The 1 in 6 estimate is arguable, given that many males' refuse to admit they've been assaulted. But the real youth behind that count show up in such facilities as the Child Trauma Center at Chicago's La Rabida Children's Hospital and CornerHouse in Minneapolis, Minn.
Services at the latter include forensic interviews of child victims of alleged abuse who number 500 per year. A third of that total are boys, and 85 percent of those have been sexually violated, said social worker Patricia Harmon, Cornerhouse's executive director.
"The boys can be a lot more closed about what happened. There's a clear sense of shame," she said.
"The biggest difference with the boys is that there's usually a [post-assault] concern about sexual orientation that they have or their families have, or both," said psychologist Bradley Stolbach, director of the Chicago trauma center and a clinical pediatrics professor at the University of Chicago Pritzker School of Medicine.
"There's this notion that if you've been abused by a man, that will make you gay," Stolbach said. "If a child has a concept of what that is, it just adds another layer of fear and anxiety."
That's one major challenge. Another involves diagnosis and treatment of the mental and emotional ills that sexual assault almost invariably triggers. Sexual assault victims often are said to be suffering from something akin to post-traumatic stress syndrome, but that oversimplifies the issue, psychiatrist Reiss said.
Clinically, PTSD sufferers cannot differentiate between present and past events.
"Rather than [trauma] being filed in their brains as a memory, it hangs there as an experience that, periodically, they actively are re-living," he said.
Sexual assault victims, he said, suffer more immediately from "affective dysregulation, a technical name for saying you've not learned how to comfort yourself or be close to someone without feeling danger at the same time."
"What's more devastating is what being sexually abused does to a person's ability to trust and be intimate," Reiss said. "There's a confusion about what's pleasure and what's pain, confusion about whether being close to someone is a welcome thing or frightening. ... 'If I go to someone for safety, will they hurt me instead?' And all of that is more devastating to their everyday life than intermittent PTSD."
It bears noting that boys who are sexually abused by women suffer all of that as well as those victimized by men, Reiss said.
"And it can be even harder for men to plow through that because, stereotypically, you were supposed to enjoy that, see yourself as being precocious and indulging a fantasy when, in fact, that abuse is really quite disrupting," he said.
Many men who do not reveal their history of having been abused or get help aimed as at easing that angst respond in extreme ways, including feeling inferior, becoming extremely withdrawn, hypersexual, hyper-macho and a "sadomasochism in which the enjoyment of sex necessitates fear or pain, which becomes any way of avoiding intimacy," Reiss said.
It showed in Pennsylvanian Treml's marriage, he said, as habitual lying to his wife about a whole slew of things. His wife's probing of whether some awful childhood thing had left him so broken is what pushed him to eventually tell what happened, he said.