While we know that most male survivors of conflict-related sexual violence in the Democratic Republic of the Congo (DRC) do not have access to care, little attention has been devoted to a systematic analysis of why this is so. Drawing from semi-structured interviews with staff of service providers and male survivors of sexual violence, as well as from focus group discussions with community members in eastern DRC, this article sets out to explore challenges and barriers related to meeting the needs of male survivors of sexual violence with respect to their medical, psychological, socioeconomic and legal needs. Our findings suggest that local framings of masculinity can both negatively and positively influence support-seeking behaviour depending on how survivors themselves engage with masculinity ideals. Based on these findings, a conceptual framework including seven levels of barriers to care for male survivors has been developed. Although service providers strive to provide high-quality care to male survivors, we show that existing responses to sexual violence have mainly been designed to address sexual violence against women and need to be re-adapted to male survivors. © 2022 Informa UK Limited, trading as Taylor & Francis Group.