Characteristics of Sexual Assault Among Men Receiving a Forensic Medical Examination

Abstract

Sexual assault is a form of violence disproportionately perpetrated against women by men; however, men also experience high rates of sexual victimization. While recent research exploring victimization of sexual assault among men does exist, little is known about situational characteristics and consequences surrounding men’s assault experiences. Therefore, the current study examines narratives of men’s sexual assault to further understand the unique experiences of men receiving a sexual assault medical forensic examination. To accomplish this, we conducted a retrospective medical chart review of sexual assault narratives from N = 45 men receiving a sexual assault medical forensic examination at a large academic medical institution in the southeastern United States. Three general constructs were identified within the records: a) Perpetrator use of coercive tactics, b) Memory loss, and c) Contextual factors. Nested within these constructs, five specific themes emerged, including: a1) Use of weapons and physical force; a2) Tactical administration of alcohol and drugs; b1) Difficulties remembering assault; c1) Consensual sexual activity turned non-consensual; c2) Incarceration. Findings from the present study common identified characteristics of sexual assaults among men receiving a sexual assault medical forensic examination, including coercive tactics used by perpetrators, consequences of sexual assault, and high-risk settings for male victimization.

Sexual assault is a well-documented public health crisis that has received widespread attention from researchers, mental health clinicians, medical practitioners, and law enforcement. Although sexual assault is disproportionately perpetrated by men against women (Budd et al., 2019), there is increasing awareness of men’s experiences of sexual assault (Matthews et al., 2018; Walfield, 2021). Across genders, few survivors of sexual assault seek help and medical attention post-assault (Gilmore et al., 2019; Price et al., 2014; Ullman, 2007). Given the numerous personal and institutional barriers to receiving post-assault care (Brobam et al., 2020; Chynoweth et al., 2020), coupled with the unique stigma associated with receiving sexual assault services post-assault for men (Bullock & Beckson, 2011), post-sexual-assault service utilization may be particularly low among male survivors. Furthermore, there is a dearth of literature on the contextual and situational factors and characteristics of sexual assault experienced by men. Thus, the current study seeks to comprehensively examine characteristics of sexual assault among a group of men receiving a forensic medical examination.

Prevalence of Men’s Sexual Assault

Although numerous large-scale epidemiological studies have consistently documented that men experience lower sexual assault victimization rates compared to women, many men still experience sexual assault victimization. National epidemiological studies indicate that nearly 6% of men report lifetime victimization, 4% of men experience adult victimization, and 1–4% of men report past-year victimization (Basile et al., 2007; Elliott et al., 2004; Krebs et al., 2007; Smith et al., 2018). Results from a systematic review indicate that 1–14% of men experienced forced intercourse, 13–27% experienced coerced intercourse, and 1–19% experienced intercourse obtained through intoxication (Peterson et al., 2011). Between 1.9% to 17.0% of men who have experienced sexual assault report being assaulted by a woman (Budd et al., 2019; Zilkens et al., 2018).

Among men, the prevalence of sexual assault is higher among certain subgroups. Sexual minority men (e.g., men who identify as gay, bisexual, pansexual, or queer) are at higher risk for sexual assault victimization than heterosexual men (Peterson et al., 2011). A systematic review found that between 11.8–54.0% of gay and bisexual men report lifetime sexual victimization, with 10.8%−44.7% of this population reporting experiences of adult sexual assault (Rothman et al., 2011). College men in fraternities also experience high rates of sexual assault; 25.5% of these men report having experienced attempted rape (i.e., forced penetration), and 13.7% experienced completed rape (Luetke et al., 2021). Incarceration can also place men at risk for sexual assault (Morash et al., 2012, Rowell-Consolo et al., 2014). One study found 13.8% to 26% of all inmates report experiencing sexual assault (Jones & Pratt, 2008), and another study found that 21% of men in prison report at least one incident of sexual assault during their most recent incarceration (Struckman-Johnson & Struckman-Johnson, 2000). Despite an increased understanding of elevated sexual assault risk among certain subpopulations of men, little is known regarding characteristics of their assaults.

Characteristics of Men’s Sexual Assault

While experiences of men’s sexual victimization is being increasingly acknowledged by researchers, little research has focused on the situational and contextual characteristics of men’s sexual assault experiences. The studies on this topic have mostly examined the frequency, severity, and physical and mental health outcomes among men experiencing sexual assault (Turchik, 2012). Additionally, several researchers have also focused on examining how survivor characteristics (i.e., history of childhood sexual abuse; homelessness; disability status) differ among men and women experiencing sexual assault (Codina & Pereda, 2022; Covers et al., 2022; Tyler et al., 2004). Differences in assault characteristics have also been examined between men and women as they relate to accessing post-assault care. When compared to women, men may be more likely to sustain physical injuries during sexual assault (Zinzow et. al., 2008), which may be facilitator of accessing post-assault care for both men and women (DeLoveh & Cattaneo, 2017; Masho & Alvanzo, 2010). Despite this, further research is needed to understand characteristics of men’s sexual assault experiences, which may also provide context to understanding their help-seeking decisions.

Factors Impacting Men’s Help-Seeking After Sexual Assault

Men experience numerous barriers to disclosing sexual assault, and only a small minority of all men experiencing sexual victimization report seeking informal or formal support after experiencing sexual assault (Donne et al., 2018; Freeland et al., 2016; Masho & Alvanzo, 2010). Gendered norms and expectations about sexual assault victimizations can create barriers for men who experience violence. Specifically, heterosexist societal norms and hypermasculine expectations of men likely inhibit help-seeking post-assault (Donne et al., 2018). Rape myths (i.e., inaccurate stereotypes or ideas about how/why sexual assault occurs) are institutionalized in media, policy, and service systems and could pose important barriers (Burt, 1980; Dworkin & Weaver, 2021). Some rape myths may create barriers for men in particular, including beliefs that men cannot be raped, only gay men are perpetrators or victims of rape, and “real” men are able to defend themselves against rape (Turchik & Edwards, 2012), or that men only experience sexual assault if they are incarcerated (Schulze et al., 2019). These myths can affect men’s willingness to seek help, decrease their willingness to report their victimization to authorities, and contribute to substantial shame among men who are survivors (Weiss, 2010). Although a significant minority of men’s assaults are perpetrated by women, cisgender heterosexual men are less likely to label their experiences as sexual assault when perpetrated by a woman (Weiss, 2010; Zilkens et al., 2018). Some rape myths pertain specifically to sexual minority identities (Braun et al., 2009). Rape myths about sexual minority men’s sexual promiscuity and inability to refuse consent to sexual acts are common and can serve as a barrier to help-seeking (Schulze et al., 2019). Heterosexual men who are assaulted by other men may be concerned that others will think that they are gay if they come forward (Allen et al., 2015; NCAVP, 2010).

Present Study

Despite data consistently indicating that many men experience sexual assault, male survivors are less likely to use post-sexual-assault resources, likely due to rape myths and other gendered social norms. Indeed, findings from international research suggests that men account for less than 2% of survivors seen in forensic medical settings (Larsen & Hilden, 2016). It is possible that specific characteristics of sexual assaults affect men’s likelihood of accessing post-sexual-assault resources, but little is known about assault characteristics among men who successfully access such resources. As the first step to address this critical gap, the overarching goal of the current study was to identify specific characteristics of sexual assault among men receiving a sexual assault forensic medical examination (SAMFE). A SAMFE is a physical examination wherein a trained medical professional—typically a sexual assault nurse examiner (SANE)—obtains a narrative of the survivor’s sexual assault and then collects physical evidence (i.e., saliva, bodily fluids) based on that report (OVW, 2013). If indicated, the medical professional may also provide post-exposure prophylactic treatments for STI, emergency contraception, and/or treatment of assault-related injuries during the SAMFE¹. Using men’s descriptions of sexual assault from the narratives in their SAMFE medical records, the present study explored key contextual and situational characteristics of sexual assault among men presenting for a SAMFE.

Method

Participants

This study used a retrospective cohort design and examined medical records from men (N = 45) receiving a SAMFE between July 1, 2014, to May 15, 2019. Participants in this study received a SAMFE within 120 hours of assault at an academic medical center in the southeastern region of the United States.

Participants in this sample included adult men with ages ranging from 18 to 58 (M = 29.55, SD = 10.98). Most (66.7%) of participants were White (n = 30), 24.4% were Black or African American (n = 11), 2.2% were Asian (n = 1), 6.7% (n = 3) did not have race recorded in their medical records, and 4.4% (n = 2) were Hispanic.

Procedure

An Institutional Review Board approved all study procedures, and all participants consented to the use of their medical records for research. We obtained demographic information directly from survivors’ electronic medical records and paired these data with the SANE notes. After pairing, we replaced individual medical record numbers with randomly generated individual identification numbers and deidentified all notes before conducting analyses.

Constructs & Data

Demographics.

SANEs assessed participant demographic information (i.e., sex, age, race, ethnicity), which the research team obtained from each participant’s electronic medical record. SANEs did not collect information about participant’s gender identity during their SAMFE (see Table 1 for participant demographics & characteristics).

Table 1.

Participant Demographics & Characteristics

	n (M)	% (SD)
Age	(29.55)	(10.98)
Race: White	30	66.7
Race: Black	11	24.4
Race: Asian	1	2.2
Race: Unknown/Unreported	3	6.7
Ethnicity: Latino/Latinx	2	4.4
Multiple Perpetrators	5	11.1
Stranger as Perpetrator	14	31.1
Woman as Perpetrator	3	6.7
Victim Incarcerated	10	22.2
Victim Homeless	5	11.1
Reported Assault to Law Enforcement	31	68.9

Law enforcement reporting.

SANEs included information on law enforcement’s involvement and if the survivors had formally reported their sexual assault to law enforcement. More specifically, all survivors that chose not to report their assault were classified as anonymous, whereas among men that had reported their assault, the specific agency involved, as well as specific personnel (i.e., detective, patrol officer), and a case-identification number were included within the patient’s record.

Sexual assault characteristics.

SANEs conducting the SAMFE recorded characteristics of each assault. SANEs asked men to “describe their sexual assault in as much detail as possible” and recorded these first-person narratives in the medical chart. SANEs typically asked probative follow-up questions to clarify this narrative and provide further detail. As part of standard SAMFE procedures, SANEs specifically asked all patients about the use of alcohol and/or drugs by the survivor and/or the perpetrator before, during, and after the assault; the relationship to the perpetrator; the perpetrator’s use of a weapon; and current prescription medications being used by the survivor. SANEs recorded the responses to these close-ended questions in the medical chart. Finally, SANEs recorded injuries (genital and/or non-genital) that they observed upon physical examination of the survivor.

Analytic Plan

We used thematic analysis to qualitatively analyze characteristics of men’s sexual assault experiences contained within their specific victimization narrative (Alaggia & Wang, 2020; Braun & Clarke, 2006). First, specific phenomenon were identified and categorized as codes (e.g., specific contextual and situational factors). After preliminary codes were established, larger organizational constructs (i.e., themes) were then established. Subsequently, to confirm that themes had emerged, direct quotes were provided. To strengthen the existing analysis and help establish a preliminary codebook, a second coder independently reviewed narratives to provide alternate perspectives on men’s sexual assault characteristics. Prior to independently analyzing study transcripts, two coders met to discuss the preliminary codebook, operationalize themes and codes, and to reach consensus on coding discrepancies that arose during initial analysis. Once mutual agreement was established, both coders independently applied the codebook to men’s narratives. Finally, the authors mutually agreed that thematic saturation was reached after no additional characteristics were identified.

Results

We identified several general characteristics of men’s sexual assaults within their SAMFE medical records (see Table 2 for a summary of men’s sexual assault characteristics). When asked to identify specific demographic characteristics of their perpetrator, 31.1% reported having been assaulted by a stranger (n = 14), 11.1% (n = 5) reported having been assaulted by multiple perpetrators, and 6.7% reported having been assaulted by a woman (n = 3). A total of ten participants (22.2%) were incarcerated at the time of their assault. Five participants (11.1%) reported being unhoused within the context of their narratives, although homelessness was not systematically assessed by SANEs. Additionally, 68.9% of participants formally reported their sexual assault to law enforcement (n = 31), where 31.1% chose to report their sexual assault anonymously (n = 13), and 26.7% of participants obtained an injury (either genital or non-genital) during their assault (n = 12).

Table 2.

Definition & Examples of Men’s Sexual Assault Characteristics

Sexual assault characteristic	Definition	Example quote
Perpetrator Use of Force/Weapons	Perpetrator used physical force or weapons or threatened to use physical force or weapons to obtain sex from victim.	[The perpetrator] comes up on me and has a knife at my throat…
Tactical Use of Alcohol/Drugs	Victim reported knowledge of or suspicion related to being rendered incapacitated due to perpetrator’s deliberate use of alcohol and/or sedating drugs to obtain unwanted sexual activity from the victim.	My friend thinks I was drugged, especially knowing the medications the [perpetrator] takes.
Memory Loss	Victim reported being unable to remember parts of their assault, including specifics as to what happened, and who their assailant may have been.	I don’t remember leaving the bar or how I got to the house. I don’t know this guy, and I have no idea where we met. We were on a bed. I don’t know, that’s all I remember.
Consensual Sexual Activity Turned Non-Consensual	Situations that began as consensual dating, social, or sexual situations (i.e., consent for some sexual activity), where consent was later withdrawn.	I reminded him that I was not interested in having sex with him. I kept trying to push him off and adjust my pelvis so he could not get his penis inside me.
Incarceration	Victim reported being incarcerated at the time of the assault.	My cell mate made me give him oral.

Our qualitative analyses identified three general constructs within SAMFE medical records: a) Perpetrator Use of Coercive Tactics; b) Memory Loss; and c) Contextual Factors. Nested within these constructs, we identified five specific themes: a1) Use of weapons and physical force; a2) Tactical administration of alcohol and drugs; b1) Difficulties remembering assault; c1) Consensual sexual activity turned non-consensual; c2) Incarceration.

Perpetrator Use of Coercive Tactics

Use of weapons & physical force.

Men described that perpetrators use of physical force or weapons during their sexual assault experiences. Concerningly, men in this sample reported that perpetrators used threats of death in conjunction with weapons to forcefully obtain sexual activity. One man reported, “He told me he would kill me with his knife if I did not have anal sex with him.” Several men also reported that the perpetrator used weapons, particularly firearms, in a threatening manner to make them perform unwanted sexual acts. For example: “[The perpetrator] pulled a gun and pointed it at my leg. I was in shock.” and “He walked up and stuck a gun in my mouth and made me suck the barrel.” As a result of their perpetrator’s use of force, men described experiencing physical pain and a sense of helplessness or powerlessness during the assault; these factors often prevented their escape. One man reported, “It was extremely painful, it went on forever. I couldn’t physically move at that point.” A similar sentiment appeared in another man’s narrative where he explained, “I was in a lot of pain, I was doubled over on the floor.” Regarding his assailant’s strength and size, one man noted, “He was bigger than me, he was a fighter, I had no choice.” Another man reported being unable to fight back against the perpetrator, reporting, “I wanted him off me and I was trying but he was forceful and was putting his weight on my back to hold me down.” Although most of the men discussing the use of physical force as a coercive tactic reported having a male perpetrator of their assault, one man who reported that he had been assaulted by a woman stated, “The second time I woke up, she was choking me - her hand was on my throat. I felt very threatened, she had both hands around my throat.” Collectively, men within the current study described a range of experiences related to perpetrators using physical force to obtain unwanted sexual activity.

Tactical administration of alcohol and/or drugs.

Numerous men reported being assaulted when they were incapacitated, and these men often suspected that their perpetrator may have deliberately and tactically used sedating substances such as alcohol or other incapacitating drugs to obtain sexual activity from them. Most commonly, men described physical effects of these substances that were distinct from their prior experiences with alcohol intoxication. One man who reported experiencing next-day effects from alcohol that were incongruent with his level of drinking stated, “I felt nauseous and have absolutely no recollection which does not happen when I drink that amount of alcohol.” Another man who experienced effects that were not aligned with the amount of alcohol he consumed stated, “We went to his house and started drinking and watching movies. That’s the last thing I remember, I didn’t drink enough for me to not remember anything.” A similar sentiment was echoed by another one who also suspected that he had been drugged, stating, “I woke up feeling like I was experiencing more than any hangover I have ever had. Like an out of body experience, and this feeling remained with me all day long and into the weekend.” Men who suspected that their perpetrator may have tactically used alcohol and/or drugs as a coercive tactic also reported being particularly motivated to receive a SAMFE in effort to find out more information surrounding their experience: “My number one thing I want to find out from this is if I was drugged,” while other men hoped to find evidence that could determine whether they had been sexually assaulted or raped: “I am worried I was drugged and just want to know. I also want to get medications just in case.”

Memory Loss

Difficulties remembering assault.

Men within the current sample reported having memory loss related to or surrounding their assault. Men reporting memory issues were unsure of whether an assault occurred, some of which were uncertain of whether any sexual activity occurred. One man indicated “The next thing I knew I was waking up in bed surrounded by vomit…I did not remember what had happened to me.” Even though they experienced some degree of memory loss surrounding their assault, some men could recall that assault did in fact occur, despite being unable to recall specific details of the encounter. One man recalled, “I remember having sex, but I did not give consent…I remember penetration, but I cannot tell you with who.” Similarly, another man reporting memory issues surrounding the assault detailed: “I don’t know this guy, and I have no idea where we met…I just have little flashes of memory.”

Contexts for Men’s Sexual Assault

Consensual sexual activity turned non-consensual.

Numerous men described sexual encounters that begun as consensual sexual encounters or situations where both parties were interested in some sexual activity, but that ultimately the sexual activity became non-consensual. One man reported, “He started coming onto me and we were kissing, that was fine. But he started touching my leg, I told him to stop, we were just getting to know each other, and he wouldn’t stop.” Similarly, this theme was reported by another man who reported having had prior consensual sexual with the perpetrator, where he stated “I kept telling him I didn’t want to do this. I don’t want this, it hurts. He said ‘relax, it’s [happened] before, it’ll work again.’” Another man stated that his perpetrator saw his reluctance to engage in sexual penetration as a form of token resistance, rather than non-consent, stating,

He kissed me and that was mutual. Afterwards we had oral sex and that was mutual. We started kissing again and that was ok. Then he tried to get on top of me again., I couldn’t deal with it. I moved away and said no. He started pushing me down. I didn’t like it and he just thought I was playing hard to get.

Men in this sample reported that their sexual partner did not respect their wishes regarding safe sexual activity and condom use and proceeded with sexual activity. One man noted, “I handed him a condom and he broke it in his hands. He [penetrated] me without a condom.” Despite men articulating the limits of the sexual activities they were comfortable engaging in, numerous men reported that their perpetrators disregarded their wishes and continued with unwanted sexual activity.

Incarceration.

Another contextual theme emerging from men’s sexual assault narratives revolved around being incarcerated. Numerous men in this sample reported being sexually assaulted while in jail or prison. All men who reported being sexually assaulted while in jail were assaulted by their cellmate. Many incarcerated men detailed extreme measures they had taken to separate themselves from their cellmate and to safely report their assault without immediate retaliation. One prisoner noted “I cut my arms with a razorblade so [the guards would] get me out.” In addition to these scenarios, several incarcerated men noted that their assaults were witnessed by other inmates and/or indicated that guards were aware of the assault. In particular, one incarcerated man detailed: “Everyone was yelling. He was making the other inmates yell for distraction. He had other inmates looking out [for him].”

Discussion

The results from this study advance our knowledge of specific characteristics of sexual assault experienced by men seeking a SAMFE. Men who experienced sexual assault and sought out a SAMFE reported narratives of their assault to the SANE described the perpetrator’s use of assault tactics involving physical force or alcohol and/or drugs. Men also described a range of memory-related impairment and difficulty in recalling specific aspects of their assault. Finally, many men endured sexual assault that had occurred in the context of incarceration, as well as during consensual sexual activity that became non-consensual.

The findings from the present study align with some of the existing literature on characteristics of men’s sexual assault experiences. Numerous participants discussed having their perpetrator use physical force or weapons to obtain sexual activity, which has been established as a unique correlate among men receiving post-assault services (Zinzow et al., 2008). While men in the current study reported feelings of helplessness due to the perpetrator of their assault using weapons, force, and substances to facilitate the assault, it is not possible to provide further interpretations of men’s affective responses in these situations, given the descriptive nature of the present study’s qualitative analyses. The broader literature on men’s sexual victimization has consistently found that men (similar to survivors of other genders) frequently experience embarrassment, shame, blame, and guilt surrounding their assault (Hlavka, 2017; Javaid, 2015; Weiss, 2010). It is possible that men within the current study experienced similar emotional responses as a result of their inability to physically fight back or escape the assault when the perpetrator used physical force or had used alcohol and substances to incapacitate them. Feelings such as shame have also been associated with decisions not to report experiences of assault among a sample of college women (Zinzow & Thompson, 2011), and it is possible that this relationship exists among men as well. In addition, it is possible that these results may also align with other attitudinal barriers to seeking post-assault services. More specifically, rape myths represent a group of attitudes that reflect ideas that men are unable to be assaulted as they are more likely to always want sex, are too strong to be assaulted, or concerns about being perceived as gay or experiencing sexual arousal, wherein it is possible that men who endorse rape myths may internalize fear that he might not be believed, which in turn may reduce their likelihood to seek formal support or report assault (Allen, 2016; Sable, 2006).

Implications for Sexual Assault First Responders

Results from the present study provide several noteworthy implications for how both SANEs and other sexual assault first-responders respond to male survivors. To address the needs of individuals reporting sexual assault, many US hospital systems have implemented SANE programs that aim to provide trauma-informed comprehensive coordinated post-assault care and facilitate the survivor’s interaction with medical and legal systems (Taylor, 2002). Although SANEs and related forensic services are now well-established in many hospital systems, historically, only 50–60% of men presenting for sexual assault-related medical care received a SAMFE (McLean et al., 2004; Stermac et al., 2004). Even as SANE programs have grown rapidly in number throughout the country, approximately one third or less of men appear to seek any medical care post-assault (Light & Monk-Turner, 2009; Walker et al., 2005). Most of these men come to the attention of medical professionals when they present for care for physical injuries from the assault (e.g., Kaufman et al., 1980; Light & Monk-Turner, 2009).

In addition to SANEs, results from the present study also may impact how services are provided by other sexual assault first responders, such as law enforcement, mental health professionals, and other medical paraprofessionals when interacting with male survivors. Sexual assault first-responders should be aware that survivors may have a range of memory difficulties post-assault, ranging from an inability to recall specific details or aspects of their assault, to not being able to remember their assault altogether, both of which are common among men who suspect their perpetrators may have used substances to incapacitate them. By having a more comprehensive understanding of men’s sexual assault experiences, results from the present study may help better prepare sexual assault first responders regarding the unique and varied needs of male survivors of sexual assault, which may help reduce numerous systematic and institutional barriers men face to accessing post-assault care. Results from the present study on the frequency to which weapons and physical force are used in men’s sexual assault experiences align with established findings on the commonality of men sustaining injury as a result of sexual victimization (Zinzow et. al., 2008). In fact, 26.7% of men within the current study obtained either genital or non-genitral injury as a result of their sexual assault. Thus, sexual assault first responders should ensure that men are able to access relevant medical resources to assess and treat assault-related injury.

While men’s affective and emotional responses to experiencing sexual assault were not discussed within the context of the narratives analyzed within the present study, it is possible that among men experiencing assaults stemming from perpetrator use of physical force or weapon to obtain unwanted sex, feelings of shame, helplessness, embarrassment, and guilt may be particularly common. Shame and guilt may also be common emotional responses for men who had sexual assault experiences stem from sexual encounters that began consensually, wherein they may feel some responsibility for what happened to them. Therefore, sexual assault first-responders may also benefit from increasing their awareness of common affective responses that may impact men experiencing sexual assault, particularly as it relates to disclosing their victimization experience.

Finally, it is important to note that this study was conducted during the midst of the #MeToo social movement, wherein experiences of sexual assault, abuse, harassment, and rape culture were publicized in effort to spotlight the prevalence of sexual assault, and to empower survivors to speak up about their experiences. Numerous studies have documented associations between the #MeToo movement and increased recognition of sexual assault experiences (Jaffe et al., 2021), as well as increases in reporting and seeking post-sexual assault services (Alaggia & Wang, 2020; Palmer et al., 2021; Rotenberg & Cotter, 2018). Given that these continues to increase (Levy & Mattsson, 2022), it is critical that sexual assault first-responders gain the training, expertise, and resources necessary to meet the unique needs of male survivors.

Limitations & Future Directions

Several limitations about this study must also be acknowledged. First, although some assault characteristics were systematically assessed for all men (e.g., sex, age, race, ethnicity, law enforcement reporting, etc.), others were not (e.g., gender, prior relationship with perpetrator, memory loss, etc.) and instead emerged via thematic analysis of the assault narratives. We are thus not able to determine the true frequency of these emergent characteristics among men seeking SAMFE. Second, given that the present study was conducted exclusively among a sample of men whom received a SAMFE, we are unable to determine how specific sexual assault characteristics identified within this study affected men’s help-seeking behavior, given the lack of a comparison group. Another limitation of the present research is that men in this sample were not asked to self-report their sexual orientation or gender. Given this, we were unable to explore differences in experiences of assault as a function of sexual minority identity (i.e., being a gay or bisexual man) or gender minority identity (transgender, non-binary). It is also important to acknowledge that it is possible that the current study may contain participants identifying as transgender women or as gender non-binary; however, since gender was not assessed during the SAMFE, it is possible that the medical records and treatment provided were not reflective of participant’s true gender identity during the SAMFE. Similarly, while men were asked to provide their home or mailing address as part of the standardized SAMFE intake process, it is possible that additional men within the study sample were homeless at the time of their assault but were not classified as such due to providing a mailing address. Given that those experiencing homelessness may be at increased risk for experiencing sexual assault (Kushel et al., 2003; Tyler & Wright, 2019), as well as experiencing greater difficulties in accessing post-assault healthcare (Santa Maria et al., 2020), further research into homeless men’s sexual assault experiences is warranted.

Given power-related concerns due to the small sample size within the present study, quantitative analyses, including bivariate correlations between survivor charactersistics and each theme were unable to be conducted. Furthermore, research has also identified some facilitators and barriers of men’s law enforcement reporting after experiencing an assault, including how specific survivor and perpetrator characteristics predict law enforcement reporting (Light & Monk-Turner, 2009; Walker et al., 2005; Weiss, 2010). To provide additional context into the association between men’s characteristics and each theme, as well as how specific sexual assault characteristics may predict law enforcement reporting, future research using a larger sample of men experiencing sexual assault is critically needed.

Conclusion

Findings from the present study provide descriptive information on common contextual and situational factors that characterize experiences of sexual assault victimization among men presenting for SAMFE. Given the complex intersections between sexuality, sexual, and post-assault access to care, more work is needed to better understand how to support men survivors of sexual assault immediately following their assault experiences.

Biographies

Daniel W Oesterle, M.S., is a clinical psychological sciences doctoral student within the Department of Psychological Sciences at Purdue University, West Lafayette, IN. His research focuses on examining risk factors for both victimization and perpetration of sexual assault, intimate partner violence, and aggression.

Grace McKee, PhD, is a statistician in the VA Endoscopy Quality Improvement Program (VA-EQuIP), which is supported by the Measurement Science Quality Enhancement Research Initiative at the San Francisco VA Medical Center. She specializes in analyzing large-scale electronic health record data such as that in the national VA healthcare system.

Dr. Emily R. Dworkin, Ph.D., is an assistant professor at the University of Washington School of Medicine and a licensed clinical psychologist. Her research addresses recovery from sexual assault and other forms of trauma, with a focus on identifying strategies to facilitate survivors’ recovery.

Allyson M. Blackburn (she & they) is a clinical/community psychology doctoral student at the University of Illinois at Urbana-Champaign.

Leah E. Daigle, Ph.D. is a Distinguished University Professor of Criminal Justice and Criminology at Georgia State University. Her research focuses on the correlates and consequences of victimization and revictimization as well as the victimization of diverse groups.

Kathy Gill-Hopple, PhD, RN, SANE-A, SANE-P, is the former director of the Clinical Forensics Program at the Medical University of South Carolina, Charleston, SC.

Amanda K. Gilmore, PhD, is an Associate Professor in the Department of Health Policy & Behavioral Sciences at the School of Public Health at Georgia State University as well as the director of the National Center for Sexual Violence Prevention in the Mark Chaffin Center for Healthy Development. Her research focuses on the prevention of alcohol use, sexual assault, and suicide, as well as secondary prevention of substance use and mental health symptoms after sexual assault.