Introduction
Sexual violence constitutes a major public health and human rights issue worldwide. According to the World Health Organization, it includes “any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or any other act directed against a person’s sexuality using coercion, regardless of the relationship to the victim or the context” [1]. Rape represents one of the most severe forms of sexual violence and is defined as any vaginal or anal penetration imposed using a penis, another body part, or an object, through force, threats, or any other form of coercion [1,2].
The consequences of sexual violence are multiple and affect both the physical and psychological health of victims. On the somatic level, they may result in genital injuries, pain, bleeding, sexually transmitted infections, and other traumatic complications [3,4]. Psychologically, victims frequently present symptoms of post-traumatic stress disorder, depression, anxiety, psychological distress, dissociative disorders, and behavioral disturbances [5-7]. These repercussions may durably impair quality of life, social relationships, and socio-professional integration.
Although sexual violence has been predominantly studied among women, men may also be victims. However, sexual violence against men remains largely under-documented due to silence surrounding these assaults, social stigma, norms of masculinity, and fear of judgment [8-10]. Male victims often hesitate to report the assaults or seek healthcare and support services, contributing to an underestimation of the true prevalence. Perpetrators frequently occupy positions of social, institutional, or economic power that reinforce domination and limit victims’ ability to report abuse [11].
The prevalence of sexual violence among men varies according to the context and populations studied. Estimates reported in the literature are generally below 5% in the general population but may reach much higher levels among people living with disabilities, prisoners, or populations exposed to armed conflict and humanitarian crises [12,13]. In South Africa, a 2022 study on gender-based violence found that 2.3% of men had experienced sexual violence during their lifetime [14]. In the Democratic Republic of the Congo, data on sexual violence against men remain limited despite the context of recurrent armed conflicts and population vulnerability.
The lack of scientific data on male sexual violence in the Democratic Republic of the Congo constitutes an obstacle to the implementation of appropriate prevention, care, and support strategies for victims. In this context, the present study aimed to describe the extent and characteristics of sexual violence among male victims and to analyze the associated psychopathological manifestations.
Materials and Methods
1. Study Design
This was a descriptive cross-sectional study.
2. Study Period and Duration
The study was conducted over four months, from October 9, 2022, to February 9, 2023.
3. Study Setting and Population
The study involved male physicians working at Makala General Referral Hospital (MGRH), for a total of 98 participants.
4. Sampling Method
An exhaustive sampling strategy was used. All male physicians at MGRH meeting the inclusion criteria during the study period were recruited.
5. Selection Criteria
a. Inclusion Criteria
Participants were eligible if they:
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Were physicians working at MGRH;
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Were male;
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Voluntarily agreed to participate and complete the questionnaire.
b. Exclusion Criteria
Physicians who did not provide informed consent were excluded.
6. Data Collection Tools and Procedures
Data were collected using a structured questionnaire adapted from a reference instrument on gender-based violence designed for male populations (Rwanda).
The questionnaire included:
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A module on sociodemographic, economic, and professional characteristics;
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Modules exploring experiences of violence in various life domains, organized from the least sensitive to the most sensitive topics to facilitate disclosure;
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Assessment of post-traumatic stress disorder (PTSD) using the Post-Traumatic Stress Disorder Checklist Scale (PCL-S) developed by Weathers et al. The scale includes three dimensions:
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Intrusion (items 1–5);
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Avoidance (items 6–12);
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Hyperarousal (items 13–17).
A score ≥44 was considered suggestive of PTSD requiring specialized care.
Symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), composed of 14 items divided into two subscales. A score ≥11 indicated probable anxiety or depression.
7. Study Variables
The variables analyzed included:
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Sociodemographic variables: age, sex, religion, residence, educational level, marital status;
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Socioeconomic variables: monthly income, dependents;
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Professional variables: occupation;
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Medical variables: personal and family medical/surgical history;
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Substance use: alcohol, tobacco, cannabis, and other psychoactive substances.
8. Operational Definitions
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Marital status was categorized into two groups: single and in a relationship/marital union;
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Number of dependent children was dichotomized into: no children and children;
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Socioeconomic level was defined according to monthly income:
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Income <57 USD/month;
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Income ≥57 USD/month.
9. Administrative Considerations
The study was conducted based on research authorization issued by the Faculty of Medicine of the University of Kinshasa.
10. Ethical Considerations
Ethical principles were respected. Ethical approval was obtained prior to the study. Free and informed consent was obtained from all participants before inclusion. Confidentiality and anonymity of collected data were strictly guaranteed.
11. Difficulties Encountered
The main difficulty encountered was the reluctance of some participants due to the sensitive nature of questions related to intimacy. This challenge was mitigated through an approach ensuring confidentiality, which facilitated continued data collection.
12. Bias Management
Several measures were taken to reduce potential biases. Social desirability bias was minimized through anonymity and confidentiality. Selection bias was reduced by exhaustive sampling of all eligible physicians during the study period. Questionnaires were administered in a discreet environment to encourage honest responses.
Data was verified before entry to reduce collection and coding errors.
13. Statistical Analysis
Data were entered and coded using Microsoft Excel 2016 and analyzed with Epi Info and SPSS version 27.
Descriptive analyses included:
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Quantitative variables expressed as mean ± standard deviation;
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Qualitative variables expressed as frequencies and percentages.
Associations between variables were tested using the Chi-square test and Fisher’s exact test when Chi-square assumptions were not met (expected frequencies <5). Statistical significance was set at p < 0.05.
Incomplete questionnaires or those with major missing data were excluded from analysis.
Results
A total of 98 physicians from Makala General Referral Hospital in Kinshasa participated in this study.
1. Sociodemographic Data
The sample consisted exclusively of male physicians. The mean age was 39 years with a standard deviation of 8.17 years. The median age was 38 years. Age was dichotomized into participants younger than 39 years and those aged 39 years or older. Participants living as a couple represented 59.18% of the sample. Most participants (75.51%) had a monthly income above 57 USD.
| Variables | n (%) |
| Age (years) | |
| <39 | 49 (50.0%) |
| 49 (50.0%) | |
| Marital Status | |
| Living as a couple | 58 (59.18%) |
| Not living as a couple | 40 (40.81%) |
| Dependent Children | |
| Children | 60 (61.22%) |
| No children | 38 (38.77%) |
| Income | |
| <57 USD | 24 (24.48%) |
| 74 (75.51%) |
2. Medical History and Substance Use
Among respondents, 10.20% had a personal medical history. Alcohol, cannabis, and tobacco use were reported by 36.73%, 1.02%, and 1.02% of participants, respectively.
| Variables | n (%) |
| Personal Medical History | |
| No | 88 (89.79%) |
| Yes | 10 (10.20%) |
| Medication Use | |
| No | 37 (37.75%) |
| Yes | 61 (62.24%) |
| Substance Use | |
| Alcohol | 36 (36.73%) |
| Cannabis | 1 (1.02%) |
| Tobacco | 1 (1.02%) |
3. Exposure of Sexual Organs, Forced Touching/Sexual Intercourse, and Violence Experienced
Victims of sexual exposure and forced touching/sexual intercourse represented 24.48% and 4.08%, respectively. Demanding to know where participants had been, disregarding their opinions in intimacy, and preventing them from speaking with other women were reported in 71.42%, 39.79%, and 38.77% of cases, respectively.
| Variables | Yes n (%) | No n (%) | Abstention n (%) |
| Exposure of sexual organs | 24 (24.48) | 74 (75.51) | - |
| Forced touching and/or sexual intercourse | 4 (4.08) | 94 (95.91) | - |
| Prevented from meeting or speaking with friends/family | 3 (3.06) | 74 (75.51) | 21 (21.42) |
| Prevented from speaking to other women | 38 (38.77) | 42 (42.85) | 18 (18.36) |
| Criticism/devaluation of actions | 13 (13.26) | 66 (67.34) | 19 (19.38) |
| Unpleasant remarks about physical appearance | 6 (6.12) | 74 (75.51) | 18 (18.36) |
| Imposed clothing/behavior style | 31 (31.63) | 49 (50.0) | 18 (18.36) |
| Disregard of opinions in intimacy | 39 (39.79) | 40 (40.81) | 19 (19.38) |
| Disregard of opinions before children | 36 (36.73) | 62 (63.26) | - |
| Disregard of opinions before others | 25 (25.51) | 73 (74.48) | - |
| Demanding to know where you were | 70 (71.42) | 26 (26.53) | 2 (2.04) |
| Refusal to speak | 37 (37.75) | 43 (43.87) | 18 (18.36) |
| Prevented access to household money | 9 (9.18) | 46 (46.93) | 43 (43.87) |
| Threats involving children | 4 (4.08) | 53 (54.08) | 41 (41.83) |
| Taking children away from the father | 2 (2.04) | 55 (56.12) | 41 (41.83) |
4. Psychopathological Manifestations
Participants presenting anxiety represented 12.24%, depression
10.20%, and PTSD 8.16%.
| Variables | No n (%) | Yes n (%) |
| Anxiety | 86 (87.75%) | 12 (12.24%) |
| Depression | 88 (89.79%) | 10 (10.20%) |
| PTSD | 90 (91.83%) | 8 (8.16%) |
5. Psychopathological Manifestations and Sexual Violence
The results showed that exposure to traumatic events such as exposure of sexual organs and forced touching was significantly associated with anxiety, depression, and PTSD, with p-values below 0.05.
| Troubles psychopathologiques | Exhibition des organes sexuels | n (%) | p-value Fisher | Attouchements et/ou rapport sexuels forcés | n (%) | p-value Fisher |
| Anxiété | NON | 86 (87,75) | 0,009 | NON | 86 (87,75%) | 0,008 |
| OUI | 12 (89,79) | OUI | 12 (12,24%) | |||
| Dépression | NON | 88 (100%) | 0,006 | NON | 88 (89,79%) | 0,007 |
| OUI | 10 (10,20%) | OUI | 12 (12,24%) | |||
| ESPT | NON | 90 (91,83%) | 0,007 | NON | 90 (91,83%) | 0,009 |
| OUI | 8 (8,16%) | OUI | 8 (8,16%) |
Discussion
This study highlights a non-negligible frequency of sexual and psychological violence among male physicians, as well as a significant association between these forms of violence and psychopathological manifestations. The study aimed to describe the extent and characteristics of sexual violence among male physicians and to analyze associated psychopathological consequences.
Sociodemographic Data
The mean age of participants was 39 years, with a standard deviation of 8.17 years. This result is relatively similar to that observed in a study conducted on sexual assault and harassment of physicians by physicians on Réunion Island [15], which reported a mean age of 41.75 years. Another study conducted in the Democratic Republic of the Congo on male survivors of sexual violence reported a mean age of 22.3 years [16]. In 2024, a medico-legal study in South Africa on sexual violence against men reported a mean victim age of 10.5 years with a standard deviation of 6.9 years [17]. These studies support the idea that sexual violence more frequently affects younger individuals.
Regarding marital status, 59.18% of physicians in our study were living as a couple. A Norwegian study conducted in 2020 examining the relationship between sexual assault, health, quality of life, and self-efficacy in the general population found that 40.81% of participants were living as a couple [19]. Another retrospective study conducted in Goma between 2013 and 2017 found that 58.1% of male victims of sexual violence were single and 25.8% were married [20]. A study conducted among men in Malawi examining sexual coercion in heterosexual relationships found that 78.6% of participants were married or cohabiting [20]. These differences may be explained by sociological and economic factors, including urbanization, educational level, cultural changes, and financial instability [21].
Forced Sexual Intercourse and Touching
The prevalence of forced sexual intercourse observed in this study was 4.08%. This proportion is lower than that reported in a French study among university students, where the prevalence was 11.4% [22]. However, it is similar to findings reported in England, where a prevalence of 4% was observed [23].
Psychological violence was also frequent, particularly disregard of opinions in intimacy (39.79%) and prohibition from communicating with other women (38.77%). These findings are partly consistent with those reported by Le Pape Marc in a study on violence against men during armed conflicts, which highlighted high exposure to sexual harassment [24].
These results suggest that sexual and psychological violence represent a significant reality among male physicians.
Psychopathological Manifestations and Forced Sexual Acts
The findings revealed a statistically significant association between psychopathological manifestations and forced sexual intercourse or touching. Several epidemiological studies have also documented this relationship. For example, a U.S. survey among male victims of sexual assault found that experiencing sexual violence was associated with an increased risk of various psychopathologies, including bipolar disorders, substance use disorders, and PTSD [25].
A synthesis of 20 studies conducted in sub-Saharan Africa in 2024 showed that sexual and gender-based violence had a significant impact on mental health, leading to PTSD, depression, anxiety, suicidal ideation, and psychological trauma [26]. Sexual abuse undermines both physical and psychological integrity and is recognized as an important risk factor for the development of psychopathological disorders [27,28].
Limitations
Several limitations should be considered. First, the cross-sectional design does not allow causal relationships or chronology between exposure to sexual violence and psychopathological disorders to be established. Observed associations may reflect reverse causality or bidirectional relationships.
Second, the small monocentric sample composed of physicians recruited by convenience limits the external validity of the findings.
Finally, because sexual and psychological violence were self-reported, common method bias and social desirability bias cannot be excluded
Conclusion
At the end of this study, victims of forced sexual intercourse and/or touching represented 4.08% of the study population. Sexual violence against men remains a poorly studied and insufficiently explored phenomenon in victimology and psychotraumatology in sub-Saharan Africa in general and in the Democratic Republic of the Congo in particular.
Long obscured by social representations associating masculinity with strength, invulnerability, and dominance, this form of victimization nevertheless leads to serious mental health consequences. Male victims of sexual violence frequently present significant psychotraumatic symptoms such as PTSD, depression, anxiety, identity disturbances, and long-lasting relational difficulties.
Developing and implementing awareness and care strategies is therefore necessary in order to address the specific needs of male victims.
Abbreviations
DRC: Democratic Republic of the Congo
HADS: Hospital Anxiety and Depression Scale
PCL-S: Post-Traumatic Stress Disorder Checklist–Specific Version
WHO: World Health Organization
MGRH: Makala General Referral Hospital
Declarations
Ethical Approval and Consent to Participate
This study was approved by the Ethics Committee of the School of Public Health of the University of Kinshasa, in accordance with the principles of the Declaration of Helsinki.
All participants received clear information regarding the objectives of the study, data collection procedures, confidentiality of information, and their right to withdraw at any time without consequences. Free and informed consent was obtained from all participants before inclusion.
Consent for Publication
Consent for data processing and open-access publication was obtained from all participants or waived when applicable.
All authors confirm that this study involved neither animal subjects nor animal tissues.
Conflicts of Interest
In accordance with the ICMJE uniform disclosure form, all authors declare that they received no financial support from any organization and report no conflicts of interest.
Availability of Supporting Data
The data used in this study include questionnaires and interviews conducted with participants. They are kept by the corresponding author and may be made available upon reasonable request while respecting confidentiality and anonymity requirements.
Funding
No funding was received for this study.
Declaration on the use of artificial intelligence
In the context of this academic work, generative artificial intelligence tools were used as an aid for certain tasks such as writing assistance, rephrasing, and improving the clarity of the text. These tools did not replace the author’s own analysis, critical thinking, or writing process. The entire content produced has been reviewed, adapted, and validated by the author, who assumes full responsibility for it.”
Authors’ Contributions
Odon Nzuzi Mabiala: Literature review, database management, statistical analyses, manuscript writing
Fiston Mbata: Statistical analysis, University of Kinshasa.
Hergy Bazungula Mumpasi: Data collection, data entry, and statistical analyses
Denise Pemba Lelo: Data collection, data entry, and statistical analyses
Nancy Makié Nancy: Data collection, data entry, and statistical analyses
Dadé Buangi Nsiangani: Data collection, data entry, and statistical analyses
Christian Kasongo Mwenze: Data collection, data entry, and statistical analyses
Justine Panzu Mavinga: Data collection, data entry, and statistical analyses
Magloire Nkosi Mpembi: Study design, literature review, statistical analyses, supervision