When the abuse began, Paul Treml was 14 years old, a schoolboy athlete, 5-feet 6-inches tall and 115 pounds.
His abuser, he said, was a decade older and seven inches taller, a hulking ex-college athlete who almost made it to the pros and who ran the youth sports league in Treml's Pennsylvania hometown.
"It was full sexual assault," said Treml, now 53, who left that league after two years of abuse. "You name it. It was repeated and complete."
For 21 years after that torture ended, Treml, a baseball player who also ran track, kept the details secret from his even closest kin. (His abuser also happened, at the time, to be a family friend.)
He started smoking marijuana and drinking alcohol, trying to blot out the fear, shame, guilt, hurt and assorted confusions about his sexuality that abuse survivors and the clinicians who treat them say are particularly acute for sexually assaulted males in a culture still prone to telling boys not to cry and to always be ready to defend themselves.
Sexual predators, clinicians said, are keenly aware that those complexities fuel male reluctance to discuss what happened.
"Boys are less likely to disclose," said University of Massachusetts clinical psychologist David Lisak, who works with male victims and victimizers. Convicted Catholic "priests understood this dynamic and picked boys partly because they are less likely to be believed," he said.
Allegations that Jerry Sandusky, the former assistant football coach at powerhouse Penn State, was a serial child molester have brought those fraught realities to the fore at a time when, by the most frequently cited reference, an estimated one in six boys will be sexually assaulted before they turn 18.
"As a kid, you're completely frightened by what's happening to you. You don't know what to do or what to say," said Treml, a regular public speaker on sexual abuse of men and boys.
"In my mind, no one would believe me. Or they'd think it was my fault or I was asking for this or I was homosexual. Those emotions become so powerful you become numb. Then you just go into denial," added Treml.
That he managed eventually to confront his abuser and tell his family, including his wife and three children -- to say nothing of going on the speaking circuit -- puts Treml in that rare number of abused boys and men who dare to face the truth of what happened to them and share that story.
While rape is traumatic for everyone, boys and men are more likely than girls or women to keep that violence to themselves for extended periods of time -- if not, forever -- and to grapple with a host of mental and emotional ills that accompany their decision, clinicians said.
"It's somehow much more shameful for a male to admit to being abused. It not only stirs their sense of weakness about being victimized but also the whole issue of sexual attitude and identity," said Dr. David Reiss, who, during more than 25 years as a practicing psychiatrist, has mainly treated adults who were abused as children, including sexually assaulted males.
"If a woman is abused, obviously there are traumas and effects from that," added Reiss, the interim medical director at Providence Behavioral Hospital in Holyoke, Mass., chiefly overseeing children and adolescent care. "In society's point of view -- and it's a negative view -- women can be seen as having attracted that attention. But it doesn't detract from her sexuality externally, even if, internally, it causes a lot of other problems."
Such allowances are hardly afforded males, he said. For them, "there's a different cultural dynamic at play that makes it much more difficult for a man to ever acknowledge having been abused."