SEXUAL ABUSE OF BOYS - DEFINITION, PREVALENCE, CORRELATES, SEQUELAE, AND MANAGEMENT

Objective.-To clarify the definition of sexual abuse of boys, update e stimates of its prevalence, and explore critically its reported correl ates, sequelae, and management. Data Sources.-Studies from 1985 to 199 7 were identified using OVID-MEDLINE and OVID-CINAHL. The search terms used were sexual abuse, sexual victimization, and sexual assault. Con straints applied included English language, human male subjects, age y ounger than 19 years, and North American samples. Study Selection.-Pub lications were included for review if they appeared in peer-reviewed j ournals; had clear research designs; reported results for at least 20 male subjects; and were not reviews, perspectives, theoretical treatis es, editorials, or letters. Data Extraction.-Study types and sampling methods were categorized using well-established definitions. Preferenc e 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 abus e samples. Studies were methodologically limited and definitions of se xual abuse varied widely. Prevalence estimates varied widely (by defin ition used and population studied), ranging from 4% to 76%. Boys at hi ghest risk were younger than 13 years, nonwhite, of low socioeconomic status, and not living with their fathers. Perpetrators tended to be k nown but unrelated males. Abuse frequently occurred outside the home, involved penetration, and occurred more than once. Sequelae included p sychological distress, substance abuse, and sexually related problems. Evaluation of management strategies was limited. Conclusions.-Sexual abuse of boys appears to be common, underreported, underrecognized, an d undertreated. Future study requires clearer definitions of abuse, im proved sampling, more rigorous data collection, more sophisticated dat a analyses, and better assessment of management and treatment strategi es. Regardless, health care professionals should be more aware of and sensitive to the possibility of sexual abuse in their male patients.