Gay bowel syndrome
Gay bowel syndrome refers to some combination of intestinal or anorectal infection/trauma among male homosexuals. Homosexuals do not like this phrase, and note that gay bowel syndrome “is neither gay-specific, confined to the bowel, nor a syndrome.”(1) However, this phrase was coined by some physicians in response to a “clinical pattern of anorectal and colon diseases encountered with unusual frequency” in homosexual men in New York City in 1976.(2, 3; see also: 4, 5) These authors noted that in a sample of 260 homosexual men, “The clinical diagnoses in decreasing order of frequency include condyloma acuminata, hemorrhoids, nonspecific proctitis, anal fistula, perirectal abscess, anal fissure, amebiasis, benign polyps, viral hepatitis, gonorrhea, syphilis, anorectal trauma and foreign bodies, shigellosis, rectal ulcers and lymphogranuloma venereum.”(2)
Some details of anorectal problems among male homosexuals
The internal anal sphincter (an involuntary muscle) does not look favorably upon foreign objects attempting to enter the rectum. This muscle relaxes during defecation, but remains in a contracted state otherwise, which seals the anal opening.
For a period following receptive anal sex, the internal anal sphincter is stretched and is unable to contract strongly, thereby failing to completely seal the anal opening until the muscle regains its original tone. Repetitive anal sex, especially with large penises or rectal insertions of large objects may damage the internal anal sphincter, thereby preventing complete sealing of the anus, and leading to fecal mucus seepage (anal or fecal incontinence). Additionally, anal sex exacerbates fecal seepage by stimulating colonic motility, which sends feces from the colon down into the lower rectum.(6)
The soiling of clothes from fecal seepage is a problem for many homosexuals. Goldstone mentioned a study where 25% of homosexuals that practiced anoreceptive intercourse and 50% of AIDS-afflicted homosexuals had anal incontinence compared to a 3% rate among heterosexual men.(6) Miles et al. compared 40 male homosexuals (all practiced anoreceptive sex) with 18 male heterosexuals.(7) Only one heterosexual but 14 (35%) homosexuals had frequent anal incontinence.(7)
To avoid soiling of clothes, homosexuals with mild problems are advised to use a menstrual-type pad in the back of their underwear to absorb moisture and waste.(6) Homosexuals with big buttocks require a fluffed-up cotton ball placed against the anal opening, together with a pad to help absorb moisture throughout the day.(6) Medical advice for homosexuals with persistent soiling includes rectal wash-outs to remove residual feces from the anal canal after bowel movements.(6) This involves inserting an ear syringe into the rectum that is filled with warm water and coated with a water-soluble lubricant. Squeezing the syringe gently and repeatedly helps wash out any residual feces from the anal canal.
Some examples of butt plugs used by homosexuals
A regular butt plug.
A rippled butt plug.
A penile-shaped butt plug.
A vibrating butt plug.
An inflatable butt plug.
More examples? Check out butt plug jewelry.
Frequent, especially prolonged anal sex often leaves tiny tears (anal fissures) around the anal opening. This prompts the internal anal sphincter to contract strongly, and makes it difficult for homosexuals to engage in receptive anal sex. To deal with anal fissures, homosexuals use butt plugs, which also effectively seal the anus. Some butt plugs are shaped like a penis,(8) others are rippled,(9) and some may have a multi-speed vibrating function.(10) Some butt plugs can approach 5 inches in diameter, and if this is not enough, then a vibrating butt plug which can be inflated to 10 inches across at its thickest is also available.(11) Some vibrating butt plugs also come with a remote control for homosexuals on the move,(11) and may feature a squirting capability too. Apparently, some homosexuals decide to simultaneously derive pleasure and function.
Butt plugs are not primarily intended for anal pleasure, but dildos, vibrators, and anal probes are. The proper tool for accommodating a penis after surgery for hemorrhoids is an anal dilator.(6) Some cases of anal incontinence are so severe, that people lose the ability to sense stool in their rectum and cannot prevent it from escaping. This calls for major lifestyle changes such as wearing diapers or in the extreme, going for a colostomy (a surgical procedure which results in bowel movements emptying in a pouch carried on the abdomen).(6)
The life of a number of homosexuals centers on the anus. Male homosexuals that behave more like girls as children have a marked preference for receptive anal intercourse,(12-14) and a less marked but significant preference for oral-anal sex (rimming).(13) In sex research involving homosexual men, the correct genitoerotic role distinction is not insertive vs. receptive behaviors, or even insertive vs. receptive anal intercourse, but receptive anal intercourse vs. all other behaviors.(13) The anus is so etched onto the minds of homosexuals that even mental illness does not prevent them from focusing on it. For instance, Ikeda et al. described the death of a 75-year-old man following the rectal insertion of a walking stick by a mentally ill homosexual.(15) As a result of repeated anorectal trauma and infections, the perianal region of several male homosexuals acquires a grotesque appearance,(16) yet few homosexuals desirous of insertive anal sex would be discouraged by the sight of such anuses.
Let us address the consequences of rimming. In third-world countries, the drinking water supply often gets contaminated with feces, resulting in a disease outbreak. Homosexuals, however, get feces directly from the source via rimming. Not surprisingly, the worms and microbes that occupy their digestive tracts span a good range of parasite diversity: Neisseria gonorrhea, herpes simplex virus, Chlamydia trachomatis, Treponema pallidum, Campylobacter jejuni, Campylobacter fetus fetus, Shigella flexneri, Entamoeba histolytica, Clostridium difficile, Giardia lamblia, and many others, including worms.(17-21) Consider some studies in this regard:
- Among 180 patients consecutively seen at a venereal-disease clinic, 29 MSM (21.5% of homosexual clients and 6.2% of bisexual clients) but no women or heterosexual men had parasitic intestinal infections.(19) Interestingly, 17% of the heterosexuals in this sample had practiced rimming, yet were free of intestinal parasites.(19) Comparatively, 37% of the bisexuals and 75% of the homosexuals had practiced rimming. Therefore, the elevated incidence of intestinal parasites among homosexuals is not solely due to rimming, but is also a result of the fact that MSM function as a reservoir of intestinal parasites.(19, 22)
- In a controlled study, 67.5% of 200 homosexual men and 16% of 100 heterosexual men had parasitic intestinal infections.(22) 27% of homosexual men and 1% of heterosexual men had E. histolytica, and 13% of homosexual men and 3% of heterosexual men had Giardia lamblia.(22) “The presence of symptoms could not be correlated with infection except when the infection was caused by more than one organism, including G. lamblia.”(22)
- In an analysis of three fecal samples from 153 homosexual men and 119 patients with abdominal symptoms, 59.5% of the homosexuals had their intestines infected by a total of 198 protozoan species, whereas 31.9% of the patients had their intestines infected by a total of 51 protozoan species.(23)
- In one study, 95 of 119 consecutively seen homosexual men with anorectal/intestinal symptoms and 29 (39%) of 75 randomly selected male homosexuals without gastrointestinal or anorectal symptoms were infected by pathogenic intestinal parasites.(17)
- In another study of 101 male homosexuals without gastrointestinal symptoms, 27% had Entamoeba histolytica, 61% had nonpathogenic protozoa with or without E. histolytica, 36% had a nonpathogen alone, and 3% had Giardia lamblia.(18)
- In an examination of 243 homosexual men without any gastrointestinal symptoms, about 12% were infected with at least one pathogenic intestinal parasite.(24)
Clearly, many homosexuals are ignorant of their intestinal infection status. Furthermore, abnormal rectal tissue structure is not uncommon among male homosexuals. In a study of rectal biopsy samples from homosexual men, 89 of whom had intestinal symptoms while 11 did not, 46% of the specimens from the symptomatic men and 27% from the asymptomatic men were abnormal; acute inflammation characterized 51% of the men with pathogens and 24% of those free of pathogens.(25)
In April, 2001, the U.S. Centers for Disease Control and Prevention (CDC) documented the first known sexually transmitted outbreak of typhoid fever in the United States. It occurred in summer, 2000.(26, 27) If it is a first, like AIDS, it should not come as a surprise that the outbreak was documented among male homosexuals. A homosexual man spread typhoid to 7 others residing in Ohio, Kentucky, and Indiana. The men were uncooperative with health officials, making it impossible to estimate how many other men might have been exposed.(26, 27) Typhoid is rare; about 400 cases are reported annually in the U.S., 80% of which can be traced to overseas travel.(26, 27) Typhoid transmission typically occurs via consumption of food and water contaminated with human feces. None of the infected homosexuals had shared either food or drink.(26, 27) The mode of transmission needs no comment.
In a nutshell, “Four general groups of conditions may be encountered in homosexually active men: classical sexually transmitted diseases (gonorrhea, infections with Chlamydia trachomatis, syphilis, herpes simplex infections, genital warts, pubic lice, scabies); enteric diseases (infections with Shigella species, Campylobacter jejuni, Entamoeba histolytica, Giardia lamblia, hepatitis A, hepatitis B, hepatitis non-A, non-B, and cytomegalovirus); trauma (fecal incontinence, hemorrhoids, anal fissure, foreign bodies, rectosigmoid tears, allergic proctitis, penile edema, chemical sinusitis, inhaled nitrite burns, and sexual assault of the male patient); and the acquired immunodeficiency syndrome (AIDS).”(28)
See the picture below for one consequence of anal eroticism
Fig 6. Amebic procteocolitis [infected intestines]; note the whitish-green ulcers that are not unusual in the large bowel of homosexual men.(29)
- Scarce M. Harbinger of plague: a bad case of gay bowel syndrome. J Homosex 1997;34(2):1-35.
- Kazal HL, Sohn N, Carrasco JI, et al. The gay bowel syndrome: clinico-pathologic correlation in 260 cases. Ann Clin Lab Sci 1976;6(2):184-92.
- Sohn N, Robilotti JG, Jr. The gay bowel syndrome. A review of colonic and rectal conditions in 200 male homosexuals. Am J Gastroenterol 1977;67(5):478-84.
- Heller M. The gay bowel syndrome: a common problem of homosexual patients in the emergency department. Ann Emerg Med 1980;9(9):487-93.
- Quinn TC. Gay bowel syndrome. The broadened spectrum of nongenital infection. Postgrad Med 1984;76(2):197-8, 201-10.
- Goldstone SE. The Ins and Outs of Gay Sex: a medical handbook for men (Dell Publishing, New York, NY, 1999 [The author is an out-of-the-closet homosexual physician]).
- Miles AJ, Allen-Mersh TG, Wastell C. Effect of anoreceptive intercourse on anorectal function. J R Soc Med 1993;86(3):144-7.
- Saghir MT, Robins E. Male and female homosexuality: a comprehensive investigation. Baltimore,: Williams & Wilkins, 1973.
- Weinrich JD, Grant I, Jacobson DL, et al. Effects of recalled childhood gender nonconformity on adult genitoerotic role and AIDS exposure. HNRC Group. Arch Sex Behav 1992;21(6):559-85.
- McIntyre MH. Digit ratios, childhood gender role behavior, and erotic role preferences of gay men. Arch Sex Behav 2003;32(6):495-7.
- Ikeda N, Hulewicz B, Knight B, et al. Homicide by rectal insertion of a walking stick. Nippon Hoigaku Zasshi 1991;45(4):341-4.
- Witte MH, Stuntz M, Witte CL, et al. AIDS, Kaposi's sarcoma, and the gay population. The germ or the terrain? Int J Dermatol 1989;28(9):585-6.
- Quinn TC, Stamm WE, Goodell SE, et al. The polymicrobial origin of intestinal infections in homosexual men. N Engl J Med 1983;309(10):576-82.
- Levinson W, Dunn PM, Cooney TG, et al. Parasitic infections in asymptomatic homosexual men: cost-effective screening. J Gen Intern Med 1986;1(3):150-4.
- Phillips SC, Mildvan D, William DC, et al. Sexual transmission of enteric protozoa and helminths in a venereal-disease-clinic population. N Engl J Med 1981;305(11):603-6.
- Koblin BA, Morrison JM, Taylor PE, et al. Mortality trends in a cohort of homosexual men in New York City, 1978-1988. Am J Epidemiol 1992;136(6):646-56.
- Most H. Manhattan: "a tropic isle"? Am J Trop Med Hyg 1968;17(3):333-54.
- Keystone JS, Keystone DL, Proctor EM. Intestinal parasitic infections in homosexual men: prevalence, symptoms and factors in transmission. Can Med Assoc J 1980;123(6):512-4.
- Jokipii L, Pohjola S, Valle SL, et al. Frequency, multiplicity and repertoire of intestinal protozoa in healthy homosexual men and in patients with gastrointestinal symptoms. Ann Clin Res 1985;17(2):57-9.
- Laughon BE, Druckman DA, Vernon A, et al. Prevalence of enteric pathogens in homosexual men with and without acquired immunodeficiency syndrome. Gastroenterology 1988;94(4):984-93.
- Surawicz CM, Goodell SE, Quinn TC, et al. Spectrum of rectal biopsy abnormalities in homosexual men with intestinal symptoms. Gastroenterology 1986;91(3):651-9.
- CNN. Sexual transmission of typhoid documented in US. [http://www.cnn.com/2001/HEALTH/conditions/04/26/typhoid.sex.ap/index.html]. 2001:April 26,1504 GMT.
- Reller ME, Olsen SJ, Kressel AB, et al. Sexual transmission of typhoid fever: a multistate outbreak among men who have sex with men. Clin Infect Dis 2003;37(1):141-4.
- Owen WF, Jr. Medical problems of the homosexual adolescent. J Adolesc Health Care 1985;6(4):278-85.
- Atlas of sexually transmitted diseases and AIDS. S. A. Morse, others, Eds. (Mosby, New York, 2003).