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Female Perpetrated
Sexual Abuse: A review of
victim and professional
perspectives
This a pre-publication, uncorrected proof and is provided for information only. The citation for
the published journal paper is: Clements, H., Dawson, D. L., & das Nair, R. (2013). Female-
perpetrated sexual abuse: a review of victim and professional perspectives. Journal of Sexual
Aggression, (ahead-of-print), 1-19.
which can be obtained from: www.tandfonline.com/doi/abs/10.1080/13552600.2013.798690
Page 1 of 34
Female Perpetrated Sexual Abuse: A review of victim and professional perspectives
Abstract
Professional attitudes towards female-perpetrated sexual abuse (FPSA) reportedly reflect the
gender-role expectations found in broader society, which cast males almost exclusively as
sexual aggressors or willing sexual-recipients, females as sexually non-coercive or victims,
and male-perpetrated sexual abuse as particularly significant or injurious. Such views,
however, appear to stand in contrast to the perspectives of individuals who have experienced
FPSA. This paper details a systematic review of peer-reviewed quantitative and qualitative
literature examining these different (professional and victim) perspectives. Although
methodological shortcomings of primary papers limit the conclusions that can be drawn,
findings suggest that victim and professional perspectives of FPSA remain discrepant;
professionals generally considered FPSA as less serious, less harmful and less deserving of
investigation than male-perpetrated abuse; whilst victims of FPSA felt their experience
significantly influenced their psychological wellbeing and ability to form and maintain
interpersonal relationships. These findings are discussed in relation to professional practice
and suggestions for future research.
Keywords
Female sexual abuse, perspectives, attitudes, impact
Page 2 of 34
Introduction
Recent studies suggest the disclosure of female-perpetrated sexual abuse (FPSA) is
increasing (Deering & Mellor, 2011). Whilst female perpetrators remain a minority compared
to males, it is estimated that they are responsible for 4-5% of sexual offences (Cortoni,
Hanson, & Coache, 2010). However, given that FPSA remains significantly under-reported
(Saradjian, 2010) with abused individuals often feeling unable to disclose (Denov, 2004), the
prevalence of FPSA may be significantly higher. Indeed, a recent casenote release from a
leading UK children’s charity reported that of the children contacting them directly to
disclose sexual abuse, females were cited as the main perpetrator in 36% of cases reported by
boys and 6% of those reported by girls (17% of total reported cases; ChildLine, 2009).
Gender expectations and constructions of femininity have been discussed as affecting
societal recognition and responses to FPSA (Allen, 1990; Hislop, 2001; Saradjian & Hanks,
1996) with some authors suggesting that a ‘culture of denial’ (Denov, 2001) exists which
places males almost exclusively within the role of aggressor or abuser and females in the role
of victim or the abused. Certainly victims often describe feeling silenced by the lack of
acknowledgement of FPSA in broader society (e.g. Allen, 1990; Bader, Scalora, Casady, &
Black, 2008; Hetherton, 1999; Mellor & Deering, 2010; Peter, 2006) and can feel isolated
from services because of their ‘unusual’ experience (Ogilvie & Daniluk, 1995).
Professional attitudes towards FPSA have previously been found to largely reflect the
gendered stereotypes found in broader society. Denov (2001) describes the topic of FPSA
provoking disbelief and discomfort amongst healthcare and law professionals, despite these
individuals having an increased likelihood of encountering victims of FPSA by virtue of their
professional roles. Denov (2001) found that both police officers and psychiatrists described
the professional culture and the training they had received as having an exclusively male-
perpetrator focus; one participant in particular described men as the “real perpetrators” (p314)
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and another remarked that “a woman doesn’t have the capacity to sexually assault, it’s not in
their nature” (p.315).
Of concern is that professional attitudes appear to impact on the level of support and
recognition victims of FPSA receive. Peter (2009) found that while 56.2% of referrals to
child welfare services for male abuse were made by professionals, only 35% of referrals for
female perpetrated abuse were made by professionals; the remaining two thirds were made by
concerned non-professionals.
The general hesitancy of professionals to recognise FPSA as a significant issue stands
in contrast to the experiences of victims of such abuse. The sexual acts carried out by females
against children are often similar to those perpetrated by males (Peter, 2009; Rudin,
Zalewski, & Bodmer-Turner, 1995) and the psychosexual impact of the abuse appears to be
as serious, if not more so, to that of male perpetrated sexual abuse (Denov, 2004; Kelly,
Wood, Gonzalez, MacDonald, & Waterman, 2002; Krug, 1989; Rosencrans, 1997). Still,
victims of FPSA report varied professional responses to their disclosures of abuse, including
disbelief or minimisation of the seriousness of the abuse (Denov, 2003, 2004; Hislop, 2001),
suggesting a stark divergence between the perspectives held by professionals regarding FPSA
and the experiences of victims. In this systematic review of peer-reviewed literature, we
examine these different perspectives, with the view that aggregating such information may
help to inform professional practice.
Method
Information Sources and Search Criteria
An overview of the literature selection process is outlined in Figure 1. The following
online social science and medical databases were searched (with period covered): PsycINFO
(1950-2011), Medline (1969-2011), EMBASE (1980-2011), CINAHL (2001-2011), British
Nursing Index AND Archive (1985-2011), AMED (1985-2011), Academic Search Elite
Page 4 of 34
(1985-2011), and Web of Science (1950-2011). Key terms used were: fem*
1
sex* off*, fem*
perp* sex* abus*, wom* perp* sex* abus*, wom* sex* abus* child*, victim*, surviv*,
profession*, healthcare profession*, perspect*, attitude*, belief*, response*, incest*, and
impact*. Terms were exploded and used singularly or in conjunction as appropriate to each
database.
Figure 1 about here
Inclusion and Exclusion Criteria
As a pragmatic minimum quality threshold, only peer reviewed academic papers were
included; theses, conference papers, books, policy papers and secondary literature (meta-
analyses) were excluded. Qualitative and quantitative studies available in English and
published between 1950 and 2011 were included. This broad timeframe and lack of
specificity regarding research methodology was in recognition of the narrow nature of the
topic and potentially slim number of relevant papers.
Studies were required to detail (1) the perspectives (e.g. attitudes, beliefs, views, etc.)
of adult men or women who had been sexually abused by an adult female(s) in childhood;
and/or (2) the perspectives (e.g. attitudes, beliefs, views, etc.) of legal and/or health or social
care professionals in relation to FPSA. Papers were only included if FPSA data were
independently reported or extractable (thus papers exploring sexual abuse by men and women
with merged data were excluded). Studies examining juvenile, child or adolescent female sex
1
The * suffix allows for truncation of the search term. For example the term fem* sex* off* will search for
female sex offender, female sexual offences, female sexual offenders, etc. providing a broader search of the
literature.
Page 5 of 34
offenders were also excluded. Papers reporting incest (e.g., mother-child abuse) were
included as child sex abuse appears to be most frequently intra-familial and most commonly
maternal in the case of FPSA (Saradjian & Hanks, 1996).
Study Selection
Initial database searches identified 595 studies potentially relevant for review. A title
scan and removal of duplicates by HC and DD independently saw 124 papers remain; these
papers were re-examined in more detail (abstract review) and the inclusion and exclusion
criteria below were applied independently by HC and DD. Any discrepancies related to the
application of inclusion and exclusion criteria were resolved through discussion or through
arbitration by RdN. In total, 101 papers were removed, leaving 23 papers eligible for full-text
review. The bibliographies of these selected papers were also examined via hand-search by
HC and potentially relevant full-text papers not identified during the initial search were
obtained (n=6). Application of inclusion and exclusion criteria to full-text articles resulted in
the further removal of 16 studies. Thirteen eligible studies remained and were included in the
review.
Data Abstraction
Studies were classified according to group: (1) Professional: legal and/or health or
social care professionals, and (2) Victims of FPSA. The general characteristics and key
findings were gathered for all studies and are tabulated in Table 1 (professional perspectives)
and Table 2 (victim perspectives). Data abstraction was conducted by HC and DD
independently and reviewed by RdN.
Table 1 about here
Page 6 of 34
Table 2 about here
Methodological Quality
Many standardised assessments exist to assess the methodological quality of
published research although debate regarding their value in systematic reviews persists (e.g.
Higgins & Green, 2008). Whilst these tools attempt to standardise the review process,
research suggests many assessments are unreliable, with quality conclusions being highly
variable (Jüni, Witschi, Bloch, & Egger, 1999). Furthermore, most quality assessments have
been developed for specific application to randomised control trials (RCTs) and thus have
little application within systematic reviews that focus on non-RCT studies.
As advocated by the Centre for Reviews and Dissemination (Tacconelli, 2010) and
others (e.g., Parker, 2004) we adapted an existing framework, the Newcastle-Ottawa Scale
(NOS; Wells et al., 2009) for the review of quantitative papers (see Table 3). For the
evaluation of qualitative papers, criteria were applied based on the recommendations of Tracy
(2010) on qualitative best practice (Table 4) as these criteria are coherent with other
qualitative assessment criteria (Kitto, Chesters, & Grbich, 2008; Yardley, 2000). The quality
of all studies was independently rated by HC and DD. If discrepancies between raters arose,
these were resolved through discussion with RdN as arbitrator.
Page 7 of 34
Results
Methodological Characteristics
Quantitative studies (Table 3).
Table 3 about here
Six studies used a quantitative methodology; four of these focussed on professional
perspectives (Gakhal & Brown, 2011; Hetherton & Beardsall, 1998; Kite & Tyson, 2004;
Mellor & Deering, 2010) and two on victim perspectives (Duncan & Williams, 1998; Kelly et
al., 2002). The quality of studies was variable; participant demographics were adequately
detailed in the majority of studies but not all, and sample representativeness ranged from
good (detailing the perspectives of psychologists, psychiatrists and child protection workers;
Mellor & Deering, 2010) to moderate (focussing on probation officers and non-professional
perspectives only; Gakhal & Brown, 2011).
Sample sizes ranged from 19 to 361 with a total of 984 participants across studies.
Inclusion and exclusion criteria were often indirectly reported rather than explicitly stated,
and blinding to the specific nature of the research was often not achieved or factored into the
research design. All studies adequately described the measures utilised therein, although
some studies used non-standardised measures (Duncan & Williams, 1998; Kite & Tyson,
2004) or adapted measures (Gakhal & Brown, 2011).
Other sources of potential methodological bias were considered; three papers used
analogue (vignette design) methodologies (Hetherton & Beardsall, 1998; Kite & Tyson,
2004; Mellor & Deering, 2010) which may provide good internal validity but potentially
compromise ecological validity (Holmes, Offen, & Waller, 1997). Two studies (Kite &
Tyson, 2004; Mellor & Deering, 2010) used postal recruitment methods, potentially leading
Page 8 of 34
to self-selecting sample biases, whilst two further studies (Duncan & Williams, 1998; Kelly
et al., 2002) utilised retrospective self-report methods which can be influenced by recall
biases.
Qualitative studies (Table 4).
Table 4 about here
Seven studies used qualitative methodologies; of these, one focussed on professional
perspectives (Denov, 2001) and six on victim perspectives (Deering & Mellor, 2011; Denov,
2004; Krug, 1989; Ogilvie & Daniluk, 1995; Peter, 2006, 2008). Sample sizes ranged from 3
to 23 with a total of 78 participants across studies.
Methodological quality of qualitative studies was assessed using criteria adapted from
Tracy (2010, see Table. 4). In terms of Rich Rigour (the degree to which a study is considered
sufficiently rigorous in terms of method, data collection and analysis), a common limitation
across studies was the overall absence of methodological description, including research
process, data collection, analysis and transcription (Denov, 2001; Krug, 1989; Peter, 2006,
2008), with only one study (Denov, 2004) providing comprehensive detail in this regard.
Most studies demonstrated some level of Reflexivity (the degree to which the
researchers make explicit their own subjective biases and reflect upon how these may impact
on the research process and findings),with two in particular offering detailed accounts of the
subjective values, biases, and dispositions of the authors, promoting transparency of method
(Peter, 2006, 2008). Similarly, most studies demonstrated some level of Credibility,
highlighting the plausibility of the research findings given the methods utilised and the depth
of description conveyed within the analysis. One study (Krug, 1989), however, was
Page 9 of 34
particularly limited in this regard, with unexplained interpretations informed by the author’s
‘psychodynamic lens’.
All studies were considered to have made a Significant Contribution to the research
area by informing the perspective of potential readers or providing knowledge that could be
transferred across different contexts, or to have particular Resonance, either in terms of a
persuasive narrative (Peter, 2006, 2008) or potential clinical impact (Denov, 2004; Mellor &
Deering, 2010; Ogilvie & Daniluk, 1995). Similarly, all studies achieved a level of Ethical
Clarity through consideration of the broader ethical implications of the research, and all
achieved a level of Meaningful Coherence by utilising appropriate theory, methods and
procedures to address the stated research aims.
Key Findings: Professional Perspectives
Although professional respondents broadly recognised FPSA as a serious issue
(Hetherton & Beardsall, 1998; Mellor & Deering, 2010) there was a general trend across
studies to minimise the gravity and impact of FPSA – particularly when compared to abuse
perpetrated by males (Denov, 2001; Gakhal & Brown, 2011; Hetherton & Beardsall, 1998;
Kite & Tyson, 2004). Professionals commonly reported more favourable attitudes towards
female than male perpetrators (Gakhal & Brown, 2011), with a tendency across studies for
professionals to indicate that social services involvement (Hetherton & Beardsall, 1998;
Mellor & Deering, 2010), and police investigation, prosecution and imprisonment (Hetherton
& Beardsall, 1998; Kite & Tyson, 2004; Mellor & Deering, 2010) were significantly less
appropriate in FPSA cases than in cases involving a male perpetrator. Interestingly, Hetherton
and Beardsall (1998) also found that perpetrator gender was considered a significant factor
when assessing the believability of an abuse allegation, and Kite and Tyson (2004) found that
length of professional service appeared to negatively correlate with perceptions of
seriousness of FPSA and the need for further investigation amongst police officers. Although
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some discrete examples were apparent within the literature (e.g. Hetherton & Beardsall,
1998; Mellor & Deering, 2010), no consistent significant differences between the
perspectives of male and female professional respondents, or between different professional
groups, were strongly evident across studies.
Key Findings: Victim perspectives
The majority of studies detailing victim perspectives focussed on the effect of FPSA
on interpersonal relationships. Recurrent themes of victims feeling betrayed by their female
abuser (Denov, 2004; Ogilvie & Daniluk, 1995; Peter, 2006, 2008) having significant
difficulties forming, maintaining, or functioning within adult relationships (Deering &
Mellor, 2011; Duncan & Williams, 1998; Kelly et al., 2002; Krug, 1989; Peter, 2008) having
a deep mistrust of women (Deering & Mellor, 2011; Denov, 2004; Peter, 2008) and feeling
socially isolated (Deering & Mellor, 2011; Ogilvie & Daniluk, 1995; Peter, 2008) were
evident across studies. Victims of FPSA also reported mistrust of professionals, either
through fearing that their disclosure of FPSA would be disbelieved (Peter, 2008) or through
having direct experience of such professional responses (Deering & Mellor, 2011; Ogilvie &
Daniluk, 1995).
The impact of FPSA specifically on sexual relationships was also highlighted within
some studies, with participants reporting increased sexual difficulties (Kelly et al., 2002),
sexual discomfort (Denov, 2004), sexuality confusion (Deering & Mellor, 2011; Denov,
2004; Duncan & Williams, 1998) or in some cases increased sexual promiscuity or
problematic sexual behaviour during adolescence (Duncan & Williams, 1998) and/or
adulthood (Deering & Mellor, 2011; Duncan & Williams, 1998; Krug, 1989).
All studies focussing on victim perspectives also detailed some aspect of the impact
of FPSA on psychological wellbeing. Victims reported self-hatred, low self-esteem, and self-
loathing (Deering & Mellor, 2011; Ogilvie & Daniluk, 1995), deserving of further abuse
Page 11 of 34
(Ogilvie & Daniluk, 1995), feeling dirty (Peter, 2008), and feeling stigmatised and shamed
(Ogilvie & Daniluk, 1995; Peter, 2008). Increased prevalence of depressive symptomology
was also commonly reported (Deering & Mellor, 2011; Denov, 2004; Krug, 1989) as was
suicidality, self-injury (Denov, 2004) and dissociation (Kelly et al., 2002) in addition to
potential maladaptive coping strategies such as substance misuse (Denov, 2004), drug
addiction (Krug, 1989; Peter, 2008) and increased alcohol consumption (Peter, 2008).
Victims also commonly reported elevated anger and aggression (Deering & Mellor, 2011;
Denov, 2004; Kelly et al., 2002; Peter, 2006), either in response to what they perceived as
their ‘loss of innocence’ (Deering & Mellor, 2011), their current level of overall functioning
(Kelly et al., 2002) or anger directed specifically towards their female abuser (Denov, 2004).
It is important to note, however, that not all victims reported negative psychological
sequelae as a result of FPSA; some individuals reported a sense of confusion regarding their
experiences, feeling a mixture of positive and negative emotions towards the abuse,
themselves (Deering & Mellor, 2011; Ogilvie & Daniluk, 1995) and the perpetrator (Peter,
2006). One participant in Denov’s (2004) study felt that the abuse had not caused him any
long-term harm, although Denov notes that that individual also had adult convictions for
sexual offences against children. Kelly et al. (2002) found that some individuals who had
experienced mother-son incest had positive and mixed feelings about the abuse at the time of
the abuse, although due to the retrospective nature of the question posed (e.g. ‘At that time [of
the abuse], did you feel that this sexual experience was abusive?’; p.429, parentheses added)
it is not clear from the study whether these perceptions were accurate (e.g. retrospective bias)
or continued into adulthood. Two participants within Deering and Mellor’s (2011) study
reported feeling ‘physically strong’ following their experience of FPSA, a finding the authors
suggested may be related to the different sexual experiences of these participants compared to
their age-related peers. Positive initial perceptions of FPSA have previously been identified
Page 12 of 34
amongst male survivor samples (Haugaard & Emery, 1989) suggesting that perceptions may
be influenced by gender. However, FPSA has been suggested to be most affecting when the
perpetrator is related to the victim, if the abuse occurred during childhood or infancy, and if
the abuse was experienced as coercive (Kelly et al., 2002).
Discussion
This review explored perspectives of FPSA from the viewpoint of both victims of
such abuse and the individuals who may come into contact with them by virtue of their
professional roles. In general terms, the findings suggest a level of disparity between the two
groups; whilst no professionals entirely dismissed the potentially harmful impact of FPSA,
there was a tendency for the seriousness of such abuse to be minimised or to warrant less
professional or legal attention than male-perpetrated abuse. In contrast, however, the majority
of victims of FPSA reported that the abuse had had a significant impact on their
psychological wellbeing, including their ability to form and maintain healthy social and
sexual relationships – a finding consistent with the reports of individuals who have
experienced male-perpetrated sexual abuse (e.g. Davis & Petretic-Jackson, 2000; Neumann,
Houskamp, Pollock, & Briere, 1996).
The reasons for discrepancies between victim and professional perspectives are likely
to be complex, but are perhaps rooted in the way in which society understands womanhood
and femininity. Culturally, women are viewed as nurturers, mothers and sexually submissive
when compared to males (Allen, 1990). The suggestion that women can be sexually abusive
provokes unease and disbelief, and as Mayer observes (1992, p.5): “society does not perceive
females as abusers; they are stereotyped as physically and psychologically incapable of
victimising”. Indeed, the concept of sexually abusive women appears to provoke such
discomfort that society may try to reframe or transform the phenomenon into something
explainable (e.g. women perpetrators are coerced by men or are profoundly mentally unwell;
Page 13 of 34
Denov, 2004). Traditional sexual scripts not only potentially constrict the ability of society to
acknowledge ‘unconventional’ narratives about sexual abuse (Finkelhor & Russell, 1984),
but also appear to facilitate more lenient (or sometimes dismissive) attitudes and beliefs
amongst professionals towards females who sexually abuse and the victims of such abuse.
Given such a societal context, it is perhaps not surprising that many victims do not
disclose FPSA, and of those who do, significant proportions report not being believed
(Deering & Mellor, 2011). Professional minimisation has damaging implications for victims
who already fear judgement (Ogilvie & Daniluk, 1995) and there appears to be a need for
professionals to broaden their conceptualisation of sexual abuse to account for the
experiences of these individuals.
Another common finding across studies was the impact of FPSA on intimate and
social relationships, underpinned by a mistrust of others (particularly women; Deering &
Mellor, 2011; Duncan & Williams, 1998; Krug, 1989; Peter, 2008). Pervasive mistrust has
implications for therapeutic relationships and is likely to lead to hesitation when confiding in
professionals; in turn, disbelieving or invalidating professional responses may have serious
deleterious effects for individuals trying to move towards rebuilding their capacity to trust
others and receive support. Furthermore, FPSA also appears to impact on some individuals’
senses of self and esteem, with some victims reporting that they ‘deserve’ further abuse
(Ogilvie & Daniluk, 1995); this may reduce these individuals’ abilities to challenge unhelpful
professional responses, or to feel further shamed and stigmatised by such responses. In
contrast, positive and informed professional responses are likely to be important if victims are
going to seek help and to benefit from the therapeutic process; professionals thus have a duty
to ensure that such experiences are acknowledged, accepted, and discussed as sensitively as
male perpetrated abuse. However, it appears from the literature sourced for this review that
more research on the specific factors that contribute to therapeutic progress with individuals
Page 14 of 34
who have experienced FPSA would be beneficial, as would a clearer understanding of the
factors that may facilitate or inhibit their disclosure of FPSA to relevant professionals. This
research would inform professional practice and would help to bridge the current gap
between victim and professionals’ perspectives of FPSA.
Limitations
This review offers a systematic overview of current literature in the field, providing a
comparative view of perspectives on FPSA at a time of increased media attention and interest
in female violence and ‘dangerous women’ (McIvor, 2004). However, there are a number of
limitations within the current review and the broader literature which limit the conclusions
that can be made. Firstly, only academic peer-reviewed literature was included, excluding
unpublished and published non-peer-reviewed findings. Although this exclusion criterion was
introduced in order to theoretically improve scientific and methodological quality, given the
limited research in this area and the potential for publication bias, future reviews would
benefit from sourcing so-called ‘grey literature’ and policy documentation.
Secondly, the selected studies varied significantly according to quality, and whilst all
papers were considered as offering a meaningful contribution to a largely under-researched
area, the absence of methodological clarity and transparency (particularly within the sourced
qualitative papers) is noted. In the current review, considerable differences in methodology
(e.g., vignette design, semi-structured interviews, postal questionnaires, etc.), procedural
robustness, sample sizes, and poor transparency of analysis (particularly in qualitative papers)
were all apparent across studies, limiting the ability to synthesise findings into a fully
coherent and accurate narrative, and to generalise the findings to broader samples.
Thirdly, our decision to include studies which used both qualitative and quantitative
methodologies undoubtedly compounded the heterogeneity within the reviewed studies,
Page 15 of 34
although excluding research on the basis of the methodology utilised rather than on
methodological quality alone is similarly problematic and may overlook key information.
Finally, the terminology we adopted (e.g., victim) may have had a significant effect
on the literature identified and reviewed, and therefore the perspectives obtained: individuals
who have similar experiences to those reported here – but who do not identify with the label
‘victim’ – may hold very different perspectives regarding their experiences. Future research
examining the effects of terminology on perceptions, disclosure decisions, and psychological
sequelae would be beneficial to further clinical and academic understanding of these
potentially complex interactions.
Page 16 of 34
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Abuse. Journal of Interpersonal Violence, 24(7), 1111-1128.
Rosencrans, B. (1997). The last secret: Daughters sexually abused by mothers: Safer Society
Press (Brandon, Vt.).
Rudin, M. M., Zalewski, C., & Bodmer-Turner, J. (1995). Characteristics of child sexual
abuse victims according to perpetrator gender. Child abuse & neglect, 19(8), 963-973.
Saradjian, J. (2010). Understanding the Prevalence of Female Perpetrated Sexual Abuse and
the Impact of That Abuse on Victims. In T. A. Gannon & F. Cortoni (Eds.), Female
Sexual Offenders: Theory, Assessment and Treatment (pp. 9-30). Chichester, West
Sussex: Wiley-Blackwell.
Saradjian, J., & Hanks, H. G. I. (1996). Women who sexually abuse children: From research
to clinical practice: John Wiley & Sons New York, NY.
Tacconelli, E. (2010). Systematic reviews: CRD's guidance for undertaking reviews in health
care. The Lancet Infectious Diseases, 10(4), 226.
Tracy, S. J. (2010). Qualitative quality: Eight “big-tent” criteria for excellent qualitative
research. Qualitative inquiry, 16(10), 837-851.
Wells, G., Shea, B., O’Connell, D., Peterson, J., Welch, V., Losos, M., & Tugwell, P. (2009).
The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised
studies in meta-analyses. Ottawa Health Research Institute.
Page 20 of 34
Yardley, L. (2000). Dilemmas in qualitative health research. Psychology and Health, 15(2),
215-228.
An asterisk (*) denotes that the paper was incorporated within the current review.
Page 21 of 34
Figure 1. Quorum diagram outlining the selection process
Articles identified for title/abstract
review (n=124)
Potentially eligible articles
accessed in full copy (n=49)
Full text articles considered for
inclusion (n=23)
Articles included for review
(n=13)
Articles excluded:
dissertations, theses, conference
papers, editorials, book reviews, book
chapters, not specifically female
perpetrators, policy documents, or
duplicates (n=75)
Articles excluded:
merged female and male perpetrator
data, focus on comparing
professional groups rather than
FPSA, focus on respondent gender
rather than perpetrator gender, adult
victims of FPSA or non-professional
samples (n=16)
Hand search:
articles identified from reference
lists of relevant studies, and
retrieved for examination (n=6)
Articles excluded:
focus not on FPSA, juvenile and
child perpetrator samples, FPSA
typology studies, prevalence
studies or reviews (n=26)
Papers retrieved from online database searches
(n=595)
Page 22 of 34
Table 1. General characteristics and key findings of studies reporting professional perspectives
Author(s) and Location
Methodology
Sample Characteristics
Summary Points and Key Findings
1. Mellor & Deering (2010)b
Australia
Quantitative
Questionnaires
Vignettes
Analysis
Inferential statistics
Professional Perspective
Psychologistsc (n=127)
Psychiatrists (n=43)
Child Protection Workers (n=61)
Total (N=231)
Gender
Females (n=172)
Males (n=59)
Age range
<35 years (n=75)
35 to 50 years (n=89)
>50 years (n=67)
All professionals indicated Social Services involvement**, investigation**,
prosecution***, and imprisonment*** more appropriate when perpetrators are male
compared to female
All professionals indicated male-perpetrated abuse more negatively affects victims than
FPSA***
Female respondents believed victims of FPSA would be less negatively affected than
victims of male perpetrators** and felt prosecution of female perpetrators not
appropriate** compared to male respondents
Both male and female respondents felt imprisonment of female perpetrators was less
appropriate** than imprisonment of male perpetrators
Psychologists less likely to consider imprisonment of female perpetrators as appropriate
than other professionals**
Child Protection workers considered female sexual abuse as more serious and warranting
further attention compared to other professionals***
b
Only the authors’ key findings and main effects (p<.01) are reported here to protect against potential Type 1 error associated with multiple comparisons.
c
The term ‘psychologist’ combines both ‘psychologists’ (n=99) and ‘probationary psychologists’ (n=28) from the original paper.
Page 23 of 34
Table 1. General characteristics and key findings of studies reporting professional perspectives
Author(s) and Location
Methodology
Sample Characteristics
Summary Points and Key Findings
2. Hetherton & Beardsall
(1998)
UK
Quantitative
Questionnaires
Vignettes
Analysis
Inferential statistics
Perspective
Social workers (n=65)
Police (n=65)
Total (N=130)
Gender
Females (n=64)
Males (n=66)
Age range
35 to 44 years
All groups highly endorsed attitudes that FPSA exists, is harmful, and felt therapy
suitable for both perpetrators and victims
Evidence of minimisation of FPSA across professionals: all groups felt that registration of
incidents of male perpetrated abuse was significantly more appropriate than registration
of FPSA incidents* and considered imprisonment to be significantly more appropriate for
male perpetrators than females**
Perpetrators gender was considered significant to professionals when rating believability
of abuse allegation**
Female social workers felt prosecution was more appropriate for female perpetrators**
and viewed therapy for victims as more appropriate than did police women**
Male social workers considered social services involvement less necessary in FPSA
cases**
Policemen felt imprisonment less appropriate for female offenders** and perceived
female abusers as less harmful compared to other professionals**
3. Kite & Tyson (2004)
Australia
Quantitative
Questionnaire
Vignettes
Analysis
Inferential statistics
Professional Perspective
Police (n=361)
Total (N=361)
Gender
Females (n=202)
Males (n=159)
Age range
19 to 57 years (M=34 years)
Overall, FPSA was considered less serious**, as having potentially less impact on the
victim**, and requiring less police action** than male perpetrated sexual abuse
There was no relationship between perceived seriousness, impact or the need for action
and police officer gender
Length of professional police service correlated negatively with perceived seriousness*,
need for further action**, and perceived impact on victim*
Page 24 of 34
Table 1. General characteristics and key findings of studies reporting professional perspectives
Author(s) and Location
Methodology
Sample Characteristics
Summary Points and Key Findings
4. Denov (2001)
Canada
Qualitative
Semi-structured
interviews
Direct observation
Analysis
Not stated - query
Discourse Analysis
Professional Perspective
Police Officers (n=13)
Psychiatrists (n=10)
Total (N=23)
Gender
Females (n=5)
Males (n=18)
Age range
35 to 60 years
Professional training only focusses on males as sexual offenders/aggressors
Professional language reflects these gendered stereotypes
Professional narratives minimise female sexuality, violence and ability to be perpetrators
Constructions of female sex offenders as harmless (e.g., educating male victim), not
dangerous, and reconstructing the nature of abuse (e.g., male victim enjoyed sexual act)
apparent in discourse
Potential implications:
o Professionals less likely to intervene in FPSA cases
o Perpetrators will not develop insight
o Re-victimisation of victims whose accounts are overlooked or minimised
5. Gakhal & Brown (2011)
UK
Quantitative
Questionnaire
Analysis
Inferential statistics
Professional Perspective
Public (n= 92)
Probation Officers (n=20)
Psychology students (n=64)
Total (N=176)
Gender
Not stated
Age range
Not stated
Probation officers held more positive attitudes towards female sex offenders than samples
of the public and students***
Probation officers reported significantly more positive attitudes towards male sex
offenders than previously published professional attitudes (prison officers, probation
officers and psychologists; Hogue, 1993; Craig, 2005, cited in Gakhal & Brown,
2011)***
Note: For quantitative studies the following significance indicators are used: * p<.05; **p<.01; ***p<.001
Page 25 of 34
Table 2. General characteristics and key findings of studies reporting victim perspectives
Author(s) and Location
Methodology
Sample Characteristics
Summary Points and Key Findings
6. Peter (2008)
Canada
Qualitative
Semi-structured
Interviews
Analysis
Not Stated
Victim Perspective
Total (N=8)
Gender
Females (n=8)
Males (n=0)
Age range
Adults – age not stated
Abuse Perpetrator
Mother (n=6)
Grandmother (n=1)
Stepmother (n=1)
Victim age at onset
6 -13 years
Duration of abuse
7 years (mean)
Form of abuse
Genital contact/fondling (n=8)
Oral sex/penetration (n=5)
Coping strategies (living with FPSA)
o Resilience - school, friends, culture
o Destructive strategies – self injury, drug and alcohol use, running away
o Seeking expert help as adults – mixed disclosure experiences, feeling excluded
from mainstream support services
Resisting (living through FPSA)
o Methods - hiding, dissociation, escape and suicide
o Silent ways of ‘saying no’, showing resilience within abuse
o Betrayals – fearing disbelief of disclosure, disclosing male but not female abuse
o FPSA was undetected by child and family services
Surviving abuse (moving on)
o Mistrust in women
o Betrayal – shattered construction of women as caring
o Isolation – withdrawing, feeling ‘dirty’
o Poverty – result of trauma, rebuilding lives
o Race – limiting access and treatment by services
Implications
o Constructions of women and violence as barriers to recognition of FPSA
o Wider themes around: stigmatisation, lowered self-esteem, impaired identity
development and difficulty forming relationships acknowledged but not fully
explored
Page 26 of 34
Table 2. General characteristics and key findings of studies reporting victim perspectives
Author(s) and Location
Methodology
Sample Characteristics
Summary Points and Key Findings
7. Ogilvie & Daniluk (1995)
Canada
Qualitative
Unstructured clinical
interview
Analysis
Phenomenological
Analysis
Victim Perspective
Total (N=3)
Gender
Females (n=3)
Males (n=0)
Age range
34.3 years (mean)
Abuse Perpetrator
Mother (n=3)
Victim age at onset
Infancy
Duration of abuse
6 to 11 years
Form of abuse
Voyeurism, exploitation, kissing,
fondling, oral sex, vaginal & anal
penetration
Shame and Stigmatisation
o Isolation and feeling ‘different’
o Shame of having been abused by a female perpetrator specifically
o Reinforced by society’s stereotypes of women
o Responses of disgust and disbelief from professionals
Sense of Betrayal
o Shared gender with mothers who should be ‘caring’ and ‘empathic’
Self-Blame
o Doubt, self-hate and low self-esteem
o Self as ‘wrong’ and ’deserving’
Identification with and differentiation from mother
o Identity conflict and confusion
o Fear of being a mother and abuser
Page 27 of 34
Table 2. General characteristics and key findings of studies reporting victim perspectives
Author(s) and Location
Methodology
Sample Characteristics
Summary Points and Key Findings
8. Krug (1989)
USA
Qualitative
Unstructured clinical
interview
Analysis
Not stated
Victim Perspective
Total (N=8)
Gender
Females (n=0)
Males (n=8)
Age range
29 years (mean)
Abuse Perpetrator
Mother (n=8)
Victim age at onset
Infancy to teens
Duration of abuse
Not specified
Form of abuse
Intercourse, intimate sexual contact,
sexual aggression and ‘seductiveness’
All participants expressed difficulties maintaining long-term relationships
Seven participants were carers for their parent (perpetrator)
Seven participants experienced depression in adulthood
Six participants reported multiple concurrent sexual partners
Five participants reported becoming significantly involved with drugs and had multiple
presenting problems
Three participants reported ‘sexual identity problems’
Page 28 of 34
Table 2. General characteristics and key findings of studies reporting victim perspectives
Author(s) and Location
Methodology
Sample Characteristics
Summary Points and Key Findings
9. Kelly, Wood, Gonzalez,
MacDonald & Waterman
(2002)
USA
Quantitative
Questionnaires
Analysis
Inferential statistics
Victim Perspective
Total (N=19)
Gender
Females (n=0)
Males (n=19)
Age range
18 to 57 years (mean 33.7 years)
Abuse Perpetrator
Mother (n=17)
Other female (n=2)
Victim age at onset
6.8 years (mean)
Duration of abuse
3.8 years (mean)
Form of abuse
Not specified
Mother-son incest found to relate to increased sexual problems*, dissociation*,
aggression* , interpersonal problems** and total symptomology* on a self-report
problem checklist
Individuals abused by females were more likely to report heterosexual sexual orientation
than those abused by males only*
Mother-son incest linked to positive and ‘mixed’ perceptions of abuse*
Page 29 of 34
Table 2. General characteristics and key findings of studies reporting victim perspectives
Author(s) and Location
Methodology
Sample Characteristics
Summary Points and Key Findings
10. Denov (2004)
Canada
Qualitative
Semi-structured
interview
Analysis
Not stated – query
Thematic Analysis
Victim Perspective
Total (N=14)
Gender
Females (n=7)
Males (n=7)
Age range
23 to 59 years
Abuse Perpetrator
Mother (n=6)
Mother & intrafamilial female (n=3)
Sister & neighbour (n=1)
Extrafamilial female (n=4)
Victim age at onset
5 years (mean)
Duration of abuse
6 years (mean)
Form of abuse
Severe (n=9; intercourse; penetration)
Moderate (n= 10; contact; fondling)
Mild (n=14; kissing; sexual invitation)
Seven victims (50%) had been abused by men and women - all rated the FPSA as more
harmful and more damaging
Victims abused by women reported a greater sense of betrayal
93% (n=13) of victims reported the FPSA as damaging and difficult to recover from
Reported long-term effects of FPSA included: substance misuse (57%), self-injury (36%),
suicidal ideation (79%), suicide attempts (55%), depression (64%), rage (100%), rage
towards abuser (36%), mistrust of women (100%), retaliation against women (29%), self-
concept and identity issues (57%), discomfort with sex (100%), fear of abusing children
(86%), and reported sexual abuse of children (29%)
Page 30 of 34
Table 2. General characteristics and key findings of studies reporting victim perspectives
Author(s) and Location
Methodology
Sample Characteristics
Summary Points and Key Findings
11. Peter (2006)
Canada
Qualitative
Semi-structured
interviews
Analysis
Not stated
Victim Perspective
Total (N=8)
Gender
Females (n=8)
Males (n=0)
Age range
Adults – age not stated
Abuse Perpetrator
Mother (n=6)
Grandmother (n=1)
Stepmother (n=1)
Victim age at onset
6 to 13 years
Duration of abuse
7 years (mean)
Form of abuse
Genital contact/fondling (n=8)
Oral sex/penetration (n=5)
All victims were sexually abused by lone female and most (n=7) experienced concurrent
violent abuse
Perspective of perpetrators as ‘bad’:
o All participants described the female perpetrators as ‘bad’
o Failure of perpetrator to ‘protect’ and ‘care’
o Conflicting discourses - rationalisation of perpetrators behaviour by victims
o Social influence: preferable to see women perpetrators as ‘victims’ - particularly
mothers
Perspective of perpetrators as ‘mad’:
o None of the victims’ perpetrators had a formal diagnosis of mental illness
o Most victims believed mothers had undiagnosed mental health problems
o Coping strategy: mental illness helps ‘make sense’ of the abuse
Perspective of perpetrators as ‘victims’:
o Recognition of perpetrators history of abuse
o Recognition of social context: limitations according to gender and power
o Discourses around perpetrator choice and responsibility
Other themes:
o Victims discussed observing other mothers, feeling isolated, angry, and feeling
their personal recovery is inhibited by society not acknowledging FPSA
Page 31 of 34
Table 2. General characteristics and key findings of studies reporting victim perspectives
Author(s) and Location
Methodology
Sample Characteristics
Summary Points and Key Findings
12. Duncan & Williams (1998)
UK
Quantitative
Questionnaires
Analysis
Inferential statistics
Victim Perspective
Total (N=67)
Gender
Females (n=0)
Males (n=67)
Age range
22 to 35 years (mean 26.5 years)
Abuse Perpetrator
Acquaintances/friends of family
Victim age at onset
Not specified
Duration of abuse
Not specified
Form of abuse
Contact, fondling, intercourse
62.7% (n=42) of individuals had experienced abuse by both females and males whilst
37.3% (n=25) had been abused by females only
Most participants had multiple sexually abusive experiences
Victims of FPSA involving coercion were more likely to compulsively masturbate as
teens* and be sex offenders in adulthood* than those abused by men only or those with
no sexually abusive histories
Victims of FPSA involving coercion were also more likely to report higher violence
within intimate relationships compared to a non-abused comparison group*
Page 32 of 34
Table 2. General characteristics and key findings of studies reporting victim perspectives
Author(s) and Location
Methodology
Sample Characteristics
Summary Points and Key Findings
13. Deering & Mellor (2011)
Australia
Qualitative
Survey
Analysis
Not stated
Victim Perspective
Community sample
Total (N=14)
Gender
Females (n=5)
Males (n=9)
Age range
29 to 64 years (M=44.6)
Abuse Perpetrator
Mother (n=2)
Sister (n=2)
Aunt (n=1)
Cousin (n=1)
Teacher (n=4)
Other extrafamilial female (n=7)
Victim age at onset
7 years (mean)
Duration of abuse
2.5 years (mean)
Form of abuse
‘Seduction’ to penetration & intercourse
All victims were abused by a lone perpetrator
Two victims reported multiple experiences of FPSA by different females and three had also
been separately abused by males
79% (n=11) of participants had not told anyone about the abuse during childhood; of those
who did disclose, only one participant reported being believed
Most participants reported experiencing negative social and emotional consequences during
childhood in response to FPSA including: depression, low self-esteem, suicidal ideation,
anxiety, inability to express emotions, shyness and introversion
Most female participants (n=4) reported being underweight and feeling unattractive as children
Two males reported that they felt ‘physically strong’ as children following the FPSA
All participants reported experiencing negative social and emotional consequences in
adulthood in response to their childhood experience of FPSA including: low self-esteem,
difficulties trusting women, depression, inability to express emotions and social isolation, and
most continued to experience a negative self-view
All participants reported that the FPSA had affected their adult sexuality in a variety of ways,
including: excessive promiscuity, difficulties in maintaining adult relationships, and celibacy
Note: For quantitative studies the following significance indicators are used: * p<.05; **p<.01; ***p<.001
Page 33 of 34
Note. (1) Participant Demographics: Yes, participant demographics are clearly reported; Moderate, participant demographics are partially reported; No, participant demographics are not adequately
reported. (2) Sample Representativeness: Yes, sample represents a range of appropriate professional or victim perspectives of different genders; Moderate, sample represents a limited range of
professional or victim perspectives, such as only one professional group or a single gender perspective; No, sample has poor representation, such as student perspectives only. (3) Inclusion and
Exclusion Criteria: Yes, inclusion and exclusion criteria are clearly reported; Moderate, inclusion and exclusion criteria are partially or indirectly reported; No, inclusion and exclusion criteria are not
reported. (4) Blinding: Yes, participants were blind to the purpose of the study; Moderate, participants were blind to some aspect of the study, such as being aware that the study focussed on child sexual
abuse but were unaware that attitudes towards FPSA specifically were being explored; No, participants were not blind to the purpose of the study. (5) Standardised Measures: Yes, appropriate and
standardised measures were utilised; Moderate, appropriate but adapted or modified measures are utilised; No, no standardised measures are utilised.
Table 3. Methodological characteristics of quantitative studies (n=6)
Study
Participant
Demographics
Sample
Representativeness (N)
Inclusion &
Exclusion
criteria
Blinding
Standardised
measures
Other Sources of Potential Bias
1. Mellor & Deering (2010)
Yes
Good (N=231)
Moderate
Yes
Yes
Postal response (self-selecting sample; response rate M =
41.75%)
Vignette Design (fictional cases)
Some participants received all vignettes thus potentially
revealing true purpose of study
2. Hetherton & Beardsall (1998)
Yes
Moderate (N=130)
Moderate
No
Yes
Vignette Design (fictional cases)
All participants received all vignettes thus potentially
revealing true purpose of study
3. Kite & Tyson (2004)
Yes
Moderate (N=361)
Moderate
Moderate
No
Postal response (self-selecting sample; response rate M =
36%)
Vignette Design (fictional cases)
5. Gakhal & Brown (2011)
No
Moderate (N=176)
No
No
Moderate
Limited sample representativeness: one professional group
compared to undergraduates and public
Utilised adapted measure without pilot testing
9. Kelly et al. (2002)
Yes
Moderate (N=19)
Yes
No
Yes
Excluded individuals with a history of sexual interest in
children
Retrospective self-report (potential reporting biases)
12. Duncan & Williams (1998)
Moderate
Moderate (N=67)
Moderate
No
No
Retrospective self-report (potential reporting biases)
Overlap of other abusive experiences alongside FPSA
Page 34 of 34
Note. Criteria adapted from Tracy (2010).
(1) Rich Rigor: Yes, the study clearly provides a rich description and rationale for the methods and forms of analysis undertaken; Moderate, the study provides a less detailed or limited description or
rationale for these criteria; No, little or no information is provided to be able to adequately assess these criteria. (2) Reflexivity: Yes, the authors provide sufficient detail regarding their potential biases
and reflect upon the impact of these within the research; Moderate, the study provides less detailed description of these criteria but does address some issues relating to researcher assumptions; No, little
or no information is provided to be able to adequately assess these criteria. (3) Credibility: Yes, the research findings appear credible given the methodologies utilised and the depth of analysis
described; Moderate, findings may be credible but weakened by superficial or less clear analysis and description; No, little or no information is provided to be able to adequately assess these criteria. (4)
Significant Contribution and Resonance: Yes, the research provides important and significant insights regarding FPSA and has practical or theoretical utility; Moderate, the research provides some
insights but is less detailed or has less applicability; No, little or no information is provided to be able to adequately assess these criteria. (5) Ethical Clarity: Yes, ethical procedures are clearly described
and the authors acknowledge the impact of broader ethical issues in relation the research; Moderate, ethical procedures are less clearly detailed or consideration of broader ethical issues is limited; No,
little or no information is provided to be able to adequately assess these criteria. (6) Meaningful Coherence: Yes, the research utilises appropriate theory and methods to achieve stated aims; Moderate,
the research utilises methods that are generally appropriate but which may inhibit or fail to address some aims; No, little or no information is provided to be able to adequately assess these criteria.
Table 4. Methodological characteristics of qualitative studies (n=7)
Study
Rich Rigor
Reflexivity
Credibility
Significant
Contribution &
Resonance
Ethical Clarity
Meaningful Coherence
4. Denov (2001)
No
No
Moderate
Yes
Moderate
Yes
6. Peter (2008)
Moderate
Yes
Yes
Yes
Moderate
Yes
7. Ogilvie & Daniluk (1995)
Moderate
No
Moderate
Yes
Yes
Yes
8. Krug (1989)
No
Moderate
No
Yes
Moderate
Yes
10. Denov (2004)
Yes
Moderate
Yes
Yes
Yes
Yes
11. Peter (2006)
Moderate
Yes
Moderate
Yes
Yes
Yes
13. Deering & Mellor (2011)
Moderate
Moderate
Moderate
Yes
Yes
Moderate
