Unhealthy sexual behaviors occur among both heterosexuals and homosexuals. Yet the medical and social science evidence indicate that homosexual behavior is uniformly unhealthy. Although both male and female homosexual practices lead to increases in Sexually Transmitted Diseases, the practices and diseases are sufficiently different that they merit separate discussion.
1. Male Homosexual Behavior
Men having sex with other men leads to greater health risks than men having sex with women1 not only because of promiscuity but also because of the nature of sex among men. A British researcher summarizes the danger as follows:
“Male homosexual behaviour is not simply either ‘active’ or ‘passive,’ since penile-anal, mouth-penile, and hand-anal sexual contact is usual for both partners, and mouth-anal contact is not infrequent. . . . Mouth-anal contact is the reason for the relatively high incidence of diseases caused by bowel pathogens in male homosexuals. Trauma may encourage the entry of micro-organisms and thus lead to primary syphilitic lesions occurring in the anogenital area. . . . In addition to sodomy, trauma may be caused by foreign bodies, including stimulators of various kinds, penile adornments, and prostheses.”2
Although the specific activities addressed below may be practiced by heterosexuals at times, homosexual men engage in these activities to a far greater extent.3
Anal intercourse is the sine qua non of sex for many gay men.4 Yet human physiology makes it clear that the body was not designed to accommodate this activity. The rectum is significantly different from the vagina with regard to suitability for penetration by a penis. The vagina has natural lubricants and is supported by a network of muscles. It is composed of a mucus membrane with a multi-layer stratified squamous epithelium that allows it to endure friction without damage and to resist the immunological actions caused by semen and sperm. In comparison, the anus is a delicate mechanism of small muscles that comprise an “exit-only” passage. With repeated trauma, friction and stretching, the sphincter loses its tone and its ability to maintain a tight seal. Consequently, anal intercourse leads to leakage of fecal material that can easily become chronic.
The potential for injury is exacerbated by the fact that the intestine has only a single layer of cells separating it from highly vascular tissue, that is, blood. Therefore, any organisms that are introduced into the rectum have a much easier time establishing a foothold for infection than they would in a vagina. The single layer tissue cannot withstand the friction associated with penile penetration, resulting in traumas that expose both participants to blood, organisms in feces, and a mixing of bodily fluids.
Furthermore, ejaculate has components that are immunosuppressive. In the course of ordinary reproductive physiology, this allows the sperm to evade the immune defenses of the female. Rectal insemination of rabbits has shown that sperm impaired the immune defenses of the recipient.5 Semen may have a similar impact on humans.6
The end result is that the fragility of the anus and rectum, along with the immunosuppressive effect of ejaculate, make anal-genital intercourse a most efficient manner of transmitting HIV and other infections. The list of diseases found with extraordinary frequency among male homosexual practitioners as a result of anal intercourse is alarming:
Herpes simplex virus
Human immunodeficiency virus
Human papilloma virus
Viral hepatitis types B & C
Sexual transmission of some of these diseases is so rare in the exclusively heterosexual population as to be virtually unknown. Others, while found among heterosexual and homosexual practitioners, are clearly predominated by those involved in homosexual activity. Syphilis, for example is found among heterosexual and homosexual practitioners. But in 1999, King County, Washington (Seattle), reported that 85 percent of syphilis cases were among self-identified homosexual practitioners.8 And as noted above, syphilis among homosexual men is now at epidemic levels in San Francisco.9
A 2010 CDC data analysis underscores the disproportionate impact of HIV and syphilis among gay and bisexual men in the United States. The data, presented at CDC’s 2010 National STD Prevention Conference, found that the rate of new HIV diagnosis among men who have sex with men (MSM) is more than 44 times that of other men and more than 40 times that of women. The rate of primary and secondary syphilis among MSM is more than 46 times that of other men and more than 71 times that of women.10
A 1988 CDC survey identified 21 percent of all Hepatitis B cases as being homosexually transmitted while 18 percent were heterosexually transmitted.11 Since homosexuals comprise such a small percent of the population (only 1-3 percent),12 they have a significantly higher rate of infection than heterosexuals.13
Anal intercourse also puts men at significant risk for anal cancer. Anal cancer is the result of infection with some subtypes of human papilloma virus (HPV), which are known viral carcinogens. Data as of 1989 showed the rates of anal cancer in male homosexual practitioners to be 10 times that of heterosexual males, and growing. 30 Thus, the prevalence of anal cancer among gay men is of great concern. For those with AIDS, the rates are doubled.14
Other physical problems associated with anal intercourse are:
retained foreign bodies.15
There is an extremely high rate of parasitic and other intestinal infections documented among male homosexual practitioners because of oral-anal contact. In fact, there are so many infections that a syndrome called “the Gay Bowel” is described in the medical literature.16 “Gay bowel syndrome constitutes a group of conditions that occur among persons who practice unprotected anal intercourse, anilingus, or fellatio following anal intercourse.”17 Although some women have been diagnosed with some of the gastrointestinal infections associated with “gay bowel,” the vast preponderance of patients with these conditions are men who have sex with men.18
“Rimming” is the street name given to oralanal contact. It is because of this practice that intestinal parasites ordinarily found in the tropics are encountered in the bodies of American gay men. Combined with anal intercourse and other homosexual practices, “rimming” provides a rich opportunity for a variety of infections.
Men who have sex with men account for the lion’s share of the increasing number of cases in America of sexually transmitted infections that are not generally spread through sexual contact. These diseases, with consequences that range from severe and even life-threatening to mere annoyances, include Hepatitis A,19 Giardia lamblia, Entamoeba histolytica,20 Epstein-Barr virus,21 Neisseria meningitides,22 Shigellosis, Salmonellosis, Pediculosis, scabies and Campylobacter.23 The U.S. Centers for Disease Control (CDC) identified a 1991 outbreak of Hepatitis A in New York City, in which 78 percent of male respondents identified themselves as homosexual or bisexual.24While Hepatitis A can be transmitted by routes other than sexual, a preponderance of Hepatitis A is found in gay men in multiple states.25 Salmonella is rarely associated with sexual activity except among gay men who have oral-anal and oral-genital contact following anal intercourse.26 The most unsettling new discovery is the reported sexual transmission of typhoid. This water-borne disease, well known in the tropics, only infects 400 people each year in the United States, usually as a result of ingestion of contaminated food or water while abroad. But sexual transmission was diagnosed in Ohio in a series of male sex partners of one male who had traveled to Puerto Rico.27
In America, Human Herpes Virus 8 (called Herpes Type 8 or HHV-8) is a disease found exclusively among male homosexual practitioners. Researchers have long noted that men who contracted AIDS through homosexual behavior frequently developed a previously rare form of cancer called Kaposi’s sarcoma. Men who contract HIV/AIDS through heterosexual sex or intravenous drug use rarely display this cancer. Recent studies confirm that Kaposi’s sarcoma results from infection with HHV-8. The New England Journal of Medicine described one cohort in San Francisco where 38 percent of the men who admitted any homosexual contact within the previous five years tested positive for this virus while none of the exclusively heterosexual men tested positive. The study predicted that half of the men with both HIV and HHV-8 would develop the cancer within 10 years.28 The medical literature is currently unclear as to the precise types of sexual behavior that transmit HHV-8, but there is a suspicion that it may be transmitted via saliva.29
c. Human Waste
Some gay men sexualize human waste, including the medically dangerous practice of coprophilia, which means sexual contact with highly infectious fecal wastes.30 This practice exposes the participants to all of the risks of anal-oral contact and many of the risks of analgenital contact.
“Fisting” refers to the insertion of a hand or forearm into the rectum, and is far more damaging than anal intercourse. Tears can occur, along with incompetence of the anal sphincter. The result can include infections, inflammation and, consequently, enhanced susceptibility to future STDs. Twenty-two percent of homosexuals in one survey admitted to having participated in this practice.31
The sexualization of pain and cruelty is described as sadism, named for the 18th Century novelist, the Marquis de Sade. His novel Justine describes repeated rapes and non-consensual whippings.32 Not all persons who practice sadism engage in the same activities. But a recent advertisement for a sadistic “conference” included a warning that participants might see “intentional infliction of pain [and] cutting of the skin with bleeding . . . .” Scheduled workshops included “Vaginal Fisting” (with a demonstration), “Sacred Sexuality and Cutting” with “a demonstration of a cutting with a live subject,” “Rough Rope,” and a “Body Harness” workshop that was to involve “demonstrating and coaching the tying of erotic body harnesses that involve the genitals, male and female.”33 A similar event entitled the “Vicious Valentine” occurred near Chicago on Feb. 15-17, 2002.34 The medical consequences of such activities range from mild to fatal, depending upon the nature of the injuries inflicted.35 As many as 37 percent of homosexuals have practiced some form of sadism.36
The consequences of homosexual activity have significantly altered the delivery of medical care to the population at-large. With the increased incidence of STD organisms in unexpected places, simple sore throat is no longer so simple. Doctors must now ask probing questions of their patients or risk making a misdiagnosis. The evaluation of a sore throat must now include questions about oral and anal sex. A case of hemorrhoids is no longer just a surgical problem. We must now inquire as to sexual practice and consider that anal cancer, rectal gonorrhea, or rectal chlamydia may be secreted in what deceptively appears to be “just hemorrhoids.”37 Moreover, data shows that rectal and throat gonorrhea, for example, are without symptoms in 75 percent of cases.38
The impact of the health consequences of gay sex is not confined to homosexual practitioners. Even though nearly 11 million people in America are directly affected by cancer, compared to slightly more than three-quarters of a million with AIDS,39 AIDS spending per patient is more than seven times that for cancer.40 The inequity for diabetes and heart disease is even more striking.41 Consequently, the disproportionate amount of money spent on AIDS detracts from research into cures for diseases that affect more people.
2. Female Homosexual Behavior
Lesbians are also at higher risk for STDs and other health problems than heterosexuals.42 However, the health consequences of lesbianism are less well documented than for male homosexuals. This is partly because the devastation of AIDS has caused male homosexual activity to draw the lion’s share of medical attention. But it is also because there are fewer lesbians than gay men,43 and there is no evidence that lesbians practice the same extremes of same-sex promiscuity as gay men. The lesser amount of medical data does not mean, however, that female homosexual behavior is without recognized pathology. Much of the pathology is associated with heterosexual activity by lesbians.
Among the difficulties in establishing the pathologies associated with lesbianism is the problem of defining who is a lesbian.44 Study after study documents that the overwhelming majority of self-described lesbians have had sex with men.45 Australian researchers at an STD clinic found that only 7 percent of their lesbian sample had never had sexual contact with a male.46
Not only did lesbians commonly have sex with men, but with lots of men. They were 4.5 times as likely as exclusively heterosexual controls to have had more than 50 lifetime male sex partners.47 Consequently, the lesbians’ median number of male partners was twice that of exclusively heterosexual women.48 Lesbians were three to four times more likely than heterosexual women to have sex with men who were high-risk for HIV disease-homosexual, bisexual, or IV drug-abusing men.49 The study “demonstrates that WSW [women who have sex with women] are more likely than non- WSW to engage in recognized HIV risk behaviours such as IDU [intravenous drug use], sex work, sex with a bisexual man, and sex with a man who injects drugs, confirming previous reports.”50
Bacterial vaginosis, Hepatitis B, Hepatitis C, heavy cigarette smoking, alcohol abuse, intravenous drug use, and prostitution were present in much higher proportions among female homosexual practitioners.51 Intravenous drug abuse was nearly six times as common in this group.52In one study of women who had sex only with women in the prior 12 months, 30 percent had bacterial vaginosis.53 Bacterial vaginosis is associated with higher risk for pelvic inflammatory disease and other sexually transmitted infections.54
In view of the record of lesbians having sex with many men, including gay men, and the increased incidence of intravenous drug use among lesbians, lesbians are not low risk for disease. Although researchers have only recently begun studying the transmission of STDs among lesbians, diseases such as “crabs,” genital warts, chlamydia and herpes have been reported.55 Even women who have never had sex with men have been found to have HPV, trichomoniasis and anogenital warts.56
References The Gay and Lesbian Medical Association (GLMA) recently published a press release entitled “Ten Things Gay Men Should Discuss with Their Health Care Providers” (July 17, 2002), (accessed 3/18/10). The list includes: HIV/AIDS (Safe Sex), Substance Use, Depression/ Anxiety, Hepatitis Immunization, STDs, Prostate/ Testicular/Colon Cancer, Alcohol, Tobacco, Fitness and Anal Papilloma.  R. R. Wilcox, “Sexual Behaviour and Sexually Transmitted Disease Patterns in Male Homosexuals,” British Journal of Venereal Diseases, 57(3): 167-169, 167 (1981).  Robert T. Michael, et al., Sex in America: a Definitive Survey, pp. 140-141, Table 11, Boston: Little, Brown, and Co., 1994; Rotello, pp. 75-76.  Rotello, p. 92.  Jon M. Richards, J. Michael Bedford, and Steven S. Witkin, “Rectal Insemination Modifies Immune Responses in Rabbits,” Science, 27(224): 390-392 (1984).  S. S. Witkin and J. Sonnabend, “Immune Responses to Spermatozoa in Homosexual Men,” Fertility and Sterility, 39(3): 337-342, pp. 340-341 (1983).  Anne Rompalo, “Sexually Transmitted Causes of Gastrointestinal Symptoms in Homosexual Men,” Medical Clinics of North America, 74(6): 1633-1645 (November 1990); “Anal Health for Men and Women,” LGBTHealthChannel, http://lgbthealth.healthcommunities.com/analhealth/index.shtml (accessed 3/18/10); “Safer Sex (MSM) for Men who Have Sex with Men,” LGBTHealthChannel, www.gayhealthchannel.com/stdmsm/ (accessed 3/18/10).  “Resurgent Bacterial Sexually Transmitted Disease Among Men Who Have Sex With Men — King County, Washington, 1997-1999,” Morbidity and Mortality Weekly Report, CDC, 48(35): 773-777 (September 10, 1999).  Heredia, “Big spike in cases of syphilis in S.F.: Gay, bisexual men affected most.”  Heredia, “Big spike in cases of syphilis in S.F.: Gay, bisexual men affected most.”  Centers for Disease Control. CDC Analysis Provides New Look at Disproportionate Impact of HIV and Syphilis among U.S. Gay and Bisexual Men. Press Release. Wednesday, March 10, 2010.  “Changing Patterns of Groups at High Risk for Hepatitis B in the United States,” Morbidity and Mortality Weekly Report, CDC, 37(28): 429-432, p. 437 (July 22, 1988). Hepatitis B and C are viral diseases of the liver. Edward O. Laumann, John H. Gagnon, et al., The social organization of sexuality: Sexual practices in the United States, p. 293, Chicago: University of Chicago Press, 1994; Michael, et al., p. 176; David Forman and Clair Chilvers, “Sexual Behavior of Young and Middle-Aged Men in England and Wales,” British Medical Journal, 298: 1137-1142 (1989); and Gary Remafedi, et al., “Demography of Sexual Orientation in Adolescents,” Pediatrics, 89: 714-721 (1992). See appendix A.  Edward O. Laumann, John H. Gagnon, et al., The social organization of sexuality: Sexual practices in the United States, p.293, Chicago: University of Chicago Press, 1994; Michael, et al., p. 176; David Forman and Clair Chilvers, “Sexual Behavior of Young and Middle-Aged Men in England and Wales,” British Medical Journal, 298: 1137-1142 (1989); and Gary Remafedi, et al., “Demography of Sexual Orientation in Adolescents,” Pediatrics, 89: 714-721 (1992). See appendix A.  Mads Melbye, Charles Rabkin, et al., “Changing patterns of anal cancer incidence in the United States, 1940-1989,” American Journal of Epidemiology, 139: 772-780, p. 779, Table 2 (1994).  James Goedert, et al., for the AIDS-Cancer Match Study Group, “Spectrum of AIDS-associated malignant disorders,” The Lancet, 351: 1833-1839, p. 1836 (June 20, 1998).  “Anal Health for Men and Women,” LGBTHealthChannel, http://lgbthealth.healthcommunities.com/analhealth/index.shtml (accessed 3/18/10); J. E. Barone, et al., “Management of Foreign Bodies and Trauma of the Rectum,” Surgery, Gynecology and Obstetrics, 156(4): 453-457 (April 1983).  Henry Kazal, et al., “The gay bowel syndrome: Clinicopathologic correlation in 260 cases,” Annals of Clinical and Laboratory Science, 6(2): 184-192 (1976).  Glen E. Hastings and Richard Weber, “Use of the term ‘Gay Bowel Syndrome,'” reply to a letter to the editor, American Family Physician, 49(3): 582 (1994).  Ibid.; E. K. Markell, et al., “Intestinal Parasitic Infections in Homosexual Men at a San Francisco Health Fair,” Western Journal of Medicine, 139(2): 177-178 (August, 1983).  “Hepatitis A among Homosexual Men — United States, Canada, and Australia,” Morbidity and Mortality Weekly Report, CDC, 41(09): 155, 161-164 (March 06, 1992).  Rompalo, p. 1640.  H. Naher, B. Lenhard, et al., “Detection of Epstein-Barr virus DNA in anal scrapings from HIV-positive homosexual men,” Archives of Dermatological Research, 287(6): 608- 611, Abstract (1995).  B. L. Carlson, N. J. Fiumara, et al., “Isolation of Neisseria meningitidis from anogenital specimens from homosexual men,” Sexually Transmitted Diseases, 7(2): 71-73 (April 1980).  P. Paulet and G. Stoffels, “Maladies anorectales sexuellement transmissibles” [“Sexually-Transmissible Anorectal Diseases”], Revue Medicale Bruxelles, 10(8): 327-334, Abstract (October 10, 1989).  “Hepatitis A among Homosexual Men — United States, Canada, and Australia,” Morbidity and Mortality Weekly Report, CDC, 41(09): 155, 161-164 (March 06, 1992).  Ibid.  C. M. Thorpe and G. T. Keutsch, “Enteric bacterial pathogens: Shigella, Salmonella, Campylobacter,” in K. K. Holmes, P. A. Mardh, et al., (Eds.), Sexually Transmitted Diseases (3rd edition), p. 549, New York: McGraw-Hill Health Professionals Division, 1999.  Tim Bonfield, “Typhoid traced to sex encounters,” Cincinnati Enquirer, April 26, 2001; Erin McClam, “Health Officials Document First Sexual Transmission of Typhoid in U.S.,” Associated Press, April 25, 2001. A representative of the Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases at the CDC in Atlanta, Georgia, confirmed this report and provided a link to the AP story on October 4, 2002.  Jeffrey Martin, et al., “Sexual Transmission and the Natural History of Human Herpes Virus 8 Infection,” New England Journal of Medicine, 338(14): 948-954, p. 952 (1998).  Alexandra M. Levine, “Kaposi’s Sarcoma: Far From Gone,” paper presented at 5th International AIDS Malignancy Conference, April 23-25, 2001, Bethesda, Maryland.  “Paraphilias,” Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, p. 576, Washington: American Psychiatric Association, 2000; Karla Jay and Allen Young, The Gay Report: Lesbians and Gay Men Speak Out About Sexual Experiences and Lifestyles, pp. 554-555, New York: Summit Books (1979).  Jay and Young, pp. 554-555.  Sade, Marquis de, Justine or Good Conduct Well Chastised (1791), New York: Grove Press (1965).  Michigan Rope internet advertisement for “Bondage and Beyond,” which was scheduled for February 9-10, 2002, near Detroit, Michigan. The explicit nature of the advertisement was changed following unexpected publicity, and the hotel where the conference was scheduled ultimately canceled it. Marsha Low, “Hotel Ties Noose Around 2-Day Bondage Meeting,” Detroit Free Press, January 25, 2002. http://www.wnd.com/news/article.asp?ARTICLE_ID=26453 (accessed 3/18/10); “Vicious Valentine 5 Celebrates Mardi Gras, Feb 15-17, 2002,” www.leatherquest.com/events/vv2002.htm.  The sadistic rape of 13-year-old Jesse Dirkhising on September 26, 1999, left him dead. See Andrew Sullivan, “The Death of Jesse Dirkhising,” The Pittsburgh Post-Gazette, April 1, 2001.  Jay and Young, pp. 554-555.  Gay and Lesbian Medical Association, “MSM: Clinician’s Guide to Incorporating Sexual Risk Assessment in Routine Visits,” http://www.healthsystem.virginia.edu/internet/psych-training/seminars/msm_assessment.pdf (accessed 3/18/10).  S. Bygdeman, “Gonorrhea in men with homosexual contacts. Serogroups of isolated gonococcal strains related to antibiotic susceptibility, site of infection, and symptoms,” British Journal of Venereal Diseases, 57(5): 320-324, Abstract (October 1981).  As of January 1, 1999, the National Cancer Institute (NCI) estimated the cancer prevalence in the United States to be 8.9 million. “Estimated US Cancer Prevalence Counts: Who Are Our Cancer Survivors in the US?,” Cancer Control & Population Sciences, National Cancer Institute, April 2002. In 1999, the American Cancer Society (ACS) estimated 1,221,800 new cancer cases in the US and an estimated 563,100 cancer related deaths, “Cancer Facts and Figures 1999,” p. 4, American Cancer Society, Inc., 1999; in 2000, the ACS estimated 1,220,100 new cancer cases and 552,200 deaths from cancer, “Cancer Facts and Figures 2000,” p. 4, American Cancer Society, Inc., 2000; in 2001, the ACS estimated a total number of 1,268,000 new cases of cancer and 553,400 deaths, “Cancer Facts and Figures 2001,” p. 5, American Cancer Society, Inc., 2001. This results in an estimated growth of 2,041,200 new cancer cases over the past three years and an estimated 10,941,200 people with cancer as of January 1, 2002. In 2001 there were 793,025 reported AIDS cases. “Basic Statistics,” CDC — Division of HIV/AIDS Prevention, June 2001.  The federal spending for AIDS research in 2001 was $2,247,000,000, while the spending for cancer research was not even double that at $4,376,400,000. “Funding For Research Areas of Interest,” National Institute of Health, 2002.  Ibid.; “Fast Stats Ato Z: Diabetes,” CDC — National Center for Health Statistics, June 04, 2002; “Fast Stats A to Z: Heart Disease,” CDC — National Center for Health Statistics, June 06, 2002.  Gay and Lesbian Medical Association Press Release, “Ten Things Lesbians Should Discuss with Their Health Care Providers” (July 17, 2002), http://www.publichealth.pitt.edu/docs/10things_lesbi.pdf (accessed 3/18/10). The list includes Breast Cancer, Depression/Anxiety, Gynecological Cancer, Fitness, Substance Use, Tobacco, Alcohol, Domestic Violence, Osteoporosis and Heart Health.  Michael, et al., p. 176 (“about 1.4 percent of women said they thought of themselves as homosexual or bisexual and about 2.8% of the men identified themselves in this way”).  See Appendix A.  Skinner, et al., Abstract; Ferris, et al. p. 581; James Price, et al., p. 90; see Appendix A.  Katherine Fethers, et al., “Sexually transmitted infections and risk behaviours in women who have sex with women,” Sexually Transmitted Infections, 76(5): 345-349, p. 348 (2000).  Ibid., p. 347.  Ibid.  Ibid.  Ibid., p. 348.  Ibid., p. 347, Table 1; Susan D. Cochran, et al., “Cancer- Related Risk Indicators and Preventive Screening Behaviors Among Lesbians and Bisexual Women,” American Journal of Public Health, 91(4): 591-597 (April 2001); Juliet Richters, Sara Lubowitz, et al., “HIV risks among women in contact with Sydney’s gay and lesbian community,” Venereology, 11(3): 35-38 (1998); Juliet Richters, Sarah Bergin, et al., “Women in Contact with the Gay and Lesbian Community: Sydney Women and Sexual Health Survey 1996 and 1998,” National Centre in HIV Social Research, University of New South Wales, 1999.  Fethers, et al., p. 347 and Table 1.  Barbara Berger, Shelley Kolton, et al., “Bacterial vaginosis in lesbians: a sexually transmitted disease,” Clinical Infectious Diseases, 21: 1402-1405 (1995).  E. H. Koumans, et al., “Preventing adverse sequelae of Bacterial Vaginosis: a Public Health Program and Research Agenda,” Sexually Transmitted Diseases, 28(5): 292-297 (May 2001); R. L. Sweet, “Gynecologic Conditions and Bacterial Vaginosis: Implications for the Non-Pregnant Patient,” Infectious Diseases in Obstetrics and Gynecology, 8(3): 184-190 (2000).  Kathleen M. Morrow, Ph.D., et al., “Sexual Risk in Lesbians and Bisexual Women,” Journal of the Gay and Lesbian Medical Association, 4(4): 159-165, p. 161 (2000).  Ibid., p. 159.