The current study explores the unique impacts of female-perpetrated child sexual abuse (CSA) on male forensic patients. This research addresses various gendered stereotypes regarding sexual violence, particularly when committed by females against males. Utilizing data from 2,734 men assessed at the Royal Ottawa’s Sexual Behaviours Clinic between 1982 and 2024, the study explores how factors such as perpetrator gender, nature of abuse, and victim perpetrator relationship may influence victims’ sexual interests, perceptions of abuse, substance use, and physiological responses within penile plethysmography. Key findings suggest that female-perpetrated CSA may be underreported due to societal scripts that minimize the impact of female offending. Victims of female-perpetrated abuse often reported lower levels of coercion and were more likely to describe themselves as ‘willing participants’, highlighting how gendered expectations of masculinity may have an affect abuse reporting. The study also revealed that victims of female abuse tend to develop unique psychological and behavioural patterns, including higher rates of biastophilic and sadistic sexual interests. The results underscore the importance of expanding clinical approaches to encompass the complexities of female-perpetrated CSA, which has traditionally been overlooked in research. These findings contribute to a growing body of literature advocating for nuanced interventions for male victims of sexual violence, irrespective of the gender of the perpetrator.

• Female Offending; Child Sexual Abuse; Male Victims; Forensic Psychiatry; PPG

Gaw KM, Murray N, Gulati S, Tippins E, Murphy L, et al. (2025) Examining the Effects of Female-Perpetrated Sexual Violence on Phallometric Responses and Perceptions of Abuse. JSM Sexual Med 9(2): 1154

In recent decades, the long-term effects of sexual abuse at the hands of male perpetrators have been studied considerably, highlighting the impact of abuse on victims’ health and functioning [1]. However, there is a lack of research that explores the prevalence of female-perpetrated sexual violence and the subsequent psychiatric, developmental, and socio-criminological implications for the victims. In particular, male victims of female-perpetrated sexual violence are often faced with additional trauma and stigmatization related to gendered social scripts, which minimizes the violence, and creates feelings of shame and embarrassment related to one’s sense of masculinity [2,3]. The current study contributes to sexual violence literature by examining the prevalence rates of CSA in a sample of male forensic patients assessed for problematic sexual interests.

Prevalence of Female-Perpetrated Sexual Violence

Sexual abuse against children is universally viewed as an extensive and costly criminal justice and social problem [4,5]. CSA has been extensively associated with long-term negative outcomes such as psychosocial problems, substance use disorder and criminal offending [1,6,7]. It has been long established that the clear majority of sexual offenders are male. Current reported official prevalence rates indicate that women are responsible for approximately 4%-5% of all sexual offences [8,9]. However, statistics reported by criminal justice or social service systems may arguably suffer from underreporting practices and underestimate actual rates of female perpetrated sexual offending [9-11]. As such, the actual rate of sexual offending committed by females is expected to be substantially higher than noted in official statistics [9,12].

Through an exploration of victimization surveys, a meta-analysis by Cotoni [9], found prevalence rates of female perpetrated sexual offending that were six times higher than official reporting data. The National Intimate Partner and Sexual Violence Survey (NISVS), conducted in the United States by the Centers for Disease Control and Prevention (CDC), found that with respect to “made to penetrate” assaults (where the offender forced penetration by the victim upon themselves during the sexual assault), 79.2% of victimized men reported female perpetrators [13]. Research has further elaborated that men in the forensic system have been more likely than those in the general population to report female-perpetrated sexual abuse [14].

Male CSA

Recent advocacy has resulted in CSA being acknowledged as a trauma that affects boys in substantial numbers [15]. Gilbert et al. [16], found that 5% of boys have experienced penetrative sexual abuse, and that up to 15% of boys have experienced non-penetrative and non-contact sexual abuse. Furthermore, Fraser and colleagues (in press) recently found that 5.2% of men accused of sexual offences reported having sexual contact with one or more adult women when they were under the age of 16. Despite such statistics, research has found that men are far less likely to disclose or report sexual abuse when compared to females [17]. Denov [10], note that sexual scripts, cognitive frameworks and social gendered stereotypes are likely to play a role in a male’s perception of his abuse and whether it is worthy of reporting to authorities.

Research on male sexual victimization has been limited due to the misconception that it is rare, especially when involving female-perpetrators [18]. Social scripts have historically facilitated incorrect assumptions that male victims either initiate or enjoy sexual assaults perpetrated by women. Such assumption was affirmed in Fraser and colleagues (in press) work, that found men are significantly more likely to report child sexual contact with an adult as a willing event if the perpetrator of the abuse was a female. Further, sexual interaction between an adult female and a younger male has historically been “glorified” in society [19-21]. Such ideals about male sexuality have led some to argue that a man would still enjoy sex even if it is being forced upon him, a common rape myth identified by Houghton [22].

Rape myths are central to discourse of male victimization of sexual abuse. For example, rape myths about males include the notion that a “real” man would not allow themselves to be assaulted, and would be able to fight off an attacker, especially if the perpetrator is female [23-25]. Researchers have noted that within rape myths, the “obtainment” of women and sex are seen as male objectives and achievements [26], which makes male consent inherent to heterosexual encounters. The overarching impact of societal standards about male sexual violence has resulted in male victims being criticized for behaviour that contradicts masculine ideals relating to strength and power and may feel less inclined to report their abusers despite dealing with negative outcomes of the abuse.

Impact of CSA on male survivors

With respect to sexual victimization, Mathis [27], suggested that no harm can be inflicted without a penis. Despite popular beliefs about the lack of harm caused by women, various studies have found that victims of female sexual offenders report suffering similar traumatic effects as victims of male perpetrated sexual offences. In particular, negative outcomes associated with CSA include depression, rage, substance abuse problems, self injury, suicidal ideation, problematic relationships, and difficulties with sexuality [8,28-31].

A qualitative study by Denov [28], found that of their sample of survivors of female-perpetrated abuse (N=14), 85.7% of the male participants indicated feeling “damaged” by the experience, and of the individuals who reported being victimized by both male and female abusers, 100% reported that the female perpetration was more harmful. Additionally, all of the individuals interviewed reported a strong mistrust of women, with 29% reporting a desire to retaliate against female strangers [28]. These results are in line with theories that suggest early childhood traumatic exposure to sexual abuse may be associated with increased cognitive distortions [32-34].

The relationship between childhood sexual abuse, adverse mental health outcomes, and substance abuse has been well documented, with male CSA survivors being more likely than female CSA survivors to report substance use [35]. Boys victimized by female perpetrators may also be particularly predisposed to sexual and social maladjustment, as well as perpetration of adult sexual offences due to distorted interpretation of their childhood abuse as minimally harmful [36]. In combination, these findings highlight that while significant and similar harm is caused by female perpetrated CSA, the cognitive distortions associated with males who are victimized may result in unique and harmful symptomology.

The Current Study

The current study is a retrospective review of men who were assessed for questions of problematic sexual interests. In particular, the current study addresses the future directions outlined by Fraser et al. [36], in which they noted research must explore the outcomes experienced by men who were subject to female perpetrated childhood sexual abuse. Study participants were assessed in the Sexual Behaviours Clinic (SBC) at The Royal Ottawa Health Care Group (ROHCG) between 1982 and 2024. This study sample size expands the number of participants seen in Fraser and colleagues (in press).

The present study asks the primary research question: how do the characteristics of childhood sexual abuse influence a person’s perception of abuse, and responses within psychometric (i.e., scales measuring cognitive distortions, substance use) and phallometric assessments? In answering this question, we hope to deepen the understanding of specific characteristics related to sexual abuse, focusing on factors such as (a) the gender of the abuser, (b) the age of initial contact, (c) the relationship between victim and perpetrator, (d) the nature of the abuse, and (e) the methods of coercion employed by the abuser. The results from this study may strengthen clinical understanding of unique impacts of female perpetrated sexual abuse. These findings can help to guide patient centered treatment approaches.

Participants

The current sample was derived from 3,335 patients who had completed a sexual history assessment (Bradford Sexual History Inventory) as a part of their assessment at the SBC. 50 patients were female, and thus their data were removed due to missing phallometric data. Furthermore, 214 patients’ data were excluded due to their being below the age of 18 at the time of assessment, which meant that they did not undergo phallometric assessment. An additional 337 male patients’ data were removed due to missing data. The final sample is comprised of male patients (N = 2,734) above the age of 18 who were accused of a sexual offense or reported a paraphilic interest in their sexual behaviours assessment. All patients consented to their information being collected for research purposes as per Royal Ottawa Healthcare Group (ROHCG) guidelines at the time of assessment, and analysis of this data was approved by the ROHCG ethical review board (REB# 0016).

Measures

The Bradford Sexual History Inventory – Version 2: The BSHI is a self-administered questionnaire designed to investigate lifetime sexual interactions across various age groups. Inappropriate sexual contact is characterized by instances where participants reported engaging in sexual activities during childhood (sixteen and below) with individuals older than sixteen or twenty. Given that the language of the questionnaire refers to inappropriate interactions as sexual “contact” rather than sexual “abuse”, the methods and results are outlined in terms of “childhood sexual contact” as opposed to “childhood sexual abuse”.

Substance Use: The Michigan Alcohol Screening Test [37], and the Drug Abuse Screening Test-20 [38], employed widely in the general population to discern occurrences or behaviours suggestive of alcohol and drug abuse, were included to assess the salience of alcohol and substance abuse for the sample. Both the MAST and DAST have strong psychometric properties [37,39], with research finding the DAST to have an internal consistency reliability estimate at .92 [38].

Bumby Cognitive Distortion Scales: The cognitive distortions observed in sexual offenders are widely acknowledged to influence the development and persistence of deviant sexual behaviours [40]. The Bumby Cognitive Distortion Scales encompass two robust psychometric questionnaires, the MOLEST and RAPE Scales, designed specifically to assess these distortions in individuals who commit child molestation and rape of adults, respectively [40]. Research findings consistently affirm the scales’ utility in clinical and research settings, highlighting their strong internal consistency, reliability, and ability to distinguish between different types of cognitive distortions [40,41].

Penile Plethysmography Testing (PPG): Phallometric testing, also known as ‘Penile Plethysmography’ (PPG) has been widely recognized as a valuable tool for assessing sexual arousal in men [42-44]. Its primary application lies in evaluating male sexual arousal patterns, particularly amongst those with a question of child sexual interest [45]. Individuals undergoing circumferential assessment are presented with a variety of sexual and neutral stimuli, whereby fluctuations in penile blood flow are measured via a sensory gauge situated on the penis [46].

The testing stimulus administered within the SBC lab consists of an independent set of legal videotape stimuli, audiotaped stimuli, and a set of nude slides that have been used in the lab for more than 30 years. The videotape stimuli include both sexual and neutral videos. The audiotaped stimuli are used to compare sexual arousal responses between descriptions of sexual activity with children, adults, and a range of consenting, coercive, violent, and sadistic settings. Within the current study, only data from the audio series were analyzed (Table 1).

Table 1: Breakdown of Phallometric Data – Trials.

Pedophile Indices.

The data analysis for the phallometric component began with transforming raw penile tumescent data into arousal measures and indices. First, the degree of arousal, represented in millimeters (mm) of change, was measured by subtracting the circumferential measurement of the penis at flaccid (baseline level) from the highest level of arousal (peak level) reached during the presentation of each individual stimulus trial. Additionally, indices were calculated for each participant using mean erectile responses (calculated as millimeters of change from baseline to peak) to specific stimuli. Indices summarize the results of an examinee’s erectile responses to PPG stimuli and provide additional detail to help clinicians understand examinee sexual preferences to various scenarios. The indices for the current study are found in Table 2.

Table 2: Explanation of pedophile indices.

Within the lab, any score of 1.0 or higher is indicative of a positive preference in a clinical setting.

Statistical Analysis

Based on responses to inquires of inappropriate sexual contact, participants were categorized into four distinct groups based on the gender of the individual(s) who perpetrated the sexual abuse: No Child Sexual Contact (CSC) reported (NC), Female CSC (WO), Male CSC (MO), and Male and Female CSC (MWO). The subjects were compared across groups on demographic variables and features of the reported sexual interactions. Comparisons were performed using chi-square tests for categorical variables and ANOVA for continuous variables. All post hoc comparisons were performed using Tukey’s Honest Significant Difference (HSD).

Prevalence Rates of Childhood Sexual Contact

The current sample included 2,734 patients assessed at the Royal’s Sexual Behaviours Clinic in Ottawa, Ontario. Of the total sample, 77.1% (n = 2108), of the population identified as never having experienced childhood sexual contact (CSC) with an adult (NC group). Furthermore, whereas 13.0% (n = 356), of the population identified CSC with an adult man (MO group), only 5.3% (n = 144) of patients identified a CSC experience with an adult woman (WO group). Lastly, 4.6% (n = 126), of the total sample identified as having CSC with both men and women (MW group). More specifically, of the population who identified experiencing CSC with an adult (n = 626), 56.9% reported contact with a male (n = 356), 23% reported contact with a female (n = 144), and the remaining 20.1% reported contact with both males and females (n = 126).

Group Differences on Demographics

Demographics: Chi-square testing found the average age at the time of assessment varied significantly between the patient groups (F(3) = 4.83; p = .002; Table 3).

Table 3: Characteristics of Reports of Childhood Sexual Contact by Men (MO), Women (MO), both Men and Women (MW), and No Contact (NC) – ANOVA Results.

The participants in the WO group (M = 36.16, SD = 12.46), were younger than those in the MO (M = 40.88, SD = 12.64) and MW (M = 38.62, SD = 11.90), groups. The mean age of the NC group (M = 38.85, SD = 13.11), at the time of assessment was similar to that of the MW group. The results also demonstrated significant variation across groups with respect to the age in which participant groups first experienced CSC (F(3) = 8.51; p = < .001; Table 3). Those in the MW (M = 7.52, SD = 3.26) and MO (M = 8.11, SD = 3.0) groups displayed a younger average age of CSC onset than the WO group (M = 9.02, SD = 3.03).

Additionally, chi-square tests found significant variation across groups with respect to diagnoses of paraphilias (X2 = 85.46; p = < .001). The most common paraphilic diagnoses were incest and pedophilia, as seen in Table 4.

Table 4: Reports of Paraphilic Interest Across Comparison Groups - Childhood Contact by Men (MO), Women (WO), both Men and Women (MW), and No Contact (NC) – Chi-square results.

However, it is interesting to note that although each group that reported CSC had higher averages of pedophilia diagnoses than the NC group, the NC group had the highest average of incest paraphilias. Interestingly, the WO group had the lowest frequency of patients with no paraphilic interest (3.3%), compared to the MO (4.7%), NC (6.9%), and MW (7.1%) groups. Furthermore, patients in the WO group (9.2%), were more likely to have diagnoses of exhibitionism than the MO (7.8%), NC (3.2%), and MW (3.0%), groups. Patients in the WO (12.5%), group also displayed a higher frequency of biastophilic interest compared to the NC (8.5%), MW (8.1%), and MO (4.7%) groups. Relatedly, patients in the WO (6.7%), group were more likely to endorse sadistic interest than the MW (6.1%), NC (2.9%), and MO (1.8%) groups. Finally, the MO group (8.6%) displayed the highest average of hebephiliac diagnoses, compared to the NC (3.4%), WO (3.3%), and MW (3.0%) groups.

Characteristics of Childhood Sexual Contact

Frequency of contact: The current study also examined whether there was variation across groups with respect to parameters of the sexual contact experienced during childhood (Table 5).

Table 5: Characteristics of Reports of Childhood Sexual Contact by Men (MO), Women (MO), both Men and Women (MW), and No Contact (NC) - Chi-square Results.

In both age group sections (CSC age 12 or below and CSC from ages 13 to 16), participants indicated frequency of sexual contact with adults by checking one of the following ranges: a) Once, b) 2 to 5, c) 6 to 10, d) 11 to 50, e) 51 to 100, or f) Over 100 times. The results demonstrated that the frequency of sexual contact occurring in both the age sections varied significantly across groups (X2 = 165.98; p = <.001; X2 = 98.79; p = <.001; Table 5). With respect to CSC occurring at age 12 or below, contact with a male perpetrator was most likely to happen once (28.6%), while contact with a female perpetrator was most likely to happen 2 to 5 times (43.8%). With respect to CSC occurring from the ages of 13 to 16, contact with a male was most likely to happen 2 to 5 times (28.7%), while contact with a female perpetrator was most likely to happen once (34.1%).

Relationship to Adult: Our results demonstrated significant variance in characteristics of child sexual abuse compared across groups. Participants in the MW group were most likely to be abused by a stranger (42%), compared to the MO (33.4%) and WO (25%) groups (X2 = 792.39; p = <.001). With respect to abuse perpetrated by biological parents, participants in the MW group were most likely to report this relationship (29.4%), compared to the MO (6.7%) and WO (5.6%) groups (X2 = 454.71; p = <.001). Participants in the MW group (42%) were also more likely to report CSC with a stranger (X2 = 792.39; p = <.001), step-parent (X2 = 135.95; p = <.001) and other relatives (X2 = 820.59; p = <.001) than individuals in the MO (33.4%) and WO (25.0%) groups. In contrast, participants in the WO group (64.6%) were more likely to be abused by an acquaintance (X2 = 1337.80; p = <.001) than those in the MW (61.1%) and MO (47.5%) groups.

Type of Contact: With respect to the type of sexual contact reported, non-contact behaviour (e.g., exposing genitals, masturbating in front of the victim) was most likely to occur in MO perpetration (X2 = 580.50; p = <.001), while pornographic behaviour (i.e., watching pornography, creating pornography) was most likely to occur in MW perpetration (X2 = 293.17; p = <.001). Table 5 demonstrates that participants in the WO were significantly less likely to encounter non-contact sexual contact (X2 = 580.50; p = <.001), pornography-related sexual contact(X2 = 293.17; p = <.001), indecent communication (X2 = 46.81; p = <.001), being forced to have sexual relations with another child (X2 = 147.99; p = <.001), oral sex (X2 = 1185.78; p = <.001), and anal sex (X2 = 495.78; p = <.001); but significantly more likely to encounter vaginal penetration (X2 = 1022.89; p = <.001).

Levels of Coercion: With respect to the application of coercion by perpetrators, bribery was reported significantly more in the MO (49.7%) and MW (47.6%) groups than the WO group (22.9%) (X2 = 1095.15; p =<.001). Highlighted in Table 5, the use of threats (X2 = 581.49; p = <.001), physical force (X2 = 652.12; p = <.001), and physical harm (X2 = 178.12; p = <.001) were all most commonly reported in the MW group. Finally, participants in the WO group (68.1%) were significantly more likely than those in the MW (49.2%) and MO (27.0%) groups to report themselves as willing participants (X2 = 1161.65; p = <.001).

Group Differences on Study Measures

Substance Use: The current study also examined whether there was variation across groups with respect to a variety of different testing scores (Table 6).

Table 6: Characteristics of Reports of Childhood Sexual Contact by Men (MO), Women (MO), both Men and Women (MW), and No Contact (NC) – ANOVA Results.

Concerning the Michigan Alcoholism Screening Test (MAST), the results demonstrated significant variation across groups (F(3,290.62) = 28.78; p = <.001). Whereas the NC group had the lowest average score on the MAST (6.34), the MW group had the highest average score (15.09). The participant groups also demonstrated similar variation with respect to the Drug Abuse Screening Tool-20 (DAST) (F(3, 218.64) = 15.23; p = <.001). The results found that the MW group had the highest average score of 3.90, compared to the WO (3.43), MO (3.03), and NC (1.58) groups.

Sexual interests: Participant groups were also compared on measures of sexual interest and cognitive distortions. Significant differences were found between groups with respect to self-report scores of levels of sexual interest (F(3) = 7.92; p = < .001; Table 6). Results demonstrated that the NC group demonstrated the lowest average score (2.26), followed the MO (2.34), WO (2.64), and MW (2.71) groups. A post hoc Tukey test revealed that the variation between the NC and MO groups (p = .759), as well as between the MO and WO groups (p = .089), were insignificant. However, the variation between the NC and WO (p = .005), between the NC and MW groups (p = .001), and between the MW and MO groups (p = .031) did demonstrate significance.

Cognitive Distortions: While groups were compared across scales evaluating cognitive distortions regarding both adult and child sexual assault, significant differences were only found concerning cognitive distortions related to sexual abuse of children (F(3) = 4.36; p = .005). The direction of significance demonstrates that the NC group, on average, endorsed the least amount of cognitive distortions (M = 55.54; SD = 16.87), followed by the WO (M = 59.93; SD = 17.03), MO (M = 60.59; SD = 18.04), and MW (M = 61.33; SD = 18.94) groups. A post hoc Tukey test revealed that the significance can be found within the difference between the NC and MO groups (p = .017). There was no significance found within any of the other group comparisons related to cognitive distortions.

Phallometric Differences Between Groups

Finally, phallometric responses of patients were examined to determine if arousal responses differed between groups based on the characteristics of childhood sexual contact (Table 7).

Table 7: Phallometric Differences Represented in Indices – ANOVA Results.

With respect to average scores across the four indices examined, the results showed no significant variation across comparison groups. Notwithstanding, an ANOVA analysis demonstrated a higher mean Heterosexual Pedophile Index (HetPI) for patients who reported abuse by a stranger (M = 1.73) than those who had not been abused a stranger (M = 1.28) (t(1872) = -2.34; p =.010).

Furthermore, looking at the total sample of patients, not distinguishing between gendered groups, the average HetPI was found to be higher in those abused by their biological parents (M = 2.24) than those whose perpetrator was not a biological parent (M = 1.29), t(1872) = - 2.75; p =.003. Relatedly, those abused by biological parents demonstrated a higher average Homosexual Assault Pedophile Index (HomAPI) (M = 1.23) than those whose perpetrator was not a biological parent (M = .79), (t(1132) = -2.51; p = .006). Furthermore, individuals abused by an acquaintance displayed a significantly lower average score on the HetAPI (M = .59) than those who were not abused by an acquaintance (M = .75), (t(1893) = 2.44; p = .007). In contrast, those abused by an acquaintance had a significantly higher average score on the HomPI (M = 1.14) than those who did not report abuse by an acquaintance (M = .79), (t(1156) = -2.46; p = .007).

With respect to the type of sexual contact (Table 8), the average HomPI was found to be significantly lower in those who encountered digital penetration (M = .42) than those who did not experience digital penetration (M = .82) (t(1132) = 2.34; p = .010). Moreover, patients who experienced non-contact behaviour had significantly higher indices (M = 1.99) than those who did not experience non-contact sexual abuse (M = 1.27), (t(1872) = -3.31; p = <.001; Table 8).

Table 8: Phallometric Differences Represented in Indices – ANOVA Results.

Relatedly, the average HetPI and HetAPI values were found to be higher among individuals who reported experiencing forced sexual activity with other children (t(31.72) = -2.23; p = .010), oral sex (t(257.83) = -2.88; p = .002), digital penetration (t(36.42) = -2.66; p = .005), and vaginal intercourse (t(1872) = -3.22; p = <.001) than those who did not experience those behaviours. Phallometric responses with respect to the presence of coercion during sexual encounters were examined as well. However, the analysis did not produce significant results (Table 9).

Table 9: Phallometric Differences Represented in Indices – ANOVA Results.

Demographic differences between groups

In the current sample, nearly a quarter of men reported having experienced sexual contact with an adult during childhood. Similar to the findings in Fraser [47], roughly half of these men reported having been sexually abused by men only, and approximately a quarter of them reported having been sexually abused by women only; the remainder reported sexual contact with both men and women. In line with previous literature, these results indicate that women perpetrate a considerable proportion of CSA [9,36]. As noted by Fraser [36], who produced a similar finding, this result suggests that victims of female perpetrated sexual violence may be inflated within forensic populations, given that female perpetration identified in the current sample is nearly double that which has been reported in the general population [9].

The outcome that those abused by women entered the clinic at a younger age on average, than those abused by men, also echoed past findings (Fraser et al., in press) and offers new perspectives on the intersection of victimization and offending. Furthermore, the elevated incidence of biastophilic (sexual attraction to non consensual acts) and sadistic (pleasure derived from inflicting pain) interests among individuals abused by women offer valuable insights into the complexities of sexual interest development and its implications within forensic populations. Abuse by female perpetrators might involve unique power dynamics that challenge traditional gender roles and expectations. The experience of female perpetrated abuse could lead to internalized power imbalances or role reversals, potentially influencing the development of biastophilic, sadistic, or exhibitionistic tendencies as a means of processing or replicating these dynamics. In tandem, these results suggest that victims of female-perpetrated abuse may experience unique developmental trajectories that both contribute to the development of specific sexual interests and accelerate their involvement in problematic sexual behaviours.

Of further interest within the results on paraphilias is the higher average incidence of incestual interest among men without a history of childhood sexual abuse. These finding challenges conventional assumptions that direct experiences of abuse are the primary drivers of such paraphilic disorders [48,49]. Clinicians should consider that paraphilic interests, including incest, may develop through a range of psychological and developmental pathways that do not necessarily align with a history of abuse. This insight suggests a need for a broader exploration of factors influencing paraphilic disorders beyond abuse history.

Characteristics of child sexual abuse based on perpetrator gender

The different characteristics of child sexual abuse based on the gender of the perpetrator provides valuable insight into the influence gender have on CSA perpetration. The greater likelihood of women abusing children aged 12 or younger multiple times differed from findings in [47], and could reflect several factors related to the dynamics of female-perpetrated abuse. Women, often occupying roles of caretakers or authority figures in familial or institutional settings, might have increased access to younger children [50,51]. This access, coupled with the nurturing role typically associated with female caregivers, may facilitate prolonged and repeated abuse of younger victims.

Participants abused by women were less likely to report instances of coercion or force than those abused by men, and were also significantly more likely to report themselves as willing participants. These findings confirm results in Fraser and colleagues (in press), and can be explained through various psychological, sociocultural, and contextual frameworks. Such narratives suggest that male victims of female abusers might be less likely to report coercive or forceful elements of their experiences, due to internalized beliefs and cultural narratives that downplay female aggression [52,53]. Relatedly, cultural stereotypes surrounding female abusers as less dangerous or less likely to engage in coercive behaviour can contribute to a minimization of the abusive nature of the experience and a greater likelihood of self-reporting as a willing participant [54,55]. Psychological narratives suggest that male victims of female perpetrators might internalize societal narratives that frame female abusers as less threatening or less capable of coercion [56,57]. This can lead to cognitive dissonance, where victims may reframe their experiences to align with these narratives [24,58]. Overall, the results of the current study demonstrate how societal expectations about masculinity and victimization can impact how male victims of female abusers perceive and report their experiences.

Psychometric measures.

The results relating to alcoholism and drug abuse provides valuable insight into the influence of child sexual abuse on substance usage. The heightened levels of alcoholism among individuals abused by both genders may reflect the compounded psychological impact of experiencing abuse from multiple perpetrators. Exposure to sexual abuse by both male and female figures could lead to a more complex trauma experience, and the interaction of different abuse dynamics could compound feelings of betrayal, confusion, and instability, contributing to heightened psychological distress and instability, factors closely associated with the development of alcohol use disorders [59].

With respect to levels of sexual interest, the finding that those who did not experience sexual abuse as a child had the lowest score on the sexual interest measure suggests that sexual abuse experiences, regardless of the perpetrator’s gender, may be associated with higher levels of sexual interest. This finding is consistent with theories from [32-34], who note that early childhood traumatic exposure to sexual abuse may influence an individual to exhibit hypersexual behaviours as a coping mechanism.

In addition, the current study examined how experiences of CSA relate to the development of cognitive distortions. Given that the groups abused by men only and women only had comparable average scores with respect to distortions, the findings suggests that cognitive distortions related to abuse are not solely a function of the perpetrator’s gender. However, the finding that the Non-Contact group had lower cognitive distortions overall related to both adults and children indicates that cognitive distortions are a broader psychological response to the experience of abuse itself rather than specific to the characteristics of the perpetrator.

Phallometric data

Although many of the phallometric analyses did not produce significant results, some elements highlight points for future consideration and research. Indices are calculated by comparing responses to different stimuli and reflect the level of preference one has for either “consenting” sexual activity with children or violent/ coercive sexual activity with children. An ANOVA analysis demonstrated a higher average Heterosexual Pedophile Index (HetPI) for patients who reported abuse by a stranger than those who had not been abused a stranger. However, when comparing biological parents who perpetrated abuse against other kinds of abusers, pedophile indices in both the heterosexual and homosexual context were higher. Further research is needed to ascertain if closer relationships to sexual abusers increase arousal responses to pedophilic stimuli.

With respect to the type of sexual contact, the results demonstrated that those whose perpetrators engaged in contact or “hands on” offending had a lower average index in some categories than those who encountered non-contact forms of abuse. This would suggest that there is a relationship between non-contact abuse and higher responses to pedophilic stimuli. Contact sexual abuse typically involves direct physical interaction and may be perceived as more invasive and traumatic compared to non contact abuse [60]. The intensity and directness of contact abuse could lead to stronger psychological aversions or negative associations with sexual stimuli, including those that are pedophilic in nature. Men who experienced contact abuse might develop strong emotional responses such as fear, disgust, or aversion towards sexual stimuli that resemble their abuse experiences. These aversive responses could manifest as reduced physiological arousal to stimuli that are perceived as reminiscent of the abusive context. The results highlight a complex interplay between trauma-related stress and sexual arousal that could result in lower arousal to stimuli perceived as threatening or aversive.

Limitations

The first limitation to note for the current study was the use of the Bradford Sexual History Inventory as the main method for obtaining participants’ experiences of sexual contact under the age of 16. In particular, the questionnaire resulted in erroneous data, most of which was deleted within the 337 removed for reporting child sexual abuse but not reporting any detail on gender of perpetrator. Notwithstanding such data cleaning, ANOVA analysis found that 10.7% (n=38) patients that reported only having sexual contact with a male reported such contact including vaginal intercourse. While the differences in definition between “sex” and “gender” may have resulted in participants identifying a male as a person identifying as a male with a vagina, the BSHI should be revised to specify whether the question refers to biological sex or gender. Additionally, the use of dichotomously categorized gender reflects a stereotyped feminine and masculine that does not properly reflect the individuals experience of gender, which is likely much more dynamic [61]. It should also be noted that the current sample consists primarily of individuals who have come into contact with the forensic system, and it is thus not possible to generalize these results to the broader population. Furthermore, limitations to penile plethysmography assessment are outlined in Laws and Cotter [62,63].

Implications and Future Directions

The current study provides valuable implications for clinicians, sexual abuse theorists and society. For clinicians, the finding that nearly a quarter of our sample who had been abused during childhood were victimized by a female highlights the importance of broadening diagnostic frameworks and treatment approaches to encompass the full spectrum of perpetrator profiles. Survivors of female-perpetrated abuse might encounter unique challenges, including difficulties in acknowledging their experiences due to societal biases and expectations. The stigma surrounding female perpetrators can contribute to internalized shame and silence among survivors [28], complicating their healing process. Thus, clinicians must be adept at recognizing signs of trauma irrespective of the perpetrator’s gender and provide a supportive environment that validates the survivor’s experiences.

From a theoretical perspective, the high prevalence of sexual abuse by women in our study prompts a reevaluation of existing theories and models related to sexual abuse. Traditional theories often emphasize male perpetrators and may inadequately address the complexities introduced by female abusers. Our research points to a need for a broader theoretical framework that incorporates gender diversity in the perpetration of sexual abuse. The recognition of female perpetrators challenges the gendered narratives surrounding sexual violence and prompts a reconsideration of how societal norms and gender roles influence both the perpetration and experience of sexual abuse.

Overall, the current study has uncovered a research gap that must be addressed to challenge current gendered norms seen in sexual violence research. The earlier forensic entry associated with female-perpetrated abuse suggests that the dynamics of victimization, including the gender of the perpetrator, play a critical role in shaping developmental and offending trajectories. Theories of offending behaviour should be revised to include the effects of female-perpetrated abuse and the unique factors it may introduce into the offending process. Furthermore, the finding that individuals abused by both genders score higher on alcoholism screening tools underscores the need for a nuanced understanding of the relationship between complex trauma and substance use disorders within forensic populations. Addressing such research gaps will help inform treatment approaches for men who have experienced sexual violence by a female-perpetration, which can improve outcome measures for such victims of child sexual assault.

The authors would like to thank our research volunteers: Annabelle Belleville, Jorja Petrie and Liza Marshall for their help in completing data entry for client data to ensure this manuscript could be completed.

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