Psychiatrists Should Ask Male Patients About Sexual Trauma

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While he was in residency training, Dhruv Gupta, M.D., said that evaluating whether a patient had experienced sexual trauma often came up when he was being instructed how to evaluate female patients. “But in clinic, I also came across men reporting sexual trauma and how it impacted them,” said Gupta, who is a forensic psychiatry fellow at the University of Pennsylvania.

One in six men has experienced sexual violence in their lives, Gupta said during the session “Overcoming Shame, Stigma, and Barriers in Addressing Victims of Male Sexual Violence” at APA’s Annual Meeting last week. The overarching goal of the session was to raise awareness about the startling prevalence of sexual violence among men, Gupta said. The presenters encouraged psychiatrists to acquaint themselves with the psychiatric symptoms and diagnoses associated with sexual violence among men, as well as the assessment tools that can help them better address this issue with their patients. Gupta chaired the session, and was joined by Saranyan Senthelal, M.D., Marissa Goldberg, D.O., and Obiora Nnaji, M.D.

Underreporting is a serious issue when it comes to sexual violence among men, Gupta explained. A major challenge in treating sexual trauma in this population is how reluctant men can be to discuss their experiences, even with their clinicians, due to stigma and shame. Cultural concepts of masculinity can prevent them from reporting their experiences for fear that they will be viewed as less of a man, Gupta said. “They experience confusion, self-doubt, fear, and guilt; this keeps them from reporting what happened,” he said.

If patients do not share their full histories with their clinicians, though, they cannot formulate an accurate diagnosis or effective treatment plan together, Gupta said. Just like a physical health condition such as hypertension, symptoms related to trauma can worsen over time and become more difficult to treat. “If treatment is initiated earlier, the downstream consequences can be less severe,” he said.

Psychiatrists should be aware of culturally sensitive and appropriate means in which to inquire about sexual trauma among their patients, Gupta and his colleagues explained during the session. Ensuring the patient is fully aware of the confidentiality of the patient-clinician relationship can help, as can creating a safe clinical environment. They also pointed to the importance of reviewing patients’ medical records to identify other signs of sexual trauma, gathering more information from family members if feasible, as well as liaising with other health professionals.

Taking a moment to ask male patients if they have experienced sexual trauma is a crucial step in providing comprehensive psychiatric care, Gupta said. In addition to helping identify and address underlying trauma that may be impacting the patient’s mental health and overall well-being, it fosters trust and rapport, validates the individual’s experience, mitigates risk for future trauma, and challenges societal biases.

“As a profession, we are increasingly recognizing the extent to which social and environmental factors can impact one’s health and mental health,” Gupta said. “As such, exposure to violence is a social determinant of mental health.” ■