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.

1. The Consequences of Male
Directed Sexual Violence
(MDSV)
‘Increasing understanding of MDSV for a
better response’
Dr David Ndawula, MD
Kampala, Uganda

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 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

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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?

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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

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 Chronic Pain Syndromes
 Back, headache, abdomen & rectal conditions
 Chronic fatigue & Malnutrition
 Gastrointestinal conditions:
 Initial nausea/vomiting (initial)
 Long term bleeding, fissures, prolapse
 Incontinence

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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

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 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

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 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.

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 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

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 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

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 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

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 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

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 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

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 Compulsive behaviors
 Overspending
 Gambling
 Sexual obsessions or compulsions etc.

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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

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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%

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 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

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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?

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 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. Thank You

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?
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