The Case

A 25-year-old male presents to the emergency department (ED) after being sexually assaulted. The patient reports no physical violence, but was at a party with some friends when he got separated from them. He had a few alcoholic drinks and later felt dizzy. The next thing he remembers is waking up in a bedroom with at least two other males, whom he did not recognize, standing over him, naked, and laughing. A few minutes after waking up, he was more alert and realized he was naked and had pain in his anus. His vital signs are normal. He was quiet and tearful. His physical exam is unremarkable. He requests police to be called. While calling the police, your charge nurse asks if the Sexual Assault Nurse Examiner (SANE) Hotline should be called? What about the rape crisis advocate?

Discussion

Males can be victims of sexual assault (SA) at any age and these assaults may be perpetrated by other males or females regardless of the victim’s and assailant’s sexual orientation. Though most people are aware of female SA survivors, male victims are often forgotten and neglected due to shame and stigma. It is estimated that one in six boys have been sexually assaulted by their 18^th birthday and one in four men will sustain unwanted sexual events in their lifetime.^1,2 Overall, about five to 10 percent of rape victims are males.^3–5 Male victims may experience SA as part of hazing or initiation rituals, in institutionalized settings, in the military, or while incarcerated. 

There are several differences between male and female victims. However, they each require the same basic health care response: 

1. Safety 
2. Ability to report to law enforcement and to have an appropriate police investigation
3. Access to a rape crisis advocate
4. Access to a medical forensic examination 
5. Access to counseling services
6. Adjudication in court

Male victims are often more reluctant to seek health care and even less likely to seek law enforcement response.^3,5–8 They often are ashamed, embarrassed, and feel they will not be believed or taken seriously. They feel, as a man, they should have been able to prevent or fight off the assault. In addition, some teenagers may think it is a status symbol to have sex with an older woman or man (even if perceived by the victim to be consensual), even if according to state law the act counts as sexual assault.