Introduction

Male-on-male rape and sexual assault is still a class of assaults seen less by many forensic physicians and other sexual assault aftercare providers, compared with assaults of women. The issue of under-reporting that afflicts all sexual assaults is especially strong in the situation of male victims owing to additional social and cultural factors. The purpose of this review is to help service providers recognise areas in which the experiences of male and female victims more commonly diverge. Naturally, a strong caveat is applied here that generalising the experiences of sexual assault is a limited enterprise and that the story of each individual should be attended to. Discussions of male-on-male compared with male-on-female sexual assault is not intended to say that the male victim is like ‘this’, or the rape of a female happens like ‘that’. Rather, it is that the range of female victim stories are more familiar to most sexual assault aftercare providers and so provides the context in which the more common features in the range of male experiences can be understood. Indicating areas of divergence, but also of similarity, will hopefully emphasise the individual nature of each incident of sexual assault. Although growing, the research specifically on this subject (e.g. excluding sexual abuse of young boys, or rape and sexual assault in general) is still a relatively small body of work. For example, in March 2012, a PubMed search of the term ‘rape’ in the title or abstract produced 4767 articles, whereas specifically ‘male rape’ produced 23. In this chapter, I make reference to key publications on the subject arranged in headings of most interest, hopefully, to its intended audience: forensic physicians.

Legal definition of rape in England and Wales

Before considering the prevalence of this issue, we should define exactly what the issue is, and that is the phenomenology of rape or sexual assault committed by a male (or males) upon another male. Why this particular phrase is used is discussed in section two below, with reference to social perspectives of, and attitudes to, male-on-male sexual assault. For the purposes of this review, the word ‘rape’ in this phrase is defined according to the current legal definition in England and Wales, although articles under review may have held different interpretations, or collected data under a different definition:

A person (A) commits an offence [of rape] if (a) he intentionally penetrates the vagina, anus or mouth of another person (B) with his penis; (b) B does not consent to the penetration; and (c) A does not reasonably believe that B consents.’ (s.1.1, Sexual Offences Act, 2003).

This definition and the Act itself were important developments in the legal recognition of rape as a gender-neutral offence in England and Wales. It maintains, however, that rape is only committed by penetration with a penis, not an object or fingers, and therefore can only be committed by males. All other penetration is a separate offence, whereas some other investigators and, of course, other jurisdictions, have broader definitions. The Sexual Offences Act 1956 was amended in 1994 to include rape of a male until the 2003 Act overhauled sexual offences law. Before 1994, rape of a male did not exist in English law in those terms, rather there was the crime of buggery (unconsenting penile-anal penetration), which carried a lesser penalty. The relatively recent recognition of rape of a male being possible and illegal is reflected in how this issue is denied or misunderstood within society.

Legal definition of rape in England and Wales

Before considering the prevalence of this issue, we should define exactly what the issue is, and that is the phenomenology of rape or sexual assault committed by a male (or males) upon another male. Why this particular phrase is used is discussed in section two below, with reference to social perspectives of, and attitudes to, male-on-male sexual assault. For the purposes of this review, the word ‘rape’ in this phrase is defined according to the current legal definition in England and Wales, although articles under review may have held different interpretations, or collected data under a different definition:

A person (A) commits an offence [of rape] if (a) he intentionally penetrates the vagina, anus or mouth of another person (B) with his penis; (b) B does not consent to the penetration; and (c) A does not reasonably believe that B consents.’ (s.1.1, Sexual Offences Act, 2003).

This definition and the Act itself were important developments in the legal recognition of rape as a gender-neutral offence in England and Wales. It maintains, however, that rape is only committed by penetration with a penis, not an object or fingers, and therefore can only be committed by males. All other penetration is a separate offence, whereas some other investigators and, of course, other jurisdictions, have broader definitions. The Sexual Offences Act 1956 was amended in 1994 to include rape of a male until the 2003 Act overhauled sexual offences law. Before 1994, rape of a male did not exist in English law in those terms, rather there was the crime of buggery (unconsenting penile-anal penetration), which carried a lesser penalty. The relatively recent recognition of rape of a male being possible and illegal is reflected in how this issue is denied or misunderstood within society.

Prevalence

The prevalence of male-on-male rape or sexual assault is estimated at around 5–10% of all sexual assaults per year in Western countries, such as the UK, USA and the Nordic countries. Home Office crime data for England and Wales show that, in financial year 2010–2011, a total of 9901 rapes of victims aged 16 years and above were recorded, of which 9509 victims (96%) were female and 392 (4%) were male. This indicates the relative rarity of the issue and how it might be that forensic physicians, counsellors or other service providers do not see many male clients. Although this represents a smaller group compared with female victims, it is one that is, and has been, growing, as represented by the ratio of male–female clients at the St Mary’s Sexual Assault Referral Centre in Manchester, UK. In the first 5 years of its existence (1986–1991), the Centre saw fewer than 20 men who had experienced an acute sexual assault (i.e. not historic or ongoing child sexual abuse), but by 2002 it saw over 40 each year. That growth in referrals was matched in type of referrals; less than 30% of men from those first 5 years were referred by the police (i.e. victim had reported the assault to the police first) whereas, in 2002, it was over 70%. Such an increase in disclosure by men, and to the police, not just direct to support services, is a local effect from the presence of an excellent aftercare service and a trend evident across the UK. Similar comparative reticence among men who report at all, and especially to the police, was recorded across Norway, Denmark, Iceland, and Finland. Such figures are the result of the incidence and types of the assaults themselves, and also the different reactions of men to disclosing what has happened to them. This is discussed below.

Terminology and perceptions

The use of the term ‘male on male rape and sexual assault’ is cumbersome compared with ‘male rape’, but specific. ‘Male rape’ could be construed as rape committed by a male, and of course excludes other forms of sexual assault. The term is explicit, similar to ‘drug-facilitated rape and sexual assault’ compared with the more sensational but also more vague or misleading ‘drug rape’ or ‘date rape’. In a wider social context, the gendering of the word ‘rape’ by the addition ‘male’ emphasises the sense that this rarely happens to men. For example, the terms ‘male nurse’ and ‘male model’ both indicate that these are professionals traditionally associated with females. Expanding the phrase ‘male rape’ into a brief descriptive sentence, thus presents the issue in detail, rather than lazily labelling it as a subcategory of ‘normal’ rape.

The term is also explicitly not about sexuality, in the way the term ‘homosexual rape’ was. The acts may be described as homosexual, but the implication that either the perpetrator, victim, or both, were also homosexual themselves was, at best, misleading. Male-on-male rape, recorded as a form of homophobic punishment, is well documented in prisons and as a form of torture visited upon prisoners of war (i.e. former Yugoslavia in the early 1990s). With the latter, the exclusive male environment in which rapes occur enables them to be rationalised as being heterosexual masculine behaviour. Consequently, after care service providers should be interested in the effects rape or other sexual assault may have upon victim sexuality rather than seeing it as being a defining aspect of the assault.

As can be seen above, even the terms we use to describe a subject are loaded with subjectivity and hidden meanings. In addition, these hidden meanings come from the perceptions and stereotypes prevalent in society about gender roles in general, and rape in particular. Readers may be familiar with the concept of the ‘rape myth’ (the stereotypical rape scenario of an unknown male, probably armed, possibly masked, raping a woman in a dark back street or park), and how victims whose stories vary from that scenario are less likely to be believed as that is the collective perception of what rape is. Our concept of rape and sexual assault informs our perception of rape victims, both in who they are and how deserving of our sympathy they are. Even the concept of rape as primarily a sexual act is refuted by many researchers, who take the perspective that rape is a violent act expressed sexually, rather than a sexual act expressed violently.

Kassing et al. discussed rape myths specific to male-on-male rape and sexual assault, and found that widely held beliefs are held in society that male rape is rare, partly because men should be able to resist, but, when it does happen, it is usually in prisons and men should be strong enough to cope with it. The presence of such perceptions of rape, rapists and rape victims in society are, of course, important to understand, as they influence the way in which society and the individuals that compose it then respond to victims. Sleath and Bull established that the stronger an individual believes in myths or stereotypes of male rape then the more they will attribute blame to a male victim of such crimes while simultaneously reducing the blame attributed to the rapist. Perceptions of masculinity are, therefore, more influential when considering male-on-male rape than are perceptions of femininity about male-on-female rape. In their review of studies on perceptions of male-on-male rape, Davies and Rogers summarised the key perceptions pertaining to male victims as below (with additional supporting citations): males blame victims more than females; male victims are blamed more than females ; homosexual victims are blamed more than heterosexual victims ; acquiescent victims are blamed more than resistant victims; and assaults on male (especially homosexual) victims are considered (especially by heterosexual males) less severe than on females.

With reference to the last point, a study of attitudes to rape by Doherty and Anderson found that participants created a ‘hierarchy of suffering’ in which heterosexual men suffered most from rape as it departed more from their typical sexual practices than it did for homosexual males or (heterosexual) women. Part of the additional suffering heterosexual male victims of rape would experience includes a perception in society that their masculinity was diminished. The investigators argue that this hegemonic, phallocentric focus belittles the rape of women and gay men, in turn reducing the opprobrium caused by their rapists.

Service provision

When considering male victims, a feature particular to them, compared with female victims, is the paucity of male-focused services and the lack of rape services prepared to deal with male rather than female victims. It is still a hard ongoing fight to produce sexual assault aftercare services that are sensitive to the needs of the victim while collecting high-quality forensic evidence for police investigation and hopefully prosecution. The UK sexual assault referral centre model represents this fight, but over 25 years since the first one opened in Manchester, UK, much of the country’s population still does not have access to such a service, and victims will be typically examined by a male doctor in a police station. That most victims are female, and that a great driver in changing service provision has come from the feminist movement, such as Rape Crisis, the focus in creating an appropriate service response has been on a response appropriate to women.

Donnelly and Kenyon’s aptly titled paper ‘Honey, we don’t do men: gender stereotypes and the provision of services to sexually assaulted males’ discusses this situation in detail. They conclude that a widespread belief exists that male-on-male rape is so rare as to not be a problem; the few victims there are would be homosexual men in a domestic abuse situation; and a denial based on a fear that the existence of male victims could threaten the resources available for female victims. Such views were also held within the feminist-based services reviewed, yet the reality of male victims of male rapists is a further example of how rape is more about control then sexual gratification, and a way to reinforce conformity to the hegemony of heterosexual patriarchy. Indeed, it is the action of patriarchy that contributes to the repression of reporting by male victims and contributes to homophobic blame attribution by heterosexual males.

Demographic features of victims

Most studies report the mean age of male victim within a range of 20–30 years; for example, 20, 21.6, 26, 27, and 28 years. Although the mean age varies between studies, within studies that report on male and female victim ages, the ages tend to be similar for both sexes; for example, both 25 years ; male 25.5 years and female 25 years. Although some do vary more, such as male 20.4 years, female 24.7 years. Grossin et al. reported on 418 cases of sexual assault recorded in Paris, covering many circumstantial aspects of the victims and assaults. Of these, a relatively high proportion (14%) were male, but only a few circumstances were reported in both male and female terms. No differences were found between male and female victims in age distribution, with both groups close to the overall mean of 15.9 years (which is, as observed above, much younger than usually recorded).

One of the other aspects mentioned in this paper that is not often covered elsewhere is that of disability. Although the investigators do not specify what kind or level of disability, nor if it was physical or mental, they recorded disability in 3.4% of the male group examined within 72 h from assault. No figure for the equivalent female group is given, although the same figure of 3.4% is reported for the proportion of disabled victims from the total sample. Those examined over 72 h were more often child sexual abuse cases, and so that proportion could be expected to reflect one-off assault situations. Some studies report on the sexuality of victims, but these figures seem to be especially subject to selection bias based on the nature of the service from which the data are gathered. For example, 3.1% of male victims describing themselves as either homosexual or bisexual among people at a general practice surgery compared with 22% at a sexual health clinic.

Data from the St Mary’s Centre in Manchester, UK, revealed that the most common location at which an assault occurred was a public place, about 30% for both sexes. The second and third most common locations for males were assailant’s residence and then their own residence, whereas for females they were transposed. These were statistically significant differences, perhaps suggesting a higher level of domestic abuse of female victims.