Male victims of sexual abuse and domestic violence: A steadily increasing phenomenon

Abstract

Violence perpetrated on male victims is a phenomenon that is currently underestimated by both national and international scientific communities, since males are historically (and stereotypically) considered the perpetrators rather than the victims of violence. As a consequence, the available literature lacks data which would allow a better understanding of this issue and its presenting features. We undertook a retrospective analysis of 231 medical files of male victims of violence over a five-year-period (2014–2018) at the Soccorso Violenza Sessuale e Domestica Centre in Milan, Italy. The sample included 112 victims of sexual violence and 119 victims of domestic violence, most of whom were younger than 18 years of age. The main aim of this study was to describe the presentations of male victims of violence in order to understand the phenomenon better, increase awareness of the issue and enable improved health-care management. The need to pay more attention to this vulnerable part of the population is mandatory in health-care services, and it includes: the provision of management guidelines, training to attending physicians and a supportive service to male survivors. Understanding which risk factors are related to male abuse can help with the development of programmes that identify, prevent and minimise violence – this being especially useful for primary-care clinicians. This is the first Italian study to deal with domestic and sexual violence involving male victims.

Keywords

Violence against males abuse clinical forensic medicine sexual assault domestic violence intimate partner violence

Introduction

The World Health Organization (WHO) classifies intimate partner violence (IPV; sometimes called domestic violence or spouse abuse) and sexual violence as major public-health problems and serious human rights abuses.¹ Violent sexual acts encompass rape, unwanted sexual advances, sexual harassment, sexual abuse of disabled people and forced marriage or cohabitation. Domestic violence encompasses all acts of physical, sexual, psychological or economic violence that occur within the family or domestic unit or between former or current spouses or partners, irrespective of whether the perpetrator shares or has shared the same residence with the victim. It also includes children witnessing any such behaviour, as well as stalking.^1–5 Domestic violence is a well-known risk factor for self-harm and suicide and is detrimental from a psychological perspective.^6–8 In this sense, resilience is fundamental and an asset for the victim, since it seems to play a pivotal role in explaining the heterogeneous reaction to abuse and violence.^7,9 The physical effects of IPV can include acute injuries such as bruises, lacerations, gunshot trauma, genital injuries, broken bones, intracranial injuries and eye/orbital injuries.^10–12 Italian Criminal Law^a clearly distinguishes the crime of sexual violence from maltreatment within the family, the latter being comparable to the notion of domestic violence.

When discussing violence, it is often assumed that females are the main victims.^13–16 The first research on domestic violence focused on female victims and on the social factors of female victimisation.¹⁷ Men are often thought of as perpetrators of most types of violence (i.e. assuming the dichotomy woman=victim vs. man=guilty). However, men can also be victims.^11,18

The phenomenon of violence towards males, both sexual and domestic, is underreported and under-investigated, even in the forensic literature. This might be because men struggle more than women to report having been victims of violence.^19,20 Over the last years, violence against males has received little public attention, remaining poorly documented^17–24 and underreported in the forensic scenario. However, the analysis of the dynamics of male victimisation and the awareness of the need to implement solutions to face this important issue has evolved over the last 10 years.¹⁷ Recently, research has reported that men suffer some form of violent behaviour (e.g. sexual violence, stalking or physical violence) by an intimate partner over their lifetime.^5,11,20

This paper primarily focuses on male victims of violence in the Metropolitan City of Milan, attracting attention because of the lesions suffered, and under the care of the medico-legal staff of the Soccorso Violenza Sessuale e Domestica (SVSeD) Service for Sexual and Domestic Violence. The main aim of this study was to analyse the phenomenon and the variables involved. Knowing which risk factors are connected with male abuse can help in developing programmes that identify, prevent and minimise violence, especially among primary-care professionals. In addition, this paper provides a description of this little-known topic for the first time in Italy, with the aim of improving the awareness and health management of male victims of violence, especially on behalf of forensic practitioners who could be involved during clinical activity in emergency services.

Methods

Sample

The study included 231 cases of male victims of violence, ranging from 0 to 55 years old. It started with the collection of all files concerning non-fatal male victims of violence observed in Milan’s SVSeD Centre over a five-year-period (from January 2014 to December 2018). All victims were assessed by forensic practitioners.

Setting

A retrospective analysis was performed on reported cases of male victims examined and reported by the SVSeD, a centre providing specialist services for the comprehensive care and support for the victims of all sorts of sexual crimes from 1995 and of domestic violence from 2014.²⁵ The SVSeD Centre is the largest Italian support clinical forensic medicine centre for victims of violence, with more than 1000 examinations every year. All victims have experienced sexual assault or domestic violence. The victims, on the basis of the violence reported, are evaluated by a group of experts in clinical forensic medicine and other specialties (e.g. gynaecology, surgery, urology, paediatrics and radiology), social workers, psychology and law.

Procedure

During the medical examination of the victims, biological evidence (for genetics and toxicology) is collected, secured for long-term storage and made available to the competent authority. For every medical report in the database, the following information was examined: year of examination; type of violence – sexual assault or domestic violence (including IPV), classified according to definitions previously reported; according to the Italian Criminal Law and the Istanbul Convention (2011), in this study, cases of sexual assault perpetrated by family, cohabitants or ex-partners in a domestic environment were categorised as sexual violence; age of victims, in five different age groups; nationality; the timing of access to the SVSeD Centre after the violence; presence of physical injuries, in particular anogenital and extra-genital injuries; and use and type of weapon. The following perpetrator data were also analysed: number of assailants; sex; relationship with the victim: the term ‘unknown’ refers to the victim’s lack of memory of what happened during the violence, while the term ‘others’ represents those persons who were close to the victims, such as family friends, guardians or individuals who had legal responsibility for these subjects.

Analysis

Data obtained from consulting medical records were reported in a digital data set and subsequently analysed with descriptive statistics using a quantitative method by open source calculator OpenEpi v3.01.²⁶ Analysed results were then grouped into frequency tables, expressed as percentages.

Ethical approval

Institutional Review Board approval for the study was obtained. The victims had given specific informed consent for the use of their data for research purposes.

Results

This research selected 231 cases of male victims who experienced violence, aged from 0 to 55 years old. The distribution of these cases increased between 2014 and 2018: 19 (8.2%) in 2014, 31 (13.4%) in 2015, 49 (21.2%) in 2016, 65 (28.1%) in 2017, 67 (29%) in 2018 (Figure 1). The growth was exponential, with an increment of 252%. A total of 112 (48.5%) cases were sexual violence, and 119 (51.5%) were domestic violence (Figure 2).

Figure 1.

Number of cases per year.

Figure 2.

Number of cases for type of violence suffered.

Male victims of sexual assault

Details of male victims of sexual assault are shown in Table 1. The 112 encountered cases of sexual assault presented an irregular distribution over time: 14 (15.68%) cases in 2014, 14 (15.68%) in 2015, 22 (24.64%) in 2016, 34 (38.08%) in 2017 and 28 (31.36%) in 2018. There were 40 victims aged between 0 and 9 years, 26 aged between 10 and 17 years, 29 aged between 18 and 30 years and 17 aged between 31 and 55 years. There were none were older than 55 years of age. The majority of victims (58.9%) were younger than 18 years of age. Victims were Italian in 75 (64.3%) cases, and 12 (10.9%) came from South America, 11 (9.8%) from Africa and seven from either Europe or Asia (6.2%). The main types of abuse suffered were anal penetration (n=39; 34.8%) and sexual harassment (n=35; 31.3%). Weapons were used in four (3.5%) cases of sexual violence for penetration: wooden sticks in two cases, glass bottles and knife handles in the other two. Another variable to consider is the number of perpetrators. In the majority of cases (67%), the crime was committed by one assailant, but in some cases (22.3%), there were two or more perpetrators; in the remaining 10.7% perpetrators was unknown. The sex of the assailant was known in 77.7% of the cases and can be divided into a subset of 82 (73.2%) males and a subset of five (4.5%) females. The known perpetrators comprised family members (22.3%), cohabitants/partners/ex-partners (1.8%), acquaintances (33.9%) and strangers (32.1%).

Table 1.

Features of sexual assault cases.

	n	%
Age of victims (years)
0–9	40	35.7
10–17	26	23.2
18–30	29	25.9
31–55	17	15.2
>55	0	0
Nationality of victims
Italian	75	66.9
European	7	6.2
African	11	9.8
South American	12	10.9
Asian	7	6.2
Type of violence
Sexual harassment	35	31.3
Oral	4	3.6
Anal	39	34.8
Oral+anal	8	7.1
Unknown	26	23.2
Weapons
Yes	4	3.5
No	108	96.5
Type of weapon
Wooden stick	2	50
Glass bottle	1	25
Knife handle	1	25
Number of perpetrators
1	75	67
≥	25	22.3
Unknown	12	10.7
Sex of perpetrators
M	82	73.2
F	5	4.5
Unknown	25	22.3
Victim–perpetrator relationship
Family member	27	24.1
Partner or ex-partner	3	2.7
Acquaintance	42	37.5
Stranger	40	35.7

Male victims of domestic violence

Details of male victims of domestic violence are shown in Table 2. The 119 male victims of domestic violence presented an increasing regular distribution over time: five (5.9%) cases in 2014, 17 (20.2%) in 2015, 27 (26.2%) in 2016, 31 (36.9%) in 2017 and 39 (46.4%) in 2018. There were 70 (58.8%) victims younger than 18 years of age; nine (7.6%) victims were older adults (>55 years old). Victims were Italian in 72 (60.5%) cases African in 21 cases (16%), South American in 11 cases (9.1%), Asian in seven (5.9%) cases, European in six (5%) cases and North American in two (1.7%) cases. In 57 (37.8%) cases, the elapsed time between the occurrence of domestic violence and arrival at the SVSeD Centre was 12 hours; in 21 (17.6%) cases, it took between 13 and 24 hours; in 12 (10.2%) cases, it took less than 48 hours; in eight (6.7%) cases, it took one week; and in 21 (17.6%) cases, it took more than a week. In almost all cases (n=112; 94.1%), there was a single perpetrator. In 72 (60.5%) cases, the assailants were male, while in 37 (33.6%) cases, they were females. In 59 (49.6%) cases, the perpetrators belonged to family members or were partners/ex-partners (n=41; 34.5%). The majority of victims (n=78; 65.6%) experienced physical abuse, with 23 (19.3%) witnessing violence. Psychological violence occurred in 10 (8.4%) cases, and stalking occurred in eight (6.7%) cases. In 35 (29.5%) cases of domestic violence, weapons were involved. Broomsticks were used in eight (23.5%) cases; knives, cigarettes and glass bottles in three (8.5%) cases; belts in six (17%) cases; ladles in five (14%) cases; irons in two (5.5%) cases; pots and pans in four (11.5%) cases; and electric cables in one (3%) case. Among the subjects who claimed physical violence, lesions were found during medical examination in 75 cases. A total of 106 injuries were described in the following anatomical regions: 33 (31.1%) to the head/neck, 25 (23.6%) to the trunk, 32 (30.2%) to the upper limbs, 15 (14.2%) to the lower limbs and one (0.9%) to the anogenital area. Injuries included 56 (52.8%) cases of bruises, 34 (32.1%) of abrasions, eight (7.6%) of lacerations, five (4.7%) of burns and three (2.8%) of fractures.

Table 2.

Features of domestic violence cases.

	n	%
Age of victims (years)
0–9	29	24.4
10–17	41	34.4
18–30	20	16.8
31–55	20	16.8
>55	9	7.56
Nationality of victims
Italian	72	60.5
European	6	5
African	21	17.6
North American	2	1.7
South American	11	9.1
Asian	7	5.9
Timing (hours)
0–12	57	47.9
13–24	21	17.6
25–48	12	10.2
49–168 (one week)	8	6.7
>168	21	17.6
Number of perpetrators
1	112	94.1
≥2	7	5.9
Sex of perpetrators
M	72	60.5
F	40	33.6
M+F	7	5.9
Nationality of perpetrators
Italian	69	58.9
European	6	5
African	20	16.8
South American	9	7.6
Asian	5	4.2
Unknown	10	8.4
Victim–perpetrator relationship
Family member	59	49.6
Partner or ex-partner	41	34.5
Others	19	15.9
Type of violence
Physical	78	65.6
Witnessed	23	19.3
Psychological	10	8.4
Stalking	8	6.7
Presence of injuries
Yes	75	63
No	44	37
Weapons
Yes	33	28
No	86	72
Type of weapon
Broom	8	24
Knife	3	9
Belt	6	18
Iron	2	6
Ladle	5	15
Pot/pan	4	12
Glass bottle	3	9
Electrical cable	1	3
Cigarette	1	3
Body locations of injuries
Head/neck	33	31.1
Thorax/abdomen/back	25	23.6
Upper limbs	32	30.2
Lower limbs	15	14.2
Anogenital area	1	0.9
Types of injuries
Bruises	56	52.8
Abrasions	34	32.1
Lacerations	8	7.6
Burns	5	4.7
Fractures	3	2.8

Discussion

Sexual abuse and domestic violence represent a dramatic worldwide problem with devastating effects on victims and the people close to them, as well as on costs for health-care services.^1,16 When domestic violence and IPV are taken into account, males are seldom considered victims because they are believed to be stronger than females and therefore less vulnerable to violence.^19,27 For this reason, little is known about this phenomenon, and the scientific literature lacks studies. In 2010, the US National Intimate Partner and Sexual Violence Survey summary report showed that 7–29% of men suffered from IPV aggression,²¹ while in Europe, the French National Delinquency Observatory reported 280,000 male victims of domestic violence.²² In 2018, the recent Crime Survey for England and Wales estimated that 695,000 males experienced domestic abuse,²³ while a report by the National Institute of Statistics – Italian public research institute (ISTAT) – described sexual harassment against men for the very first time in Italy.²⁴ The survey showed that among the Italian population aged >14 years, 3,754,000 (18.8%) men have suffered from harassment in their lifetime. Males aged between 14 and 24 years are at greatest risk of sexual harassment, and 62.1% of male and 42.7% of female victims of sexual abuse have never disclosed their traumatic experience to anyone.²⁴ In Italy, a proper understanding of this issue is very challenging. In fact, there are very few reports on sexual violence,^18,25 and no data are available regarding domestic violence against male victims. Males tend to avoid reporting the violence they have suffered,^17–20,25 and the results of this study confirm that every year in the SVSeD Centre in Milan, males represent <5% of victims, although an increase in their number has been observed between 2014 and 2018. However, in comparison to more than 1000 cases recorded every year for female victims, data on the male victim population are still limited. Currently, in Italy, there is no statistical study regarding the phenomenon of domestic violence involving male victims.

According to the international literature, there is an under-estimation of domestic violence among both sexes. Many victims do not ask for help due to fear of further violence, psychological pressure or retaliation, or because they have no resources outside the domestic environment (e.g. minors). Domestic violence accounted for 51.5% of all the victims examined at the SVSeD Centre during the same period, being more frequent than sexual violence and showing a regular increase.^4,19 Regarding the age of victims, those aged 0–18 years were the most represented within the male population studied, representing more than half (around 60%) of the total, of whom one third were younger than 10 years old. These data are consistent with the results obtained from other studies, mostly involving female subjects, which show that young children experience the highest risk of abuse.^4,11,24 The study reveals that perpetrators were male in 60.5% of cases of domestic violence and 73.2% cases of sexual violence. Women, on the other hand, were assailants in 33.6% in domestic violence and 4.5% of sexual assault cases. In seven cases, domestic violence was perpetrated by both a man and a woman together. As regards the type of violence, anal penetration was the most frequent type of sexual violence, followed by sexual harassment, involving, respectively, 34.8% and 31.3% of total cases. In domestic violence, the majority of abuse was physical (65.6%). According to the literature, men who suffer physical violence often report minor cutaneous traumas, and they often present with less severe injuries than women.^20,28 In those cases, about 85% involve minor cutaneous lesions (bruises and abrasions), mainly located in the head/neck region or in the upper limbs. More severe lesions include lacerations, burns and fractures. Differential diagnosis is a critical issue because in the domestic setting, the same injuries, especially in the head/neck region, can be accidental or self-inflicted.^29–31 In addition, the high prevalence of physical assaults matched with about 60% of cases presenting at the SVSeD Centre during the first 24 hours since the violence occurred. As far as the relationship between victims and perpetrators is concerned, in the majority of cases, they were acquaintances (33.9%) in sexual assaults, while domestic violence events occurred between family members and partners or ex-partners (84.1%). Use of weapons was infrequent in sexual assaults (only four cases), while in domestic violence, weapons are involved in almost a third of cases (29.5%). Familial violence was characterised by the use of household items, in agreement with data available in the literature.³

These epidemiological and circumstantial features have to be considered for the future consequences of individuals involved. Some studies suggest that a subject who experienced violence in his/her lifetime could develop long-term physiological and psychological issues, in addition to the fact that victims can become perpetrators of violence themselves.^4,32–34 On the basis of these findings, it is essential that government and health-care services begin to implement preventive actions through a multidisciplinary intervention. In this regard, a new Law (D.L. 69/2019 – ‘Red Code’) was recently established (8 August 2019) within the Italian legislation, with the aim of introducing more effective and rapid tools in favour of victims of domestic and sexual violence. The most important among those introduced are: shorter duration of trials for sexual assaults, maltreatment and persecution acts; easier adoption of protective measures for the victims; more severe punishment in case of crimes of maltreatment, sexual violence and persecution acts; and mandatory attendance for police forces on training courses aimed to prevent crimes of domestic and sexual violence.³⁵ This new law makes it clear that the Italian state is planning to pay increasing attention to sexual and domestic violence crimes. In addition, it is necessary that adequate attention and support by social workers and therapeutic services are provided to male victims of violence,^36,37 as well as careful and scrupulous collection of medico-legal data. Moreover, the international scientific community should carry out further research to understand better the actual epidemiology, the alerts and the best therapeutic and supportive techniques to help men report the violence they have experienced. Awareness can be raised through a better understanding of this phenomenon among the medico-legal community.

The present study has important limitations. First, as previously mentioned, a limited percentage of male victims were actually examined, despite frequently reporting both sexual and domestic abuse. As a consequence, the exact incidence remains unknown. In addition, most of the information came directly from the victim – the examining clinicians do not have access to police records or investigations. The analysed data also considers all males presenting over the five-year period, and it therefore includes both adult males and children within the same sample. Given that they are likely to present with different sorts of problems and needs as victims, future research is recommended in which both groups are considered separately. Further, our analysis considered only part of the population of Italy, belonging to one Italian metropolitan area, where care services, such as the SVSeD Centre, are available. Therefore, the results may not be fully representative of victims of male violence within the wider population.

Conclusions

Although research has been carried out in recent years to understand the numbers and consequences of violence against males, much effort is still needed. This is the first Italian report dealing with domestic and sexual violence perpetrated on males who were assisted by forensic physicians. The present study showed an increasing number of cases of men suffering from physical and psychological abuse, proving that men, as well as women, can experience sexual assault and domestic violence. Even if this phenomenon is statistically less important than the well-known one concerning the female population, the need to pay more attention even on behalf of clinical forensic doctors to this vulnerable part of the population is mandatory. In particular, health-care services should provide management guidelines and appropriate training to physicians who face such a delicate matter, as well as a supportive service to the victims. Moreover, the establishment of awareness-raising campaigns addressed to the population could be appropriate in order to increase the number of men willing to ask for help. In particular, forensic physicians who are used to dealing with females should pay similar attention to potential male victims of sexual and domestic violence who seem to present similar trends in trauma and type of lesions.

Footnotes

Declaration of conflicting interests

The authors declared no conflict of interests with respect to the research, authorship and/or publication of this article.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

ORCID iD

Lorenzo Franceschetti

Note

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