Definition, Prevalence, Correlates, Sequelae, and Management
William C. Holmes, MD, MSCE; Gail B. Slap, MD, MS
Objective.—To clarify the definition of sexual abuse of boys, update estimates
of its prevalence, and explore critically its reported correlates, sequelae, and management.
Data Sources.—Studies from 1985 to 1997 were identified using OVIDMEDLINE
andOVID-CINAHL. The search terms used were sexual abuse, sexual
victimization, and sexual assault. Constraints applied included English language,
human male subjects, age younger than 19 years, and North American samples.
Study Selection.—Publications were included for review if they appeared in
peer-reviewed journals; had clear research designs; reported results for at least 20
male subjects; and were notreviews, perspectives, theoretical treatises, editorials,
Data Extraction.—Study types and sampling methods were categorized using
well-established definitions. Preference was given to studies with large samples,
with case-control or cohort designs, and/or with adjustment for effect modifiers or
Data Synthesis.—We identified 166 studies representing 149 sexual abusesamples. Studies were methodologically limited and definitions of sexual abuse
varied widely. Prevalence estimates varied widely (by definition used and population
studied), ranging from 4% to 76%. Boys at highest risk were younger than 13
years, nonwhite, of low socioeconomic status, and not living with their fathers. Perpetrators
tended to be known but unrelated males. Abuse frequentlyoccurred outside
the home, involved penetration, and occurred more than once. Sequelae included
psychological distress, substance abuse, and sexually related problems.
Evaluation of management strategies was limited.
Conclusions.—Sexual abuse of boys appears to be common, underreported,
underrecognized, and undertreated. Future study requires clearer definitions of
abuse, improved sampling,more rigorous data collection, more sophisticated data
analyses, and better assessment of management and treatment strategies.
Regardless, health care professionals should be more aware of and sensitive to the
possibility of sexual abuse in their male patients.
SEXUALABUSEof young and adolescent
girls has been well studied, with a
consequent keen awareness of theexisting
and potential abuse of girls. In contrast,
a relative silence about the abuse
has fostered a belief, among both health
professionals and society at large, that
the problem is uncommon and the outcomes
are not severe.1,2 Recent events
suggest otherwise. In the past year
alone, there have been several widely
publicized stories of boys whose allegedhomicidal acts were propelled, at least in
part, by their own sexual abuse histories.
3,4 Greater attention to male sexual
abuse and its potential outcomes appears
In a 1984 review, Finkelhor5 estimated
that 3% to 4.8% of males in the
United States had a history of prepubertal
sexual contact with an adult male.
Perpetrators tended to be unrelated acquaintances
or strangers,and victims
tended to have families of origin that
werepoor, physically abusive,andonly 1
parent. When public authorities were
contacted about the abuse, reports were
made to the police rather than child protective
services. Boys were less likely
than girls to report sexual abuse because
of the fear of retribution, the social
stigma against homosexual behavior,
the desire to appearself-reliant, and
the concern about loss of independence
following disclosure. Finkelhor5 postulated
that male underrepresentation in
commonly studied databanks from child
protection agencies reflected both low
reporting overall and preferential reporting
to less commonly studied police
See also p 1864 and Patient Page.
Studies of male sexual abuse have increased
since 1984. Their...