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Print version ISSN 0103-6564
Psicol. USP vol.23 no.2 São Paulo Apr./June 2012 Epub July 17, 2012
Sexual violence against boys: epidemiological data, characteristics, and consequences1
Violência sexual contra meninos: dados epidemiológicos, características e consequências
Abus sexuel en garçons: données épidémiologiques, caractéristiques et conséquences
Violencia sexual contra niños: dados epidemiológicos, características y consecuencias
Jean Von Hohendorff; Luísa Fernanda Habigzang; Silvia Helena Koller
Federal University of Rio Grande do Sul (UFRGS)
This theoretical essay provides information about sexual violence against males in Brazil, given the scarcity of national studies on the subject. This lack of theoretical and practical knowledge creates challenges for professional work. Searching the national databases of scientific research revealed only one study, so international publications were employed. This study examines epidemiological data about sexual violence against males in Brazil as well as the characteristics of the victims, authors, and situations of sexual violence. This essay also considers the possible consequences of this type of violence. The found literature often discusses the difficulties boys have in reporting their experiences of sexual abuse, as well as their doubts about their sexual orientation. In conclusion, although sexual violence against males is less frequent, it does occur and thus requires preventative and therapeutic strategies. Furthermore, more national studies on this topic must be made.
Keywords: Sexual violence. Boys. Men.
O objetivo desse ensaio teórico é contribuir para a produção de conhecimento sobre a violência sexual masculina no Brasil, tendo em vista a escassez de estudos nacionais. A carência de conhecimento teórico-prático torna a atuação profissional um desafio. Buscaram-se trabalhos científicos em bases de dados nacionais, porém apenas um estudo foi encontrado. Diante disso, recorreu-se a publicações internacionais. Dados epidemiológicos da violência sexual masculina no Brasil, bem como as características das vítimas, dos autores e das situações de violência sexual, além das possíveis consequências deste tipo de violência, foram conteúdos abordados nesse estudo. A dificuldade dos meninos em relatar suas experiências de violência sexual e as dúvidas quanto à orientação sexual são aspectos frequentes na discussão da literatura encontrada. Conclui-se que, embora em menor prevalência, a violência sexual masculina ocorre e necessita de estratégias preventivas e terapêuticas. Além disso, é necessário o incremento de estudos nacionais sobre a temática.
Palavras-chave: Violência sexual. Meninos. Homens.
L'objectif de cet essai théorique est de contribuer à la production de connaissances sur l'abus sexuel chez les hommes au Brésil, en raison de l'absence d'études nationales sur ce sujet, le manque de connaissances théoriques et pratiques devenant un défi à la performance professionnelle. Nous avons cherché des articles scientifiques dans des bases de données nationales où, néanmoins, une une seule étude a été trouvée, raison pour laquelle nous avons eu recours aux publications internationales. Les données épidémiologiques de l'abus sexuel chez les hommes au Brésil, les caractéristiques des victimes, des agresseurs et des situations de violence, tout comme ce qui possiblement en découle, sont des contenus que nous avons abordés dans cette étude. La difficulté pour les garçons de parler de leurs expériences d'abus sexuels et leurs doutes concernant leur orientation sexuelle sont souvent discutés dans la littérature trouvée. Nous concluons que, bien que moins répandu, il y a de l'abus sexuel chez les hommes au Brésil, ce qui exige le développement de stratégies préventives et thérapeutiques, ainsi que l'accroissement de la recherche nationale sur ce sujet.
Mots-clés: Abus sexuels. Garçons. Hommes.
El objetivo de este ensayo teórico es colaborar con la producción de conocimiento sobre la violencia sexual masculina en el Brasil, llevando en consideración los estudios nacionales. La falta de conocimientos teórico-prácticos hace de la actuación profesional un desafío. Se buscaron trabajos científicos en bases de datos nacionales, aunque apenas un estudio fue encontrado. Delante de esto, se recorrió a publicaciones internacionales. Datos epidemiológicos de la violencia sexual masculina en el Brasil, así como las características de las víctimas, de los perpetradores, de las situaciones de violencia sexual y de las dudas cuanto a la orientación sexual son aspectos frecuentes en la literatura encontrada. Se concluye que, a pesar de la menor prevalencia, la violencia sexual masculina ocurre y necesita de estrategias de prevención y terapéuticas. Además, es necesario que haya un incremento en los estudios nacionales sobre la temática.
Palabras-clave: Violencia sexual. Niños. Hombres.
The studies in Brazil apparently approach the sexual violence against children and adolescents regardless the victims gender, however, when an analsysis of the researches participants is made, it is found that there is a predominance of female victims. Different aspects, such as mechanisms and factors related to sexual violence (Drezettet al,. 2011); sexual exploitation (Cerqueira-Santos, Rezende & Correa, 2010); psychopathological sympthoms (Habigzang, Cunha, & Koller, 2010); judicial context (Dobke, Santos & Dell’Aglio, 2010) and victims treatment (Lucânia, Valério, Barison, & Miyazaki, 2009; Habigzang et al., 2009; Padilha & Gomide, 2004) are addressed in these studies. On the other hand, the number of national studies published, which address, specifically, male victims is very short. When a brief non-systematic survey on the Brazilian studies about the subjetc was made in national databases (BVS Psi e Scielo, Periódicos Capes), for instance, only one publication (Almeida, Penso, & Costa, 2009) was found.
Face to the shortage on national studies about male sexual violence, the professional performance becomes a challenge, once it lacks theoretical-practical knowledge for its embasement. Thus, the aim of this theoretical essay is to contribute for the production of knowledge about male sexual violence. For that reason, besides the study of Almeida, Penso and Costa (2009), other sources were consulted (books, dissertations and international studies). Starting from these materials, this essay seeks to approach three male sexual violence aspects: epidemiological data; victims, offenders and situations characteristics, and possible consequences along to the victims development.
These three aspects were chosen for being considered essential for the knowledge about sexual violence against boys. In other words, it is necessary to know how much this kind of violence occurs (epidemiological data), what are the most frequent characteristics of the victims, offenders and of the violence itself, as well as the consequences it brings along.
Epidemiological data of sexual violence against boys in Brazil
Estimates indicate that one out of four girls and one out of six boys has been through some kind of sexual violence in childhood ou teenagehood (Sanderson, 2005). According to this data, girls are more likely to be victmized than boys, however, such difference is not big enough to justify the lack of studies about the male population in Brazil. It is clear that the subject of male sexual violence still lacks more social visibility so that victims, professionals, and society in general are able to perceive it as a health public problem, the same way it happens to sexual violence against girls and women (Holmes, Offen, & Waller 1997).
This section searched for studies published in databases (BVS Psi e Scielo, Periódicos Capes), originated from researches in the national territory, about sexual violence against boys epidemiological data.
Most of the studies found were made in the south of Brazil. Out of a total of 11 studies found, 6 had been made in southern states (De Lorenzi, Pontalti, & Flech, 2001; Habigzang, Koller, Azevedo, & Machado, 2005; Machado, Lueneberg, Régis, & Nunes, 2005; Martins & Jorge, 2010; Pelisoli, Pires, Almeida, & Dell´Aglio, 2010; Polanczyc, Zavaschi, Benetti, Zenker, & Gammerman, 2003), followed by the southeast region which presented three studies (Campos, et al., 2005; Ferriani, Garbin, & Ribeiro, 2004;Lucânia, Miyazaki, & Domingos, 2008).
The predominant means of data collection was the documentary analysis, made through the consultation of judicial shift, medical records, protocols and registration forms. Only one study made use of a screening tool to check the occurence of sexual violence (Polanczyc et al., 2003). Thus, it points out that there is a major investigation of epidemiological data in clinical population, in other words, the investigation is made in victims local services such as clinics, reference centers, children and teenagers protection centers (in Brazil called "Conselhos Tutelares"), public treatment programs, and hospitals, while the study of non-clinical population was made in only one research developed in public schools (Polanczyc et al., 2003). Regardless the means of data colection, all the studies reported high levels of female sexual violence. However, the biggest differences were perceived in studies which used the clinical population, while the study with non-clinical population (Polanczyc et al., 2003) reported the smallest difference between genders, being 59.3% female and 40.7% male.
The data originated from clinical population refelcts the level of cases which were notified and sent to treatment. These data ilustrates the predominance of female victims, with levels that can range between 64.2% (Ferriani et al., 2004) and 91.5% (Lucânia et al., 2008). Thus it is possible to raise the hypothesis that sexual violence against girls is notified with a higher frequence than the sexual violence against boys. That might be related to boys dificulty in relating the occurence (Pinto Junior, 2005; Weiss, 2010), once the female sexual violence has been culturaly "expected" (Pfeiffer & Salvagni, 2005; Pinto Junior, 2005), while the sexual violence against boys is banalized due to manhood stereotypes. Consequently the report of boys and men about their sexual violence experiences is hampered given their fears of other people's reactions and shame of relatives and other people who are close to the victim.
In national extent, in the period between May 2003 and March 2010 the national denunciation call service (in Brazil called "Disque 100" - A national confrontation program of sexual violence against children and adolecents, 2010) made more than two million visits, besides more then 120 thousand denunciations received and sent to treatment all over the country. Out of the 211.107 victims registered in the denunciations of sexual, neglicence, physical and psychological violence with gender informed, the percentual which most differed among the victims was in the levels of sexual violence. Only the percentage was revealed, being 62% for females and 38% for males. Specifically about the registrations of sexual violence, it was verified that in all the variations presented (sexual exploitation, children and adolecents traffic, sexual abuse and pornography) the female gender victims were of a higher number, getting to the level of 82% in the occurences of sexual exploitation. In the situations of sexual violence and pornography, it was found a raise in the number of male victms, but they were still a lower percentage (30%) than the female gender. Specific information about the boys (e.g. Age) or about the sexual violence situation (e.g. Duration time) were not revealed.
The studies published in southern region of Brazil reported sexual violence against boys levels between 15% (Pelisoli et al., 2010) ans 40.7% (Polanczyc et al., 2003) in comparison to the cases in the female population. The studies in this region are presented next.
A documentary analysis on the cases of sexual violence against children and adolecents, reported at The Childhood and Youth Prosecution Center of the state of Rio Grande do Sul, indicated a lower number of sexual violence cases against boys. Out of a total of 71 shifts, in the period between 1992 and 1998, 19.1% of the cases referred to boys, while 80.9% referred to girls (Habigzang et al., 2005). In a descriptive study made at the abuses clinic of Caxias do Sul/RS, in the period between December 1998 and December 1999, a 100 abuse cases were analysed (sexual, physical and emotional violence and negligence). Out of theses cases, 59 referred to sexual violence, being the majority (49 cases) perpetrated against girls (De Lorenzi et al., 2001). With the aim of checking the prevalence of sexual violence among adolecent students (aged 13 to 20) from the 8th grade in 52 public schools in Porto Alegre, a study which used a screening tool found out that out of 1193 participants, 27 (2.3%) had been victims of sexual violence. Out of this number, 16 were females, while 11 were males (Polanczyc et al., 2003). The documetary data of 340 cases of juvenile violence notified to the Children and Teenagers Protection Center (Conselho Tutelar) and to the program "Sentinela", in the city of Itajaí (state of Santa Catarina), in the period between 1999 and 2003 pointed out that 287 (84.4%) of the notification cases referred to sexual violence against girls, while 53 (15.6%) were against boys (Machado et al., 2005). The analysis of 4294 treatment forms of children aged five to twelve who had been victims of sexual violence, made by Centro de Referência no Atendimento Infanto-Juvenil (CRAI – a reference center in the treatment of children and teenagers), from Porto Alegre, between the years of 2002 to 2006, indicated that 75% of the cases referred to the female gender, while 15% referred to the male gender (Pelisoli et al., 2010). The cases of sexual violence among children and teenagers aged 0 to 14, registered at Children and Teenagers Protection Centers (Conselhos Tutelares) and victims tratment programs from the city of Londrina (state of Paraná), in the year of 2006, were investigated starting from medical records. Out of 186 cases, 25.8% were males, while 74.2% were females (Martins & Jorge, 2010).
In the southeast region of the country, the studies which were found reported levels of sexual violence against boys between 8.5% (Lucânia et al., 2008) and 28.6% (Ferriani et al., 2004), when compared to the cases of girls. Such studies are approached next.
The survey on notification of sexual violence cases occured in the southeast region, in the city of Ribeirão Preto (state of São Paulo), received at Centro de Referência da Criança e do Adolescente (a treatment center), in the year of 2000, reportesd 14 cases. Out of which, nine were girls (64.3%) and four were boys (28.6%), being one case without any information about the gender (Ferriani et al., 2004). In another study (Lucânia et al., 2008), the characterization of sexual violence victims received at the project called "Projeto Acolher" from Hospital de Base (São José do Rio Preto, São Paulo), in the period between December 2001 and October 2007, was made based on medial records. One hundred and eighteen attendances were registered, being 108 (91.5%) for the female gender, and 10 (8.5%) for the male gender (Lucânia et al., 2008). In the study which analysed 211 attendance notification forms, made at Conjunto Hospitalar de Sorocaba (state of São Paulo), between April 2003 and March 2004, most of the victims (190 cases) were females, while 21 cases involved boys or men (Campos et al., 2005).
When it comes to the northeast region, two studies were found. The study of Inoue and Ristum (2008) found out that, out of 2522 attendance protocols of a sexual violence victims denunciation and assistance program from the state of Bahia, in the period between August 2001 and August 2004, only 200 protocols (7.9%) referred to male children and adolescents (Inoue & Ristum, 2008). In the other study, the medical records of 60 children and adolecents aged zero to 18, attended in the period between 2005 and 2006, by "Programa Sentinela" from the city of Campina Grande in the state of Paraíba, indicated that 51 cases (85%) referred to the female gender and nine cases (15%) to the male gender (Baptista et al., 2008).
The espitemiological data presented in the studies found reported sexual violence levels against male victims between 8.5% (Lucânia et al., 2008) and 40.7% (Polanczyc et al., 2003) when compared to female victims, confirms the estimates which indicate the predominance of cases with the female gender (Sanderson, 2005).
Although, it is not possible to assert wheter the sexual violence against boys in Brazil occurs with less frequence or it is just less notified than the violence against girls. Different aspects need to be taken into account when the epistemiological data are analysed.
Considering the fact that the violence can be presented in many ways, including apparent physical violence or not, the denunciation and confirmation of sexual violence occurence is difficult (Pfeiffer & Salvagni, 2005), and that can influence the epistemiological data reported. Besides that, there are different definitons of sexual violence considered by science (for example, some studies define sexual violence just as the physical contact between the offender and the victim, while others encompass the interactions whitout physical contact). Although the studies which were consulted did not specify what was considered sexual violence, it can be a factor that contributes for the variability in data.
The dificulty boys have in reporting the occurence of sexual violence (Pinto Junior, 2005; Weiss, 2010) can also influence the epistemiological data. This dificulty is related to cultural facts by which the male sexual violence is banalized, while the female sexual violence is "expected" (Pfeiffer & Salvagni, 2005; Pinto Junior, 2005). The victim's embarassment and stigmatization due to manhood patterns based on masculine independence and stoicism can also interfere on the sexual violence disclosing (Sanderson, 2005; Weiss, 2010). Moreover, sexual violence victims, males or females, might be afraid of doing the denunciation and consequently suffer some kind of retaliation from the offender and might also fear the separation of the offender in the context of intrafamily sexual violence (Williams, 2002).
Characteristics and consequences of sexual violence against boys and men
The discussion of characteristics in sexual violence situations, its victims and offenders is useful so that it is possible to understand its dynamics, besides helping on the planning of preventive and therapeutic interventions. Therefore, studies which approached sexual violence characteristics, dynamics and its consequeces were sought.
The sexual violence dynamic, specially intrafamily, wheter it is against girls or boys, tends to be complex due to factors which might be involvend in its maintenance. Among them, threats and bargains stand out, culminating in the "Secret Sydrome", in which the child and/or teenager does not reveal the sexual violence fearing the offender's possible reactions (Furniss, 1993). The description of a 13-year-old boy's case who was raped by his uncle during three years exemplifies this syndrome (Almeida et al., 2009). The victim only disclosed the sexual violence episodes three years after they had started. According to the authors, in spite of all the psychological and affective damage the boy suffered during this period, the presence of affective and financial earnings, evidencing the presence of bargains and privileges, besides the uncle's threats, contributed for the situation to be kept a secret. The boy's mother reported that the offender used to give the victim material presents which his parents could not afford. Moreover, the offender was attentive and affectionate with the boy supplying his needs, once his father was distant besides being an alcoholic (Almeida et al., 2009). Therefore, it is possible to realize the interference of many aspects on the early disclosing of sexual violence cases. Among them, the offender's affective investment, the presence of bargains, threats and family conflicts.
Although there is not a children or adolecent profile which is more likely to be a sexual violence victim since all of them are at risk, in spite of their personal or social characteristics, some studies made with the male public indicated characteristics that might be identified as risk factors: living just with the mother, or with none of the parents; having parents who married again or are separated, parents who are alcohol addicts or have criminal behaviors; black or black descendant boys; social-economical factors, such as belonging to lower social levels, were identified in a science review study (Holmes & Slap, 1998) and in interviews made with six boys aged 7 to 13, who had been sexual violence victims (Kristensen, 1996). Boys younger than six years old would be more exposed to intrafamily sexual violence, while for those who are older than twelve, the risk of extrafamlial sexual violence would be higher (Holmes & Slap, 1998).
Regarding the victims' age, studies made in Brazil do not get to a consensus, although there is a tendency that the victims are boys under 12 years old. In one investigation of cases received at a children and teenagers reference center in the city of Ribeirão Preto in the year 2000, four cases were of sexual violence against boys and the age groups found were: three to six, seven to 10, 11 to 13 and 14 to 18 years old, with one case each (Ferriani et al., 2004). The attendance protocols of a victim's denunciation and assintance program from the state of Bahia, in the period of December 2001 and August 2004, were analysed in the study of Inoue and Ristum (2008). Out of 200 protocols of cases involving the male gender, 185 referred to boys under 13 years old. The same way, among 21 sexual violence cases against boys and men received in the hospital Conjunto Hospitalar de Sorocaba (São Paulo), between April 2003 and March 2004, most part (18) were boys aged 1 to 12, and three for teeenagers aged 12 to 18 (Campos et al., 2005).
The insvetigation of sexual violence cases against children and teenagers aged zero to 14 denounced at Conselhos Tutelares and victims' attendance programs, from the city of Londrina (state of Paraná), in the year 2006, indicated that, out of 186 cases, 25.8% were males, being the age group between five and nine years old, the most frequent (66.7%), followed by de age group of 10 to 14 (25%) and zero to four (8.4%) (Martins and Jorge, 2010). The characterization of sexual violence victims attended at the project called "Projeto Acolher" from Hospital de Base (São José do Rio Preto, São Paulo), in the period between December 2001 and October 2007, revealed that out of 118 attendances, 10 were males. Out of which, seven were boys aged zero to twelve, two were teenagers aged 12 to 18, and a men aged 53 (Lucânia et al., 2008).
A possible explanation for the predominance of the group age until 12 among boys who were sexual violence victims, might be assigned to the physical and cognitive development. As the boys develop they grow their cognitive capacity of understanding what is right or wrong and get more able to notice the difference between inadequate intereactions, such as the ones which occur in the sexual violence, and expected interactions. Besides that, physical strength the boys acquire during adolescence might intimidate possible sexual violence offenders. Regarding offender's characteristics, they are generally male and heterosexual (Holmes & Slap, 1998). They are usually an acquaintance of the child, mainly relatives, aged between pre-adolescence and adulthood (Kristensen, 1996).
The homosexual violence situations, in other words, when the victim and offender are the same gender, usually occur between a parent or relative male offender and the boy (child or teenager) victim (Pfeiffer & Salvagni, 2005). However, the violence can also be perpetrated by the victim's mother. It tends to be less considerated due to the mechanisms of secret and negation, and having in mind the social image which is assigned to the maternal figure, someone who protects the offspring (Pinto Junior, 2005). In a study with seven psychologists who attended boys who had been sexual violence victims in the health system of Grande Recife, it was found that among the offenders, the father had greater incidence, followed by uncles and stepfathers. Cousins, mothers, grandfathers and godfathers had lower incidence. Besides that, when questioned about the boys' feelings towards their sexual violence perpetrators, the most evident was the ambivalence between hatred and love. This ambivalence seemed to be greater when the pepetrator was the boy's father. In some cases, the boy misses the offender, being determinant the degree of their relationship prior to the sexual violence. Feelings such as hate, fear and repulsion were also reported (Pires Filho, 2007). Although the sexual violence results in sorrow, the one who commits it does not do it all the time, which confuses the victim and generates the child's ambivalent feeligns towards the pepetrator. The victim wishes the sexual violence to stop, but does not wish the offender, generally a family member, to be punished.
The place of sexual violence occurence was also approached in a study with six boys, aged seven to 13, who had been sexually assaulted. The places in which it happened were: the victim's home (three cases), school (one case), the offender's home (one case), and an institution which the boy used to go to (one case) (Kristensen, 1996). Furthermore, a systematic science review found that between 54% and 89% of the sexual violence situations were extrafamilial, and out of these, between 21% and 40% were commited by people the victim did not know. Between 46% and 93% were an isolated episode and 17 to 53% were cronic cases and had the duration between less than six months to 48 months (Holmes & Slap, 1998).
Sexual violence victims do not usually talk about the subject (Sanderson, 2005). They hope to forget about the ocurrence, protect the offenders or fear the reactions the revelation may cause (Holmes & Slap, 1998). The reason for not revealling the violence reported by the boys between seven and 13 years old, included the fear of their parents' reaction, fear of a possible family disruption, and also, the offender's reaction (Kristensen, 1996). Besides, the revelation was not the victims choice, having occured becaused relatives and other close people found out about the violence because of neighbors comments or signs presented by the child (anal bleeding or abnormal behavior) (Kristensen, 1996).
The duration, frequency, and the conditions in which the sexual violence occurs (with or without the presence of threat and/or violence), besides the child's or adolecent's age, relationship with the offender, reaction of the caregivers face to the revelation and the absence of parental figure are indicated as mediators factors of the violence impact (Araújo, 2002; Furniss, 1993; Kristensen, 1996; Sanderson, 2005).
The sexual violence can be considered as a generalized stress point and, that way, the victims might develop problems in areas which they may be more likely to (Williams, 2002). The consequeces of sexual violence are complex, since they involve many harmful effects for the victim: physical problems (trauma, sexually transmitted diseases); emotional (fear, anxiety, depression); behavioral (social retreat, inapropriate sexual behavior - Amazarray & Koller, 1998); besides cognitive changes (Borges & Dell´Aglio, 2008).
Regarding the sexual violence consequeces, cognitive, emotional and behavioral changes, seem to be related to its occurence in the male gender, they are: learning difficulty, school problems (Pires Filho, 2007); sexual games; childish behavior; enuresis; weight gain; worry about cleanliness (Kristensen, 1996); stigmatinzing; shame; revictimization or pair abuse; sleeping difficulties; specific fears (dark, being alone); absence of mind; an aggressiveness (Kristensen, 1996; Pires Filho, 2007); risky sexual behavior and hipersexuality; besides interpersonal problems (Holmes & Slap); axiety, invasive thought, escape and desertion, legal problems such as shoplifting and pickpocketing; self image problems (Holmes & Slap, 1998; Kristensen, 1996; Pinto Junior, 2005). Furthermore, disruptive disorders, post-traumatic stress cases, somatization, paranoia, bulimia, depression, suicide, substance abuse, antisocial personality and borderline personality were identified in children victims of sexual violence (Holmes & Slap, 1998).
According to the research made with professionals who attended male victims, among male sexual violence consequences, concern about sexual orientation was considered the main difference between cases of sexual violence perpetrated against girls and boysn(Pires Filho, 2007). The sexual violence make boys to feel more confuse about their sexuality (Pires Filho, 2007; Sanderson, 2005), and fear homosexuality (Pires Filho, 2007), once the sexual violence episode tends to happen, commonly in a homosexual relation. However this fact is not considered as a definitive homosexual behavior, neither for the victims not for the aggressors (Pfeiffer & Salvagni, 2005).
The conflict about sexuality might be aggravated by the family reaction, which might bring up doubts and/or make insinuations about the victmized boys' attitudes. Moreover, among the mothers' reactions there is the concern about their sons' sexual orientation (Pires Filho, 2007).
In a study made through interviews with 26 male sexual violence victims (average age 33.7 years old) in childhood, consequeces of these experiences were indentified: affective problems (rage, fear, abandonment, guilt, and shame); cognitive distortions (unable to consider their experience as a violence, negative schemes related to people and themselves, and self guiltiness); interpersonal dificulties (sense of betrayal, isolation, negative relationships in childhood) ; problems related to sexuality and sexual orientation (manhood and homosexual matters, and difficulties in intimate relationships). Problems related to homosexuality matters were more frequent in victims raped by other men. The confusion related to their manhood led participants to inhibit the psychological process resulting from the occurrence of sexual violence, in other words, expression of feelings such as sadness, fear, abandonment, onde these feelings are not consistent with what would be socially expected for a man at the time of the research (Lisak, 1994). Thus they ended up guiding their behavior to the stereotype of masculinity - to be strong, active, and in control of situations. The sexual violence perpetrated by someone from the same gender puts the victim in a situation of vulnerability and submission incompatible with typically masculine characteristics (Lisak, 1994; Tremblay & Turcotte, 2005). To sum up, the victimization of men contradicts the dominant concepts of masculinity (Weiss, 2010). Thus, boys and men might develop behaviors in order to assert or reassert their masculinity. Agressive behavior, destructiveness, disobedience, confrontation and hostility attitudes can be perceived (Pinto Junior, 2005). Moreover, male victims tend to present more externalizing symptoms than male victims, among them, substance abuse and agressive behavior Ullman & Filipas, 2005).
Aiming to investigate the impact of intrafamilial sexual violence against boys, seven psychologists that served in public institutions in Grande Recife, were interviewd at least four years ago (Pires Filho, 2007). The professionals' reports showed that aggression and sexuality exacerbation were the most common consequences in boys victims of intrafamilial sexual violence. The symptoms of disruptive disorders also seem to be more frequentl in boys than in girls victims. These include the disorder and attention deficit hyperactivity disorder (ADHD), oppositional-defiant and the conduct disorder.
The most common symptoms are cognitive function disorders, such as atention and concetration; stealling, runaways, substance abuse, lying, authority rule and limits breaking (Maniglio, 2009).
However, in a comparative study between male and female victims, there were not found long term differences of victimization (Dube et al., 2005). From a retrospective curtting research, 17.337 adults (54% women and 46% men) who had been through sexual violence in childhood were investigated. The participants aswered to a questionaire about family disorders and violence during childhood, besides questions related to health. A multivariate logistic regression analysis was used to investigate possible connections between sexual violence, health and social problems (drug use and abuse, mental illness and current problems with marriage and family), according to the victim's gender. Through the study it was concluded that the long-term impact on victims of sexual violence was similar for both genders. According to the authors, this result indicates that boys and girls are vulnerable to the consequences of victimization occurrence in childhood, and that they both need treatment (Dube et al., 2005).
The consequences of sexual violence are mediated by different factors, including the form of violence. A study compared male sexual violence victims according to the type: "no contact" (sexual requests and exhibitionism) and "with contact" (sexual intercourse, manual or oral genital contact, touch or sexual kiss) which were compared to a third group of individuals who did not experience sexual violence (control group) in a study that investigated the relation between psychological adjustment and sexual violence (Collings, 1995). A list of self-report about somatization symptoms, obsessive-compulsive symptoms, interpersonal difficulties, depression, anxiety, hostility, phobic anxiety; paranoid ideation, and psychosis was used for the investigation of psychological adjustment.
In the comparison between the control and "no contact" groups, there was significative difference only for interpersonal difficulties, while the comparison between control group and the group "with contact" indicated significant difference for somatization and obsessive-compulsive disorder, depression, anxiety and hostility, interpersonal difficulties, phobic anxiety, paranoid ideation, and psychosis (Collings, 1995). In another study, three distinct groups were formed with the aim of investigating adult men's perceptions about their initial sexual experiences: self-indentified as sexual violence survivors; without the experience of sexual violence; and finally, survirvors of sexual violence according to pre-established definitions (presence of coercion, age difference between victim and perpetrators greater than or equal to five years). The participants who had identified themselves as sexual violence survirvors revealed high and significant levels of stress twice as likely to have participated in psychotherapy than the group identified as survivors, according to pre-established criteria (Steever, Follete, & Naugle, 2001). These data may suggest that the victim's perception of of sexual violence is a mediating factor on its impact (Collings, 1995; Steever et al., 2001).
The repercussions of sexual violence can also reach the victim's family. Facing the revelation, feeelings such as panic, anger, depression, crying (Kristensen, 1996; Pires Filho, 2007), besides the doubt about the boys sexuality, dificulties in stablishing limits to the child, and fear that child might become a sexual violence offender can be experienced by family (Almeida et al., 2009)..
Given the complexity of sexual violence and the anxiety it generates, it becomes frequent that the victims' families give up on care (Araújo, 2002; Pires Filho, 2007).
Although the studies about the consequeces on male sexual violence indicate similarities, such as the presence of anxiety, legal problems, sel-image problems and doubts about sexual orientation (Holmes & Slap, 1998; Kristensen, 1996; Pinto Junior, 2005) methodological issues limit the results generalization. For example, some studies used the clinical experience of professionals working with sexual violence victims(Pires Filho, 2007; Tremblay & Turcotte, 2005), and did not have direct access to the victims, while other had direct contact (Almeida et al., 2009; Collings, 1995; Dube et al., 2005; Kristensen; 1996; Lisak, 1994; Steever et al., 2001; Ullman & Filipas, 2005; Weiss, 2010).
In studies with professionals, the result is limited to their view of what the pacients lived. Among those which turned to the victims, the age difference between participants is noticeable, ranging from childhood and adolescence (Almeida et al., 2009; Collings, 1995; Kristensen, 1996; Pinto Junior, 2005); adolescence and adulthood (Steever, et al., 2001; Weiss, 2010); and onlu adults (Dube et al., 2005; Lisak, 1994; Ullman & Filipas, 2005). Besides that, different techniques for data collection were used, such as systematic literature review (Holmes & Slap, 1998; Pfeiffer & Salvagni, 2005); documental analysis (Weiss, 2010); case study (Almeida et al., 2009); interviews and questinonaires (Dube, et al., 2005; Kristensen, 1996; Lisak, 1994; Pinto Junior, 2005; Ullman & Filipas, 2005); and tools to check symptomatology (Collings, 1995; Steever et al., 2001).
Even if science indicates common consequences to boys and men who suffered sexual violence, each case is unique and is influenced by several variables. The studies indicate tendencies and are limited to methodological matters. Thus, it is necessary to consider the individuality of each case.
Different psychopathological cases are related to the experience of sexual violence, however, asymptomatic cases can occur, in other words, people who apparently do not develop any negative consequences (Williams, 2002). Factors such as resilience, searhing for help and denunciation of the violence (Koller & De Antoni, 2004), occurence in a shorter period of time, offenders without a close tie to the victim and without the use of other kinds of violence and penetration and the support of a pretective figure would be involved in these cases (Williams, 2002).
This theoretical esay indicates the necessity of increasing national studies about male sexual violence. Only one specific article was found in Brazilian data basis (Almeida et al., 2009). Besides that, other publications (e.g. Dissertations and books) are also in a short number. Aspects such as shame and the difficulty boys and men have in reporting the occurence of sexual violence, as well as the difficulties related to the denunciation itself, may contribute to this scenery. Moreover, boys and men can not perceive sexual violence situations as violence or might consider it as sexual initiation behavior and consequently do not notify the occurence. As the cases in boys and men are less reported and thus, kept secret the access to this population for the conduction of research may be hampered.
Even if they are a shorter number, cases of male sexual violence still occur and require attention. When studying and disseminating data about male sexual victimization it is possible to start a movement of cultural change about the underreporting of cases in Brazil. Future studies can contribute for demystification of male sexual violence which is evidenced by the lack of national studies about the subjetc. Research about the dynamics of sexual violence situatuion, victims and offenders characteristics, besides its possible long and short-term consequeces will provide information and data which can be used in preventive and therapy strategies. International studies, for example, indicate the presence of doubts regarding the sexual orientation (Lisak, 1994; Tremblay & Turcotte, 2005; Weiss, 2010) and the tendency to externalizing behaviors (Maniglio, 2009; Ullman & Filipas, 2005) as consequences of male sexual violence. The study of Brazilian men and boys can evidence peculiarities due to environmental and cultural factors, besides adding new knowledge to existing ones.
Because it is a complex situation, all those who have contact with boys and men, in other words, parents, teachers and professionals should be able to identify signs and symptoms resulting from sexual violence tome make the necessary referrals.
The increase in publications on the subject, as well as continous education of professionals and media coverage can be beneficial for the recognition of sexual violence situations.
Professional performance should be based on training, study and cooperation with other professionals in a multidisciplinary team. It is essential for victims' treatment to be based on a contextualized and comprehensive approachof each case. Specific intervention models for boys and men need to be planned and subsidized in evidence-based practices, so that its efficiency can be proved, as it occurs in other countries (Romano & De Luca, 2005, 2006).
Finally, this article sought to contribute to the production of knowledge about male sexual violence in Brazil, besids promoting the discussion of the subject. Having in mind its complexity, other studies are necessary in order to address issues not covered in this theoretical essay, such as relational and social aspects of male sexual violence, among them, school dropouts and the possibility of victims becoming perpetrators.
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Received: 21/03/2011 1 Article based on the dissertation named "Adaptação e avaliação de uma intervenção cognitivo-comportamental para meninos vítimas de violência sexual", written by the first author and guided by the third author. Jean Von Hohendorff, master and doctoral student in Psychology, Federal University of Rio Grande do Sul (UFRGS). Address: Rua Ramiro Barcelos, 2600, Sala 104, Porto Alegre, RS, Brasil 90035-003, phone: 5551. 33085150. E-mail: firstname.lastname@example.org Luísa Fernanda Habigzang, Post-Doctoral student (CAPES scholarship) in Psychology, Federal University of Rio Grande do Sul. Address: Rua Ramiro Barcelos, 2600, Sala 104, Porto Alegre, RS, Brasil 90035-003, phone: 5551. 33085150. E-mail: email@example.com Silvia Helena Koller, Professor, Federal University of Rio Grande do Sul. Address: Rua Ramiro Barcelos, 2600, Sala 104, Porto Alegre, RS, Brasil 90035-003, phone: 5551. 33085150. E-mail: firstname.lastname@example.org
1 Article based on the dissertation named "Adaptação e avaliação de uma intervenção cognitivo-comportamental para meninos vítimas de violência sexual", written by the first author and guided by the third author.
Jean Von Hohendorff, master and doctoral student in Psychology, Federal University of Rio Grande do Sul (UFRGS). Address: Rua Ramiro Barcelos, 2600, Sala 104, Porto Alegre, RS, Brasil 90035-003, phone: 5551. 33085150. E-mail: email@example.com
Luísa Fernanda Habigzang, Post-Doctoral student (CAPES scholarship) in Psychology, Federal University of Rio Grande do Sul. Address: Rua Ramiro Barcelos, 2600, Sala 104, Porto Alegre, RS, Brasil 90035-003, phone: 5551. 33085150. E-mail: firstname.lastname@example.org
Silvia Helena Koller, Professor, Federal University of Rio Grande do Sul. Address: Rua Ramiro Barcelos, 2600, Sala 104, Porto Alegre, RS, Brasil 90035-003, phone: 5551. 33085150. E-mail: email@example.com