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Male is relatively common but also relatively ignored in American society (and elsewhere). One extensive and highly regarded US-based study found that 1 in 6 boys experience some form of sexual abuse by the age of 18. Other research suggests the ratio may be as high as 1 in 4. Adult males can also be sexually victimized, most often in prisons or the military.

Still, despite well publicized scandals involving the Catholic Church and Penn State football coach Jerry Sandusky, the issue of male sexual abuse is largely unacknowledged and unaddressed.

Most likely, our cultural ignorance regarding male sexual abuse stems from the fact that American males (and males in most other cultures) are expected to be invulnerable and to not feel emotional pain. In other words, guys are supposed to be macho and in control and to fend for themselves. And these beliefs are inculcated at a very early age. Straight out of the womb, in many cases. This despite the fact that boys are every bit as vulnerable, both physically and emotionally, as girls.

My colleague Dan Griffin writes and speaks extensively about the rules for being a man and the deleterious effects thereof. In a 2013 interview posted here, Dan says, “We tell men don’t cry, don’t show your emotions unless it’s , be strong, don’t ask for help, don’t be vulnerable, be sexually aggressive, put work before relationships, put success before relationships. Basically we tell them that power and having power is central to being a man. [This means] it’s against the rules for men to acknowledge trauma. So [as traumatized men] we spend a lot of time telling ourselves that whatever it is that happened to us wasn’t painful, that we’re not suffering.”

Sadly, these man rules seem to apply even with sexual abuse. As a result, males tend to keep their sexual abuse secret, stuffing their feelings and living in denial about what happened. So instead of talking about their trauma, they clam up, either taking it to the grave or delaying disclosure, often for years on end. In fact, the organization MaleSurvivor.org reports that the average length of time between male sexual abuse and disclosure is twenty years, and this number does not account for abuses that are never reported. Essentially, the man rules tell us that guys are not allowed to be abused, and if they are abused, they are not allowed to admit it, and if they do admit it, they can expect to encounter not empathy and support but disbelief and disdain.

Sometimes people seem to think that sexually abused males are defective and toxic because they were sexually abused. Or maybe people think they were defective and toxic before the abuse, and that’s why the abuse occurred. Neither belief is true, of course. But people nonetheless think this way.

Unfortunately, sexual abuse, like other forms of trauma, typically leads to all sorts of emotional and psychological issues. This is even more likely if/when the trauma is chronic (repeating)—as sexual abuse very often is. One study (focused on trauma in general rather than abuse in particular) found that survivors of chronic abuse (four or more significantly experiences prior to age 18) are:

1.8 times as likely to smoke

1.9 times as likely to be obese

2.4 times as likely to experience ongoing

2.5 times as likely to have panic reactions

3.6 times as likely to be depressed

3.6 times as likely to be promiscuous

6.6 times as likely to engage in early-life sexual intercourse

7.2 times as likely to become

11.1 times as likely to become intravenous drug users

So there is a clear and undeniable link between childhood trauma, in particular chronic trauma, and a wide variety of symptoms and disorders. Essentially, chronic abuse creates layers of traumatic experience, with each layer reinforcing previous layers of emotional damage. In time, the layers are like an onion. The deeper you cut, the more pungent it becomes, and the more likely you are to evoke tears. And this is true regardless of a victim’s . Males suffer just as much as females.

As therapists have long been aware, the only truly effective way to peel back these layers of pain and suffering is talking about (and re-experiencing) the trauma. However, as mentioned earlier, victims of male sexual abuse typically do not do this. Instead they keep their trauma secret, pretending it didn’t happen or that they wanted it and were in control of it, or that it was fun, or whatever. They follow the man rules. Instead of talking about their experience and dissipating the power of what happened, they bury it and ignore it until it rots and festers and creates , anxiety, addictions, etc.

Exacerbating matters in most cases of early-life male sexual abuse is that it’s usually committed by a known perpetrator, either a family member or some other trusted . This form of close relationship trauma, known as trauma, nearly always creates stronger and ultimately more destructive responses than less personal traumas. Essentially, the betrayal of a close relationship is incredibly confusing to the victim, who relies on the perpetrator for food, shelter, emotional support, and other forms of support. Because of this inequality the child often internalizes blame (rather than blaming the perpetrator), thinking that he did something wrong or that he is inherently flawed in some way, and therefore cannot expect to be loved and cherished and properly cared for.

It is exactly this sort of sexualized that drives the later-life problems associated with all forms of trauma. Unfortunately, as discussed above, because sexually abused males are expected to follow the man rules, even at a very early age, they tend to keep their abuse secret, allowing their shame to grow and to gradually distort their .

Even worse, when sexually abused males do choose to talk about their abuse, they don’t always garner the and supportive response they need, because all of us—even therapists—are trapped in the man rules to some degree. Even highly trained clinicians have societally influenced expectations, sometimes thinking that sexually abused males should be able to just get over it without a lot of whining and crying. And thanks to these and similarly misguided cultural beliefs, it can be very difficult to identify, empathize with, and effectively treat a male client’s sexual trauma history.

When psychotherapists do choose to fully address male sexual abuse issues, they nearly always do so imperfectly, failing to recognize and incorporate not only their own cultural biases but the client’s. For instance, a wonderfully empathetic therapist who has shaken off the shackles of the man rules might recognize a client’s sexual abuse and want that client to immediately feel what he needs to feel, accepting and acknowledging the pain. However, the client, still mired in the rules of being a man, might not be ready for this and may in fact struggle with the very idea of it. Sometimes in situations like this the client will become frustrated and act out, expressing anger and a desire to quit treatment.

My point here is that therapists treating male survivors of sexual abuse must often walk a fine line. Yes, to heal from this trauma our clients must talk about and feel the pain of their abuse. Unfortunately, as they’re feeling the shame and pain of their abuse, they’re also feeling shame and pain about becoming vulnerable and violating the man rules. It’s a double-whammy. As such, with male survivors of sexual abuse the healing process typically and necessarily proceeds slowly, in fits and starts, with plenty of breaks. Often it is two steps forward, one and three-quarters steps back. Nevertheless, over time, if the therapist and client are both willing to persevere, healing can and does occur. And with it comes a significant reduction in the client’s concurrent anxiety, depression, addictions, and other problematic symptoms.