “superior, masculine” affects. To achieve hostile–dominant interpersonal
goals driven by the effects of excitement, wrath, disgust, and contempt, macho scripts
thereby enhance masculine gender role behavior. The macho must be hypermasculine in
thought and deed, not simply male and not just masculine [75–79].
The “superior masculine” gender script has in fact become a cultural ideology when it
elevates both patriarchal supremacy as the ideal political and familial value and antagonistic
physicality and toughness as the core of masculinity [75–79]. The most significant group
of scripts is the ideological one because of its breadth, abstraction, and ability to give fact
meaning and emotion. Ideologies are the main forces behind grouping, differentiation, and
division since they stand in for the diverse religions by which people live and die. Men
who adhere to the macho philosophy are bound together in male honor societies, the sexes
are distinguished by male domination and female submission, and society is split into the
strong and the weak based on how well each group of people has embodied the values of
“true masculine superiority”. By assuming that physicality, virility, and masculinity are the
ideal essence of real men who are adversarial warriors competing for scarce resources in a
dangerous world, we define the ideology of machismo as: a system of ideas forming a world
view that chauvinistically exalts male dominance [75–79]. Parents’ training of male children
into a heightened, hypermasculine gender script known as the “macho script” is sanctioned
and encouraged by the machismo cultural ideology. Ideological scripts are a type of script
that simultaneously validate and fulfill themselves. As they lessen the temptation of relaxed
enjoyment and communion and prevent the experiencing of the unmanly effects of fear,
distress, and shame, these scripts interpret, predict, control, replicate, and evaluate the
manly effects of surprise, excitement, anger, disgust, and contempt for the inferior foe. This
is what it means to be a macho man [75–79]. In summary, the seven key elements of the
macho man include:
1. Unrelieved and unexpressed distress is intensified by the socializer until it is released
as anger.
2. Fear-expression and fear-avoidance are inhibited through parental dominance and
contempt until habituation partially reduces them and activates excitement.
3. Shame over residual distress and fear reverses polarity through counteraction into
exciting manly pride over aggression and daring.
4. Pride over aggressive and daring counteraction instigates disgust and contempt for
shameful inferiors.
5. Successful reversal of interpersonal control through angry and daring dominance
activates excitement.
6. Surprise becomes an interpersonal strategy to achieve dominance by evoking fear
and uncertainty in others.
7. Excitement becomes differentially magnified as a more acceptable effect than relaxed
enjoyment, which becomes acceptable only during victory celebrations.
These elements of the macho men mentality/ideology can lead to a version of toxic
masculinity [75–79]. Most studies characterize toxic masculinity, in part, as a collection of
behaviors and attitudes that may involve hiding or suppressing suffering, maintaining a
façade of toughness, and possibly even acting as a sign of dominance. The truth is that men
have been pressured to be particularly tough due to the pervasive fear of being labeled
as “feminine” or “weak” in many cultures. In this respect, toxic masculinity requires
Behav. Sci. 2023, 13, 304 10 of 22

men to not display their emotions publicly or openly. We can therefore conclude that
toxic masculinity is a direct outcome of society, which teaches men these stereotypes
from an early age [80–84]. Boys and men are at risk of conforming to this desired image
from unqualified agents or even from other boys or men who are unable to handle the
masculinity figure due to all these cultural lessons being linked to aggression and violence.
According to statistics, men are disproportionately represented in jails, and they also have
a higher propensity than women to perpetrate violent crimes and women are most likely
to become their victims. Depending on how they approach the situation, women’s roles in
this conundrum can be a double-edged sword [80–84]. This tension of maintaining one’s
masculinity lies at the heart of many aspects of AMSVo.

4.5. Incarceration and AMSVo

Both men and women experience pressured and coerced sex while incarcerated [85,86].
A common belief is that men are only raped in institutional settings such as prison [87].
Struckman-Johnson and associates (1996) found that 20% of those anonymously surveyed
reported being forced to have at least one sexual contact while incarcerated. The range of
sexual behaviors included intercourse (vaginal, anal, or oral) and sexual touching. Findings
regarding the sexual violence of men during incarceration vary greatly. For example,
Struckman-Johnson and Struckman-Johnson (2006) reported that higher rates of sexual
assaults were found using anonymous surveys and lower rates in those studies that used
interviews [66].

4.6. The Effect of Medical and Support Staff

Misconceptions are not only prevalent among the public, college students, and law
enforcement but medical trainees, crisis workers, and counselors [17,50,52,65,66,88–90]. For
instance, Kassing and Prieto (2003) studied counselors-in-training on the endorsement of
rape misconceptions [52]. They found that counselor trainees accept some of the detrimental
rape biases. They found that both male and female trainees expressed beliefs that people
can do things to protect themselves from rape, thus implying a measure of responsibility
for their victimization. One significant problem contributing to misconceptions about adult
male victims is that it has remained virtually invisible (Kubiak 2018). The lack of accurate
information and attention given to male victims by researchers, theorists, and media outlets
has hidden the problem from view [91]. The first book addressing male rape was not
written until the 1970s, and since then, only a handful of books and reviews have been
published on male sexual victimization [92]. Despite these books on the topic [58,93], they
have failed to capture widespread attention. Kassing and Prieto (2003) found that male
counselor trainees were more likely to accept falsehoods surrounding rape to a greater
extent than female trainees, especially if those male trainees had never counseled a sexual
assault victim [52,65]. Another finding was that in terms of blame toward male victims, after
accounting for trainee sex, age, social desirability, and experience with victims, participants
perceived the nonresistant male rape victim negatively for not putting up more resistance
against their attacker.
Studies that examined the level of blame assigned to men and women have shown
mixed results. While some studies have found that male victims are blamed significantly
more than female victims [94,95], results from other studies indicate women are assigned
greater [96,97]. Other studies such as the findings of White and Robinson Kurpuris (2002)
found that blame was attributed to a victim when participants held to more traditional
gender-roles, particularly attitudes toward women and their roles in society and beliefs
that men need status and respect [98].
The fact that the public associated AMSVo with homosexuality and prison populations
obfuscates the reality that these crimes occur among heterosexuals, in the workplace, in
dating relationships, and within other contexts. Knowledge and understanding are the best
antidotes for ignorance.
Behav. Sci. 2023, 13, 304 11 of 22

5. Victim Responses
Whether male or female, victims are often not perceived with compassion and, in fact,
may be blamed for their victimization [96]. Walker et al. found that when male victims do
report, they often experience disbelief, hostility, and blame; such reactions hold true even
when the rape is disclosed to friends and relatives. Furthermore, research seems to uphold
the sex-role stereotypes associated with sexuality [56,57]. Research shows that both men
and women respondents take male victims less seriously when the perpetrator is female
than when the perpetrator is male [60]. Respondents typically judged such sexual assault
as being mutual and associated with nominal stress and more enjoyment [96]. Even male
respondents focus on the sexual act rather than the exploitative or assaultive nature of the
act. In a study examining attitudes of male rape, Doherty and Anderson (2004 and 2008)
engaged 30 male–female dyads in a discussion of vignettes of male rape [99,100]. They
noted that men and women discussed the topic by differentiating the experiences of male
and female victims and by stressing the similarity of the physical act of intercourse with
rape. Accordingly, participants found heterosexual male rape as more disgusting than
rape for homosexual men and women because it deviated from the normative heterosexual
practice. This is consistent with Mitchell and colleagues (1999) who found that participants
viewed homosexual male rape victims as more responsible, less traumatized, and finding
the act more pleasurable [101].
The tendency of the public to blame victims is not unique to men but appears to exist
at higher rates. Advocacy for men and greater public awareness are the best means of
combatting the unseen victims.

6. Populations and Perpetrators of AMSVo

To date, most of the research on male rape has focused on institutional rape (e.g.,
correctional facility) and male-on-male rape. Studies on incarcerated men have found that
their greatest fear is being raped in prison—a valid fear, because 7–12% of imprisoned
men reported being raped an average of nine times [102]. Man and Cronan (2001) refer to
the numbers of prisoner sexual assaults as “simply staggering” and “rampant” (p. 129).
A selected number of studies have examined rape associated with homosexuals [22,103].
Examining the case of male-on-male rape, Vearnals and Campbell (2001) hypothesized
that rape might be motivated by sex or by men wishing to demonstrate domination;
interestingly, Man and Cronan (2001) hold that domination is the main motivation for
rape in prison [104]. King and Woollett (1997) investigated men who sought counseling
following their attack [105]. They found that 87% were assaulted by at least one man,
7% by women, and 6% by a man and a woman. Forced and anal penetration took place
in almost all cases and 23% feared for their lives. In most of these cases, the assailant
was known to the victim. Several studies investigated male rape by women perpetrators.
Coxell and associates (1999) found that 46% of men reported rape or attempted rape by a
woman [46]. Sorenson and colleagues (1987) found that white, college-aged men in a Los
Angeles community census sample were most at-risk for experiencing sexual coercion and
that most of the perpetrators were female acquaintances or lovers who used psychological
pressure as opposed to physical force [106].

7. Risk Factors
The identification of variables that influence likelihood of AMSV is fundamental for
prevention efforts (Loh et al., 2005) [107]. Ioannou, Hammond, and Machin (2016) classified
sexual victimization into three general categories: the characteristics of the victim, the
characteristics of the perpetrator, and situational characteristics (environmental, substance
use, and violence factors) [108].

7.1. Characteristics of Victims

Studies have examined the characteristics of adult men who are sexually victimized.
Ages ranged from 20 to 30 years old, were predominantly white, and considered vulnera-
Behav. Sci. 2023, 13, 304 12 of 22

ble [35,109,110]. Vulnerability was noted in several studies, particularly in prison settings.
According to Walker et al., a person’s routine and lifestyle influences the level of exposure
one has to potential perpetrators and how vulnerable one is as a target. Studies are mixed on
whether heterosexual men or homosexual men are more likely to be victimized [111–115].
The relationship between alcohol and victimization has been studied, leading to mixed
findings. For example, Monks et al. (2010) found that victimization was related positively to
alcohol risk scores and alcohol consumption-related problems. Men who drank were more
likely to be victimized than those who did not. In contrast, Light and Monk-Turner (2009)
found that 88% of men said that there was no substance abuse at the time of the assault [53].

7.2. Characteristics of the Perpetrators

Studies on the characteristics of perpetrators are lacking [108]. The importance of
knowing these characteristics was noted by Loh and associates (2005) [107], who contend
that the most effective way to reduce victimization is to focus on perpetrator characteristics.
Dominance and power tendencies have been noted [109]. While some studies have found
that most perpetrators are heterosexual [32], others report homosexuals as the most likely
offenders [116]. Most studies have found that the offender is known to the victim [111,116],
whereas Groth and Burgess (1980) interviewed offenders and found that 75% attacked
strangers [103].

7.3. Environmental, Substance Use, and Violence Factors

Research on location has found that homes, car parks, and public parks were used
frequently [35]. The relationship between alcohol and victimization has been studied,
leading to mixed findings. Monks and associates (2010) found that men and women experi-
enced similar levels of sexual victimization and that victimization was related positively
to alcohol risk scores and alcohol consumption-related problems. In contrast, Light and
Monk-Turner (2009) found that 88% of men said that there was no substance abuse at the
time of the assault [53]. Since sexual assault is primarily regarded to be about sex, the eroti-
cized rage and violence are ignored. The preponderance of research indicates that AMSV
is more likely to be violent than that directed toward women [23], although some studies
suggest that violence is greater toward women [112]. Du Mont and others (2013) found that
male victims are subjected to significant violence, which includes strangulation, restraining,
confinement, gagging, dragging, slapping, hitting, kicking, and biting [27]. Additionally,
they found that about 20% report being forced to drink alcohol or use drugs prior to the
assault and that 20% reported being attacked by more than one assailant. Sexually, male
victims often experience sodomy and/or are forced to perform fellatio as well as genital
touching and cunnilingus [89,101]. Ernst, Green, Ferguson, and Weiss (2000) found that
men who are anally penetrated experience at least one form of rectal injury. Walfield (2018)
notes that: “ . . . results from the National Intimate Partner and Sexual Violence Survey
(NIPSVS) indicate approximately a quarter of men (23.6%) experience some form of sexual
violence over the course of their lifetime, which includes rape, being made to penetrate an
individual, sexual coercion, and/or unwanted sexual contact” (p. 3) [59]. Use of weapons
has ranged from 5% to 48.8% [32,53,114]. Weapons are less common when the offender is
known to the victim [117], and rapes that are performed against incarcerated victims are
less likely to involve weapons [66].
According to qualitative research on abusive gay relationships, psychological abuse
is frequently present alongside physical and sexual assault [21,118–121]. As has been
seen in heterosexual partnerships, different types of partner abuse can also occur in gay
relationships. Even though several forms of abuse were considered in certain studies on
gay partner abuse, only one prior study established associations between the various forms
of abuse. In addition, there is a moderate to strong relationships between the victimization
reports of various forms of abuse in a small convenience sample of gay men [21,118–121].
The fact that the act-based assessments of partner abuse do not take the victim’s experience
into account is one of its limitations. Depending on the power and intent of the aggressor,
Behav. Sci. 2023, 13, 304 13 of 22

as well as the victim’s reaction, the same violent act might result in several outcomes. As
a result, the assessments of the effects of abuse, such as harm and need for medical care,
must be added to measurements of abuse [21,118–121].
Public perception is that substance use is a significant contributing factor of any type
of sexual violence [53,122]; yet research finds a wide discrepancy in the role that it plays.
More research is needed that differentiates types of substances. Additionally, research
is still required to determine what factors increase the offender’s perception of victim
vulnerability, differences between methods used, and factors related to types of violence.

8. The Emotional Impact on Male Victims

8.1. Mental Health Problems
In the search focusing on male sexual victimization, distinct differences between
male and female survivors began to emerge. As a result of victimization, men may ex-
perience a profound emotional disruption. Psychologically, victimization is especially
trauma-producing for men [42,116]. Walker and colleagues interviewed 40 male rape
survivors, leading to a detailed and descriptive analysis of the impact of the assault on
men [56,57]. During the incident, men reacted with freezing, fear, helplessness, and sub-
mission. About 27% reported that they fought back without success. In the aftermath
of the assault, they identified both short-term and long-term effects. Studies have also
identified higher rates of mood disturbances, anxiety, suicidal ideation and behavior,
non-suicide self-injury, grief and loss reactions, drug abuse, somatic problems sleep diffi-
culties, sexual difficulties, increased changes in self-perception, social dysfunction, stigma,
shame, lower self-esteem, hostility, fantasies about revenge, and an increase in a sense of
vulnerability [41,53,56–58,89,116,123–125]. Post-traumatic stress disorder and rape trauma
syndrome have also been noted. Self-blaming also affects how people respond to the victim,
being perceived as less well-adjusted and more responsible for the rape than those who
do not [32,114,126,127].

8.2. Response to AMSV

Despite the trauma associated with being raped, Sarrel and Masters (1982) found that
men can respond sexually under disturbed emotional states, including anger and terror.
They noted that men still experience post-trauma reactions [24]. A significant reaction
immediately following the sexual trauma, as Frazier (1994) notes is anger because it is
considered more masculine to respond that way [128]. However, many male victims reacted
with a “controlled” style of coping exemplified by subdued reaction characterized by a
calm, composed, acceptance and minimization of the assault. It is speculated that such a
reaction reflects the aspect of male socialization to be emotionally inexpressive to aversive
situations. Furthermore, Rogers (1998) suggested that this type of coping strategy renders
male victims prone to long-term psychological problems as it makes help-seeking less
likely, and denial undermines men coming to terms with their rape.

8.3. Decline in Relationship Satisfaction and Couple Intimacy

Studies also note problems with sexuality, sexual orientation, and sexual function-
ing [51,71,72]. One of the major impacts is on the male victim’s thoughts regarding his
sexuality and sexual orientation. Many men report feeling less masculine, and some
assume that they must be “gay” for another male to sexually assault them. Sexual
dysfunction is also common, similar to the problems associated with male-to-female
rape [24,41,51,56,57,71,72,116]. Specifically, research has noted impotence, anxieties over
sexual activity, and increased promiscuity with women as a means of validating their
sexual identity [41,56,57,116,129]. Somatically, men report poorer physical health than men
who have not been victimized [129]. Specifically, men report numerous somatic symptoms,
including tension, headaches, nausea, vomiting, ulcers, colitis, constipation and abdominal
pain, fecal incontinence, decreased appetite and weight loss, and sexually transmitted
infections [89,116,123,129,130].
Behav. Sci. 2023, 13, 304 14 of 22

9. Help-Seeking
Seeking professional help is especially difficult when the emotional distress is asso-
ciated with poorly understood and misconceived ideas related to male victims of rape.
Furthermore, AMS victims have fewer resources and greater stigma with sexual assault
than female sexual assault victims [18]. Finkelhor (2008) notes that male victims face a
lack of formal support systems [131]. The uniqueness of male victims requires clinicians
to attend to the distinct issues surrounding their assaults. Light and Monk-Turner (2009)
found that only 29% of men presented for help; such men were more likely to have been
physically injured and have experienced penetration [53]. Despite 89% of male sexual
assault victims reporting physical injuries, these researchers found that only 58% of male
victims who reported being penetrated sought medical help. Pesola and others (1999)
found that among men who sought help at an emergency room, 94% did so within 36 h of
the assault [132].
For those who do seek help, Iseley and Gehrenbeck-Shim (1997) reported that most
male victims went to rape crisis centers [32]. Of the 54 centers surveyed, only 15% reported
having met with male victims. Most programs are ill equipped to provide adequate
resources and appropriate staff to assist men, since services are designed for female, not
male, victims. According to Washington’s (1999) study, only five percent of centers are
prepared to meet male victim needs. This might explain the findings of Donnelly and
Kenyon (1996), who interviewed 30 sexual assault treatment provides [17,133]. They noted
that many rape crisis centers either explicitly refused services to male victims, were highly
insensitive to their needs, and considered the issue inconsequential. Yet, these researchers
noted very negative attitudes toward male victims. They made statements such as “ . . . we
don’t do men”, “men can’t be raped”, and “most males that are fondled or sodomized are
males that wanted to be sodomized”.

10. Implications for Counseling

Given the paucity of literature addressing the treatment of male victims, counselors
need self-awareness, training, and knowledge about the similarities and differences of male
and female victims and must learn about the scope of treatment modalities and options.

10.1. Training on AMSVo

Mental health providers need to be able to correctly assess and identify gender-specific
sexual trauma symptoms. Untrained therapists and those who fail to carefully screen and
assess for the possibility of sexual assault on male victims are not likely to uncover it. Many
graduate counseling programs do not require a human sexuality course. Without being
educated, clinicians are primarily influenced by their own personal biases and counseling
experience regarding whether and how to assess, treat, and demonstrate sensitivity to
male victims. Davies (2002) contends that not only is research needed to identify the
specific needs of men to improve service quality, but that providers go “above and beyond
treatment for victimization generally” (p. 210) [25].

10.2. Counselor Awareness

Counselors need to self-examine their own beliefs, biases, and feelings [25]. The
scope and depth of a counselor’s self-awareness is often proportionate to the ability to
understand themselves through the experience of counseling [134]. Therapist self-insight
helps a counselor distinguish between what is happening inside the self and what is
happening with the client. Unaware counselors are vulnerable to being swept away by
emotional tidal waves [134].

10.3. Creating a Safe-Haven

Male survivors would greatly benefit from being recognized as individuals who had
suffered a devastating and traumatic event. A welcoming posture is especially critical for
male victims [134]. Thus, working with men necessitates unique sensitivity to creating
Behav. Sci. 2023, 13, 304 15 of 22

a haven for them to process the incredible and ineffable pain. When stories of sexual
victimization are disclosed, counselors need to respond with warmth, compassion, empathy,
and acceptance. Furthermore, connecting the client to his afflicted and distressful emotions
will necessitate a haven. Along with this, normalizing the traumatic aftermath is another
means of generating safety.

10.4. Counselor Assessment

Barriers to successful assessment is understanding the many reasons men remain
silent, including unawareness, denial, the stigma of being a male victim, shame, fear, guilt,
and fear of the listener’s reaction. Additionally, male victims may feel complicit if others
perceive a lack of resistance against the attacker; shame and confusion over their body’s
response to the assault; spiritual issues, especially if the perpetrator is a spiritual authority
figure; and physical injuries associated with the attack. Young and associates inferred
that unprompted disclosure was unlikely, placing the responsibility with the clinician to
identify the assault [135]. Male victims were less likely to be asked about an abuse or
assault. Read and colleagues identified several barriers to counselors inquiring about abuse
and assaults [136]. Some of the barriers included: fears of vicarious traumatization, fears of
inducing false memories, the client being male, and the client being more than 60 years of
age. Agar and others identified several rationales for why it is crucial that mental health
providers solicit information about a history of abuse: it allows the ability to conceptualize
a client’s presenting problems more precisely; it enables the understanding of a client’s
hesitancy to form a therapeutic alliance and build rapport; it helps to accurately identify
hesitation instead of labeling it as resistance; and finally, it allows the understood client to
receive an accurate diagnosis and, thus, appropriate treatment.

10.5. Validation of Experience

One role that helpers can play is supporting victims in acknowledging what has
happened. While this is not completely unique to male victims, the misconceptions and lack
of understanding can obfuscate the realities of what occurred. Donne and colleagues (2018)
note that organizations are far more accustomed to supporting women in this regard [21].

10.6. Treatment Modalities

As a result of the unique impact on male rape victims and the range of possible
reactions, longer-term and more specialized help is likely to be required [116]. The lack of
research on male survivors, however, limits mental health providers’ ability to customize
a male-oriented approach. Since most of the research on therapeutic effectiveness is
focused on female victims, research on and clinical experience with female survivors can
inform treatments for men. Cortois (1997) contends that since a combination of individual
and group therapy has proven efficacious for female victims, it is likely appropriate for
men [137]. Trauma models seem to be an effective approach to treatment.

10.7. Individual Therapy

Given the dearth of research addressing treatment strategies for male survivors of
sexual violence, the literature concerning female survivors and adult men who experienced
childhood sexual trauma can inform the treatment process. Male sexual survivors would
benefit from identifying, labeling, and feeling feelings; cathartic exercises; learning adaptive
coping strategies; anger management training; identity work; self-esteem approaches;
boundary setting; approaches used with self-injurious behavior; treatments for co-occurring
disorders and issues, such as depression, anxiety, substance abuse, sexual compulsivity,
etc.; addressing sexual functioning issues; forgiveness of self and other work; intimacy
building; and the promotion of safety strategies [138–142].
Behav. Sci. 2023, 13, 304 16 of 22

10.8. Group Therapy

Though individual treatments provide an avenue for expressing and modulating
emotions, group therapy provides a common ground to facilitate feeling understood. A
significant impact on men is isolation. The conflicting nature of the traditional views of
masculinity and the culture of therapy contribute to male victims’ exclusion from the
survivor community [143]. Without the connection to a healing community, men are
abandoned to live in their misconceptions, distortions, and false beliefs. Group therapy
provides an avenue for men to have those internal experiences identified and normalized.
It is a vehicle toward shame-reduction. Group counseling allows for catharsis, which
holds long-lasting benefits for male sexual survivors [144]. Moreover, group therapy
offers the opportunity to use role-play and psychodrama. Both experiential methods offer
opportunities to empower clients to act assertively, an often-counter narrative to the actual
assault. Male victims can also act out existing or latent feelings within a non-judgmental
and supportive environment [145].

10.9. Support Groups

General social support is often lacking for the male survivors of sexual assault when
compared to female victims [40]. The lack of support from parents, family, and friends who
are informed of the sexual assault creates a greater challenge for men. Kaufman et al. (1980)
suggested that controlled reactions lead to men being emotionally inexpressive [146].
Accordingly, social support is critical of assisting male survivors in having their experiences
normalized in a support milieu. While forming specific groups for male victims might be
difficult geographically, online communities offer a means of connection. Davies (2002)
advocates for law enforcement and medical staff being trained in making referrals to
support groups that know how to help male victims [25].

11. Limits and Future Directions

Both quantitative and qualitative studies on adult male sexual violence are relatively
few. The literature has poorly distinguished between different types of sexual violence,
using the terms interchangeably. The United States’ Federal laws define sexual assault, rape,
molestation, and other such terms as unique, although related, forms, which can obfuscate
the drawing of meaningful conclusions for each type of sexual violence. Romantic partner
sexual abuse, for example, is not clearly defined, although date rape is identified as its own
form of violence. Many studies employ different research methodologies, including the use
of very different participants who are drawn from community, student, and clinical groups.
Victims who are studied in clinics may report higher distress and greater impairment
compared to other groups.
Recommendations to enhance culturally relevant adult male sexual violence studies,
including within-group cultural variability and comparisons against other populations
across factors such as prevalence, impact, and treatment. Investigations need to consider an
intersectional approach to assessing adult male victimization, which includes perspectives
of gender identity, sexual identity, race, ethnicity, socio-economic status, and religious
identification and commitment. Investigating offenders of AMSVo and the effects of societal
and cultural responses requires attention. How similar and different are preparators of
AMSVo from men who sexually offend against women?
All sexual trauma is clearly a serious public health problem. This review has several
implications for advocates. It may provide a platform for providing awareness, preven-
tion, and intervention training for law enforcement, the medical system, mental health
practitioners, and other groups who have a connection to adult male sexual victimization.
Such advocacy may open doors for collaborative work with all public systems to minimize
the likelihood of secondary victimization and long-term distress. Since the public tends
to believe that adult male sexual violence is a homosexual problem, education is critical
to improving reactions to disclosure, reducing stigma, and raising awareness of available
services and resources for survivors. Clearly, the greatest need for research is treatment.
Behav. Sci. 2023, 13, 304 17 of 22

Identifying interventions that are male-specific will help treatment to be targeted and
evidence-based. The full helping spectrum from support groups to trauma-based inpatient
treatment, including attrition, requires investigation.
Practically, studies need to identify and define desired outcomes from increased efforts
to address AMSV. Such outcomes are likely multiple, complex, and empirically supported.
Research needs to speak to how to approach, assess, and address adult men prior to, during,
and after the evaluation. By acquiring a common foundation of knowledge and fostering
collaborations, those in the field may increase access to support and resources, so that all
adult male survivors who experience the emotional aftermath of sexual trauma may follow
a path of recovery that is healing and empowering.

12. Conclusions
Examining AMSVo is important because it is an issue that has been largely ignored in
the literature. Given the fact that the stigma associated with men and the reluctance of them
to disclose, it is not surprising that it has been a topic largely neglected in the literature.
Much of the literature is old, dating back to the 1970s, when seminal research was taking
place. Since that time, the empirical investigation of AMSV has been limited over the
course of nearly 50 years. Given the lack of research into adult male sexual victimization,
we do not have any certainty regarding what is applicable to today’s victims and what
is outdated. The extant literature clearly dispels the misconceptions that men cannot be
victimized outside of prison walls. According to this review, men frequently have erections
or ejaculate uncontrollably during a sexual assault; nonetheless, the victim’s response does
not imply consent. This review also supports the notion that anal rape might cause men to
experience involuntary erections or ejaculations. These physiological responses complicate
the impacts on men. It is as if their bodies are giving consent while their psychological
selves feel violated.
Furthermore, current studies document the extensive negative impact on men. Advo-
cacy and treatment efforts need to continue to be developed and researched, refined, and
implemented to address the unique needs of male victims. When male victims are viewed
as authentic members of the sexual survivor community, treatment and resources tailored
to them should increase. Finally, the message that “rape is rape no matter who the victim
is” needs to be emphasized.

Author Contributions: J.K. and J.C.T. contributed to the initial draft and revisions of the manuscript.
All authors have read and agreed to the published version of the manuscript.
Funding: No funding was used for this manuscript.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors declare no conflict of interest.

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