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Sexual Abuse of Boys
Definition, Prevalence, Correlates, Sequelae, and Management
William C. Holmes, MD, MSCE;
Gail B. Slap, MD, MS
JAMA. 1998;280:1855-1862.
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 OVID-MEDLINE and OVID-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 not reviews, perspectives, theoretical treatises, editorials, or letters.
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 confounders.
Data Synthesis.— We identified 166 studies representing 149 sexual abuse samples. 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 frequently occurred 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.
From the Division of General Internal Medicine, Department of Medicine (Drs Holmes and Slap), Center for Clinical Epidemiology and Biostatistics (Drs Holmes and Slap), Leonard Davis Institute (Drs Holmes and Slap), and the Craig-Dalsimer Program in Adolescent Medicine, Departments of Medicine and Pediatrics (Dr Slap), University of Pennsylvania School of Medicine and The Children's Hospital of Philadelphia, Philadelphia.
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