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MEDICAL PROFESSIONALS

The largest study of IPV injury patterns in men — a nationwide analysis of over 2 million IPV-related emergency department visits from 2005 to 2015 — found that an estimated 353,382 men presented to U.S. emergency departments with injuries from an intimate partner (Khurana et al., 2022). That’s roughly 32,000 men per year walking through your doors with injuries caused by the person who shares their bed.

Most of them didn’t tell you the truth about how they got hurt. And most of them were never asked.

A UK study found that only 1.6% of men — including self-identified male IPV victims — had ever been asked by a healthcare professional about potential IPV victimization (Morgan et al., 2014). In the U.S., 91.8% of male IPV victims who saw a medical doctor for their injuries were asked about the cause — but only 60.4% were truthful, and only 14% were provided any IPV resources (Douglas & Hines, 2011).

32,000 men per year go to the ER for IPV

WHAT INJURIES TELL YOU

Male and female IPV victims present with distinctly different injury patterns. If your screening criteria are calibrated for female victims — which they almost certainly are — you are missing male victims. The Khurana et al. (2022) study identified several critical differences.

Lacerations, not contusions, are the marker for male IPV.

In female victims, the signature IPV injury is contusion/abrasion — bruising from being struck. In male victims, the most common injury is laceration (46.9% of all male IPV injuries vs. 13.0% in women). This reflects a fundamental difference in how violence is perpetrated against men: women are significantly more likely to use knives, sharp instruments, and objects (Cho & Wilke, 2010; Brown, 2004; Kernsmith & Craun, 2008).

If you are looking for bruises to identify male IPV, you will miss nearly half of them. Look for cuts.

Cutting injuries are 8x higher in men — and more frequent in raw numbers.

98,856 men presented with cut/pierce injuries compared to 58,998 women — despite men representing only 17.2% of total IPV visits. Men were more likely than women to have been stabbed with a knife (6% vs. 1%), hit by a thrown object (10% vs. 3%), and hit by an object other than a gun (12% vs. 3%) based on NCVS data (Cho & Wilke, 2010). Women compensate for physical size and strength differences by using weapons (Chan et al., 2013; Purcell et al., 2021; Thureau et al., 2015).

Upper extremity injuries signal defensive wounds.

25.8% of male IPV injuries were to the upper extremity — arms, hands, and fingers — compared to 14.1% for women. In men, 68% of all upper extremity injuries were lacerations. The pattern — forearm lacerations, hand cuts, finger wounds — is consistent with a victim raising their arms and hands to block an attack from a sharp instrument (Khurana et al., 2021; Thomas et al., 2021). These are defensive injuries. Recognize them as such.

When men show up, they’re hurt worse.

Men were hospitalized at more than double the rate of women — 7.9% vs. 3.7% (p = .0002). The average male IPV patient was older than the average female patient (36.2 vs. 29.4 years). Men constituted more than one-third of all IPV victims over 60 years of age. The data supports what researchers call the “greater vulnerability/severity hypothesis” — men need additional vulnerabilities (such as age) or severity of injury to seek help at all (Khurana et al., 2022). The ones in your ED are the ones who couldn’t brush it off anymore.

Men only seek help when they can’t ignore it.

35.1% of male IPV victims in one study reported an injury severe enough to need medical attention. Only 18.1% actually went to a medical provider (Douglas & Hines, 2011). For every man you see in the ED with an IPV injury, there are roughly two more at home who needed to come in and didn’t.

Male vs. Female Injury Differences

HOW TO SCREEN FOR MALE IPV

Identifying male IPV victims in medical settings does not require a new system. It requires adapting the system you already use.

Ask the question — of every patient.

Universal screening for IPV should include men. The majority of male IPV victims in a UK study — including self-identified victims — felt that universal or targeted screening was necessary (Morgan et al., 2014). They want to be asked. They are waiting for someone to ask.

Ask him alone.

Do not screen for IPV with a partner present. This applies to male patients exactly as it does to female patients. If his partner is in the room, he will not disclose. Many of the men in the Hope et al. (2021) homicide reviews were never questioned alone.

Use behaviorally specific language.

Do not ask: “Are you a victim of domestic violence?” Most men will say no — even men actively being abused — because they do not identify with that language.

Instead, ask:

  • “Has your partner ever hit, pushed, shoved, cut, or thrown things at you?”
  • “Has your partner ever threatened you with a weapon or object?”
  • “Has your partner ever prevented you from leaving a room or your home?”
  • “Do you feel safe at home?”

These behavioral questions bypass the identity barrier. A man who will never say “I’m a victim” may readily say “yes, she’s done that.”

Know what to look for.

Based on the Khurana et al. (2022) findings, the following injury patterns in a male patient should raise clinical suspicion for IPV:

  • Lacerations — particularly to the head/neck and upper extremity — especially from sharp instruments
  • Forearm lacerations — the most common defensive wound pattern in male IPV victims
  • Hand and finger injuries — lacerations and fractures consistent with blocking attacks
  • Injuries inconsistent with stated mechanism — the same red flag you already know from female IPV screening
  • Repeat visits with unclear or changing injury explanations
  • Older male patients — men over 60 represent more than one-third of all male IPV ED visits

Know the demographic risk factors.

In the NEISS-AIP data, Black men were significantly overrepresented among male IPV patients (40.5% vs. 28.8% of female patients, p < .0001). Most U.S. studies of male IPV victims underrepresent Black men (Khurana et al., 2022). This suggests additional stereotypes and barriers that Black men must overcome to be recognized as victims.

Provide resources whether or not he discloses.

If you suspect IPV but the patient does not disclose, you can still provide resources: a printed card, a discreet pamphlet, a website. Tell him: “I see injuries like this in people who are dealing with difficult situations at home. If that ever applies to you, here’s where to find help.” That one sentence — delivered without judgment — may be what brings him back. Or what keeps him alive.

YOUR ROLE IN BREAKING THE CYCLE

You see patients that no other system catches.

90% of male IPV victims received no formal services at all (Bureau of Justice Statistics, 2019–2024). Many of the men who come through your ED or walk into your clinic will never call a hotline, never contact a DV agency, and never see a therapist. You may be the only professional encounter they have.

You are often the first professional to see the evidence.

Long before a man calls police or contacts a lawyer, his injuries bring him to you. That makes you the earliest potential point of intervention in the cycle of violence. A proper screen, a documented injury, and a resource card may be the difference between escalation and escape.

Your documentation matters in court.

In custody disputes and protection order hearings, medical records carry significant weight. Thorough, objective documentation of injuries — including mechanism, location, and patient-reported cause — provides evidence that can support a male victim in court. Incomplete or dismissive documentation does the opposite.

You can normalize help-seeking.

For a man who has been socialized to “take it” and who has been told by society that men don’t get abused, hearing a medical professional say “this looks like it may have been caused by someone close to you, and that’s something we take seriously” can be transformative. It tells him that what’s happening has a name, that it’s taken seriously, and that help exists. You may be the first person in his life to communicate that.

You can connect him to the right resources.

Keep a referral list of male-inclusive services available in your department:

  • Mental health professionals who understand male IPV (the most trusted and effective formal resource for men — 70.6% found them helpful)
  • Family law attorneys
  • The National Domestic Violence Hotline: 1-800-799-7233
  • Local shelters that accept men (if any exist in your area)
  • BecomingTheHero.com — a comprehensive resource built specifically for male survivors

HE NEEDS YOU

He’s Already in Your Waiting Room

Right now, somewhere in an emergency department in this country, a man is sitting on a gurney with a laceration on his forearm that he says came from a broken glass. He’s telling you what you want to hear because he’s been trained — by society, by the system, by experience — that telling the truth will either get him laughed at or arrested.

He is waiting for someone to ask the right question. He is waiting for someone to believe him if he answers. He is waiting for someone to hand him something — anything — that says help exists.

That someone is supposed to be you.

Ask the question. Believe the answer. Document what you see. And give him a way out.

32,000 men a year. They’re already in your waiting room.