Nov. 20, 2011 -- 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."
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.
His wife, a lawyer, also was the person who successfully persuaded her husband's hometown to change the name of a municipal park that was briefly named after Treml's abuser, a former parks and recreation director for that town who, Treml said, surrounded himself back then with about a dozen boys who also were relatively small in stature.
Fighting back against one's abuser and the abuse can take many forms, Treml said. When he was in his 30s, he confronted the man, who, in the years after abusing Treml, pleaded no contest to a charge of corrupting minors by supplying alcohol to boys from school for troubled kids.
"Telling my whole family was a big part of my healing process," Treml said, adding that he's in touch with others who, during their shared boyhood, were assaulted by the same man. They have chosen not to speak up about it.
"Being able to speak about it publicly is extremely empowering. It's how I've gone from being a victim to being a survivor," Treml said. "The way I look at all of this is if I can help one kid, I've done my job."
Particularly for men, being vocal about what they've endured "takes a lot of courage," Reiss said. "It takes courage to say you've been taken advantage of, and courage to accept that, if you're going to deal with this, you're going to feel much worse before you feel better.
"On many different levels, it also takes courage to deal with friends and family who don't want to believe you, and, after you tell it, to lose friends and family who themselves have been abused and don't want to acknowledge that. Quite often, in my own practice, that's what I see."