The Consequences of Male
Directed Sexual Violence
(MDSV)
‘Increasing understanding of MDSV for a
better response’
Dr David...
2
 Without a doubt MDSV and GBV in
general are particularly destructive because
their effects are non-fatal, protracted b...
3
The ‘likely’ & the ‘other’ survivor?
 Typically happens behind closed doors
 The ‘other’ group where these acts occur
...
4
Physical & Biological effects
 Injuries
 50% - Bruises, lacerations and tears of the anal
& genital area, broken bones...
5
 Chronic Pain Syndromes
 Back, headache, abdomen & rectal conditions
 Chronic fatigue & Malnutrition
 Gastrointestin...
6
Emotional & Psychological Effects
 The effects on one’s psyche tend to be
more serious and enduring
 Research has sugg...
7
 Acute stress disorder (DSM-IV)
 Severe in first 3/52 declining over 3/12
 Shock, apathy, disbelief .. .
 Reduced af...
8
 Depression
 up to 30% affected
 Men 4x more likely
 Substance Abuse - Alcohol, Cannabis & Nicotine
 When compared ...
9
 Low self esteem
 Social withdrawal
 Anxiety disorders
 GAD, Hyper vigilance
 Panic attacks, phobias of situations/...
10
 Confusion about their sexual
orientation
 Questions about whether or not they have
become homosexual
 Homophobia – ...
11
 Loss of power/inadequacy as a man
(Emasculation) – many disappointed they
could not defend their families or themselv...
12
 Guilt, shame and self blame
 Walk around in diapers/cloth!
 Feel like they have lost their ‘manhood’
 Many struggl...
13
 General mistrust of others affecting
intimacy & relationships
 Affects family & community – domestic
violence
 Chao...
14
 Compulsive behaviors
 Overspending
 Gambling
 Sexual obsessions or compulsions etc.
15
Socio-economic Effects
 Marital and family breakdown
 Secondary trauma to service providers,
family and community
 J...
16
What have we seen in practice?
 n=232
 73 (31.5%) male
 54% males report 1-2 years after the event
 Commonest condi...
17
 Barriers to accessing care:
 Society – Gender ‘expectations’ of men
Misinterpretation as gay
 Personal – Fear of re...
18
Some key areas needing further research
 Prevalence of MDSV? Combat/non-
combat
 Community perceptions of male surviv...
19
 Factors affecting access and utilization of
SV services by male survivors?
 Best practice models of care?
 Screenin...
Thank You
Group Questions
 How well do we understand MDSV in all its
contexts? Where are those gaps and what do
we need to do to br...
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Consequences of Male-Directed Sexual Violence Part 1

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At a UN-sponsored seminar on sexual violence in conflict against men and boys Dr. David Ndawula of Uganda spoke of the consequences of this male-irected sexual violence. Dr. Ndawula is a medical doctor with extensive knowledge of the physical, psychological and socio-economic impacts and interventions related to survivors of sexual violence.

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  • Male sexual abuse is any non concensual act of sexual coercion and/or domination which threatens the physical and or psychological wellbeing of a boy or male adolescent or adult. They typically involve a misuse of power and may or may not involve physical force.
  • – ‘ you try to hide what everyone knows or has seen’ One client is knowledgeable the other is not Can happen in families, in institutions, in trust relationships, on dates, clubs etc
  • These can both be fatal or non fatal Fatal Homicide Suicide Disease and injury related mortality Non fatal Physical & Biological morbidities Disability Psychological Social Economic HIV and related infections NFD – 232 PATIENTS (31% MALE) Half show up within 2 years of assault Back pain is very common and can signal rectal problems Fissures in ano at NFD at a rate of 6.5%
  • HIV at NFD at 1.3%
  • Whether or not there was violence How long the abuse went on Disclosure and the response of the person told Prior history of trauma Who committed the act Socio-biological characteristics of survivors The cultural background Positive family and social support Society’s response to the problem – actual and perceived The victims appraisal of the violence Many of the clients I deal with call it a curse Study results Results Both male and female victims of abuse had significantly higher rates of psychiatric treatment during the study period than general population controls (12.4% v. 3.6%).Rateswere higher for childhoodmentaldisorders, personality disorders, anxiety disorders and major affective disorders, but not for schizophrenia. Male victims were significantly more likely to have hadtreatmentthan females (22.8% v.10.2%). Conclusions This prospective study demonstrates an association between child sexual abusevalidatedatthetime and a subsequentincreaseinratesofchildhood and adultmentaldisorders. Downplay the impact of what they went through as a coping mechanism
  • Ntinda has PTSD rate of about 18.5% PTSD includes a range of psychological distress: fear, emotional numbness, flashbacks, nightmares, obsessive thoughts and anger. Post traumatic stress reactions can occur months or years after an incident. Sexual assault victims also suffer psychological reactions specifically related to sexual assault. Victims may feel terrified of the offender and fear for their lives. Victims may also feel humiliation, shame, and self-blame. If the assault is perpetrated by an acquaintance, friend, or lover, violation of trust can be an issue for the victim. Because of their shame and fear about how people will react, many victims keep the rape a secret. "With regard to PTSD, RTS, and RR-PTSD, I think they are essentially the same phenomenon but with some key differences. I think such labels are good for both laypeople and professionals to help them understand that there may be differences in the experiences of those who suffer from the traumatic experiences of rape as opposed to combat related trauma. I think distinctions are also important in that they may help in establishing support groups ....those who have suffered from similar traumatic experiences may be more comfortable with others that have had the same experiences. The labels may help rape trauma victims seek out groups that are most appropriate for them so that they won't find themselves in a room full of vets with whom they cannot relate when they are in dire need of emotional support.
  • The inability to become sexually aroused or achieve sexual satisfaction in the appropriate situations because of mental or emotional (also known as psychological) reasons. No physical problems, specific illnesses, or medication side effects appear to cause the problem. Although psychosexual dysfunction is not life threatening, it can have a major effect on your relationships and self-esteem. This condition is treatable; contact your doctor if you think you may have psychosexual dysfunction. Psychosexual dysfunction is a sexual dysfunction that is due to psychological causes rather than physical problems, medical illnesses, or the side effects of medication. Some of the psychological conditions include: Depression Anxiety (feelings of nervousness, fear, or worry) Traumatic sexual experience (abuse, rape) Guilty feelings Stress or anxiety Uncertainty about your sexual orientation Worry or fear about how you are able to perform sexually Negative body image
  • Poorly defined sense of self – self preservation with little internal locus of control. Codependent behaviors with an aim to avoid feelings of confusion and vulnerability
  • Borderline personality disorder - a mental illness characterized by impulsive behaviors including intense anger, suicidal tendencies, self-mutilation, promiscuity and difficulties with relationships, report some sort of childhood trauma: [1] Sexual abuse is an important, independent risk factor for the development of borderline personality disorder in male victims.[1] [1] Holmes, W. C., M.D., MSCE, and G.B. Slap, M.S., M.S. Sexual Abuse of Boys. 280(1) Journal of the American Medical Association (1998): 1855-1862, citing numerous studies. [1] Herman, 1989.
  • May confuse their emotional needs with a need for sex
  • Outright rejection & isolation Marital strife, spouse abandonment Absenteeism from work leading to loss of jobs Disrupted male gender roles (typically man is breadwinner/protector) in the family and community causing breakdown in social structures Social stigma, ostracism ‘ Secondary victimization’ results in further emotional damage Communities consider them an abomination or even a curse Fear of venturing out into public places and other phobias
  • These are clients referred to us having undergone some form of sexual violence We are not seeing the impacts on society and the male gender
  • Culture typically propagates the myths of: Males cannot be sexually abused or traumatized Sexual abuse makes a man gay Sexually abused men inevitably become abusers themselves Males are less traumatized by SV than women
  • Consequences of Male-Directed Sexual Violence Part 1

    1. 1. The Consequences of Male Directed Sexual Violence (MDSV) ‘Increasing understanding of MDSV for a better response’ Dr David Ndawula, MD Kampala, Uganda
    2. 2. 2  Without a doubt MDSV and GBV in general are particularly destructive because their effects are non-fatal, protracted but resulting in lifelong morbidity  It remains the unspoken issue when dealing with addiction, suicide, domestic violence, anger issues and male criminality  Understanding the consequences will go a long way to develop strategies to help both individuals and entire communities
    3. 3. 3 The ‘likely’ & the ‘other’ survivor?  Typically happens behind closed doors  The ‘other’ group where these acts occur in the open in full view of others’  The contexts in which it happens? Priority?  The survivor with multiple traumas ?  The survivor who is also a perpetrator?  Primarily & secondarily traumatised survivors? Good & bad coping mechanisms?  The secondarily traumatised masses?
    4. 4. 4 Physical & Biological effects  Injuries  50% - Bruises, lacerations and tears of the anal & genital area, broken bones, teeth etc.  Injury to penis and reproductive capacity  Infections  Gonorrhea, Chlamydia hepatitis, syphilis, HIV  Anal, oral, genital and elsewhere  Sleep Disorders
    5. 5. 5  Chronic Pain Syndromes  Back, headache, abdomen & rectal conditions  Chronic fatigue & Malnutrition  Gastrointestinal conditions:  Initial nausea/vomiting (initial)  Long term bleeding, fissures, prolapse  Incontinence
    6. 6. 6 Emotional & Psychological Effects  The effects on one’s psyche tend to be more serious and enduring  Research has suggested that the effects can be modified with people having varying degrees and combinations of effects  A prospective study on survivors of SV show that they are 4x more likely to require psychiatric treatment with M:F being 2:1
    7. 7. 7  Acute stress disorder (DSM-IV)  Severe in first 3/52 declining over 3/12  Shock, apathy, disbelief .. .  Reduced affect, helplessness, Intense fear  Post traumatic Stress disorder  Found in up to 30% survivors and seen up to 16 years after the event!  Found in Depression, Presence of physical reminders, those who ruminate, memories
    8. 8. 8  Depression  up to 30% affected  Men 4x more likely  Substance Abuse - Alcohol, Cannabis & Nicotine  When compared to non-victims, rape survivors were 3.4 times more likely to use marijuana, 6 times more likely to use cocaine, and 10 times more likely to use other major drugs.
    9. 9. 9  Low self esteem  Social withdrawal  Anxiety disorders  GAD, Hyper vigilance  Panic attacks, phobias of situations/people  Fear of real and perceived dangers  Psychosexual dysfunctions  Prevalent. Almost pathognomonic of MDSV
    10. 10. 10  Confusion about their sexual orientation  Questions about whether or not they have become homosexual  Homophobia – fear/intolerance of homosexuality  Gender confusion  Going out to prove their masculinity
    11. 11. 11  Loss of power/inadequacy as a man (Emasculation) – many disappointed they could not defend their families or themselves  Gender shame  Confusion of one’s sexual identity – one wonders if he has now become a woman (feminization)  Denial of vulnerability
    12. 12. 12  Guilt, shame and self blame  Walk around in diapers/cloth!  Feel like they have lost their ‘manhood’  Many struggle with the fact they were aroused  Suicidal ideation/Suicide  Up to 15x higher in surviving men
    13. 13. 13  General mistrust of others affecting intimacy & relationships  Affects family & community – domestic violence  Chaotic relationships  Borderline personality disorder  May engage in risk-taking  Puts them at further risk
    14. 14. 14  Compulsive behaviors  Overspending  Gambling  Sexual obsessions or compulsions etc.
    15. 15. 15 Socio-economic Effects  Marital and family breakdown  Secondary trauma to service providers, family and community  Job loss & Poverty  Delinquency  Dependence on others or even resorting to ‘survival’ (transactional) sex that puts them at further risk
    16. 16. 16 What have we seen in practice?  n=232  73 (31.5%) male  54% males report 1-2 years after the event  Commonest conditions:  Gastrointestinal complaints 31.5%  Psychological/Emotional 26.0%  Infections 25.0%  HIV <1%
    17. 17. 17  Barriers to accessing care:  Society – Gender ‘expectations’ of men Misinterpretation as gay  Personal – Fear of repercussions/not safe Fear of society reaction Shame  Structural – No available services Initial provider reaction Expertise of provider
    18. 18. 18 Some key areas needing further research  Prevalence of MDSV? Combat/non- combat  Community perceptions of male survivors of MDSV? Culture and MDSV?  Ripple effect on communities?  What are the needs of survivors of MDSV? How different are these from female survivors of SV?
    19. 19. 19  Factors affecting access and utilization of SV services by male survivors?  Best practice models of care?  Screening & Management of survivors  Different needs of ex-combatant/civilian MDSV  Impact of MDSV on gender identities in affected communities?
    20. 20. Thank You
    21. 21. Group Questions  How well do we understand MDSV in all its contexts? Where are those gaps and what do we need to do to bridge them?  While help exists in ‘stable’ settings, how can we prioritize care in ‘unstable’ settings?  Are there examples of models of care giving sustainable, effective & holistic care?  How can we best approach those barriers to care coming from the caregivers themselves? 21

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