more likely to sustain serious injuries than heterosexual male victims. Sometimes victims become infected by a sexually transmitted disease as the result of rape, but it is infrequent and includes only a small portion of male victims. Psychological effects Rape victims, males and females, may find it difficult to report the sexual assault against them. There is a myth that a male sexual assault victim will become a perpetrator themselves. This myth is very damaging to victims, both to their mental states and to how people treat them. Elizabeth Donovan, a psychotherapist, stated that males have the added burden of facing a society that does not believe that rape can happen to them at all. The social stigmatization of male victims is also damaging and has been described as 'secondary victimization'. It has been linked to the under-reporting of rape and post-rape trauma; male victims are also susceptible to post-traumatic stress disorder. Some studies have found that some victims chose not to report their assaults as they fear being labelled as a 'closet homosexual', bisexual, or as promiscuous. Regarding the blaming of victims of rape, researchers, in 1993, conducted an experiment and found that a statistically significant proportion of males tend to blame the victim, even when the rape victim was a male. Long-term effects Compared to men who have not been sexually assaulted, men who were sexually assaulted before age 18 have a greater risk of having mental health problems, including symptoms of post-traumatic stress disorder and depression; alcoholism and drug abuse; suicidal thoughts and suicide attempts; problems in intimate relationships; and underachievement at school and at work. Because of gender expectations, being a male child victim of sexual abuse can lead to: Pressure to prove his manhood physically and sexually (becoming stronger and engaging in dangerous or violent behavior; having multiple female sexual partners). Confusion over gender and sexual identity. Sense of being an inadequate man. Sense of lost power, control, and confidence to his manhood. Problems with closeness and intimacy. Sexual problems. Fear of becoming 'homosexual' or 'gay'. Homophobia. Suicide possibility The suicide rate for sexually abused males is 14 to 15 times higher than for other males. McDonald and Tijerino found in their research that some participants state that there were occasions on which they felt so bad that they engaged in self-harming behaviors, including suicide attempts, and/or had suicidal thoughts. There is also a study