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.
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
Holmes WC, Slap GB. Sexual Abuse of BoysDefinition, Prevalence, Correlates, Sequelae, and Management. JAMA. 1998;280(21):1855–1862. doi:10.1001/jama.280.21.1855