Homosexuality: A doctor’s perspective

A sexual medicine expert provides his medical opinion on homosexuality

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What is sexual orientation?

Sexual orientation is a term used to refer to an individual's primary physical, emotional, romantic and sexual attraction to individuals of a specific gender [male or female]. The most commonly recognised sexual orientations are heterosexuality, homosexuality and bisexuality.

According to the American Psychological Association [APA] "also refers to an individual's sense of personal and social identity based on those attractions, behaviours expressing them, and membership in a community of others who share them".

What is homosexuality?

A sexual attraction to [or sexual relations with] persons of the same sex is known as homosexuality. While homosexuality would technically cover same-sex preferences among both males and females, lesbianism is a term which specially implies female-female preference. Studies in the West have shown that about 4% of men and 2-3% of women are exclusively homosexuals and 10% are bisexuals as they enjoy sex with both the genders.

So far there has been no conclusive scientific evidence to believe that a person is born with a particular sexual orientation. There is no consensus among scientists about the exact reasons that an individual develops a heterosexual, homosexual or bisexual orientation. Although much research has examined the possible genetic, hormonal, anatomical, developmental, cultural and social influences on sexual orientation, no findings have convincingly emerged, that permit scientists to conclude that sexual orientation is determined by any particular factor. However, the largest group of researchers believe that sexual orientation [Homosexuality, Heterosexuality or Bisexuality] is a result of an 'unconscious' choice that a person makes during his growing years, due to various known and unknown factors, often beyond the conscious control of the person.

It is a result of various factors such as the basic personality type, uncensored exposure to sex, parental influence, lack of correct and value-based sex education, experience of direct or indirect child abuse. However, if a person truly wishes to modify his/her sexual orientation at any age willingly, it is possible to help such a person. Such change, of course, cannot be imposed on him/her. If imposed, nothing will help! His/her self-motivation plays a major role.

Irrespective of a person's homosexual or lesbian orientation, the homosexual or lesbian is mentally sound, emotionally stable, intelligent, sharp, talented, efficient, hard working, faithful, trustworthy and socially well-adjusted like the rest of the [non-homosexual] population.

Equal human rights

All human beings have equal worth and therefore straight or homosexual, everyone has the right to live with human dignity. I am all for 'equal human rights' for homosexuals, and to not treat them like some inferior species or second-class citizens. They are as much human as anyone and thus deserve to be treated humanely.

Having said that, being a medical practitioner in the field of sexual medicine for over two decades, I have seen severe medical complications arising out of 'consensual sodomy' or 'anal sex', whether between two homosexuals, or even when it has been compelled on a woman by a man. The physical and emotional trauma of these victims stirs my heart and cannot go unmentioned in the midst of all this debate of 'de-criminalising consensual sexual behaviour in privacy between two same-sex individuals'.

I fully agree with every scripture that separates the person from the action. Therefore, I reiterate that while all human beings should be viewed and treated equally with the same human dignity by law and society, all sexual acts done by anyone homosexual or straight, if causing physical or emotional trauma to another, [whether minor or major], should also be equally punished by the law of the land.

Cases

Sexual exploitation of servant

Jagan, a 19-year-old illiterate boy from a very poor family in rural India, got a job in Mumbai as a domestic servant. His distant relative, a 37-year-old man Prakash who was working as a cook in a rich family, got him this much needed opening. The rich owners of the house would leave the house everyday in the morning and would return at eight in the night. In their absence Prakash would use cooking oil as a medium and force anal sex on Jagan. Jagan was helplessly dependent on Prakash could never gather courage to resist him and started consenting to the exploitation.One day he developed a rectal prolapse [a medical condition wherein the walls of the rectum protrude through the anus and hence become visible outside the body], bled profusely, and had to be taken to the hospital.

Anal sex as an experiment

Vinod and Swapnil, two 18-year-old boys were working as office boys in a private office. They would surf the net in the absence of senior employees and watch porn. One day they consensually attempted anal sex with each other and invited a double trouble. While Vinod developed a bad tear in his rectum, Swapnil developed Paraphimosis [a painful surgical condition of the penile foreskin that needs an emergency circumcision surgery without which the penis could be permanently damaged].

Sexual advance at workplace

Amit was a 20-year-old frail boy from a poor family. His father was dead and his old mother was ill. He had two younger sisters at home to support. He got a job of a peon in a private office after a lot of struggle and a long wait. His boss, a 46-year-old rich, married man fancied anal sex. He pressurised Amit to have anal sex with him after office hours in the privacy of his cabin. Amit felt helpless as this job was vital for him. He consented to the demands of his boss. A few months later, when he approached a doctor, he discovered he had developed infected painful fissures at his anus, and had partially lost control on the sphincter mechanism of the anal opening. He had lost his job and had no courage to approach the police as he felt he had neither the moral right nor the legal standing as he was and adult and he had 'consented' to this act in 'privacy'.

Secret sexual life

Amol, a 32-year-old married man was a bisexual. He would indulge in anal sex with some of his male office colleagues 'consensually' for mutual pleasure. His wife was completely oblivious to this side of her husband. Amol also never felt that his secret parallel life would ever affect his marriage. During the second pregnancy of his wife, the obstetrician detected that she was not only HIV positive, but her tests for Syphilis, Hepatitis-B and Genital Herpes were also found positive. Amol tested positive for these four STDs too. It was obvious that Amol had contracted all these STDs from his multiple homosexual contacts and now his wife and unborn child were also victims of these life-threatening infections.

In all the four cases above, the involved individuals were 'adults' and were engaging in anal sex with 'mutual consent' in 'privacy'. These are just a few classic examples. Incidents such as these are rampant. Doctors get to see several such cases in their private practice as well as in general hospitals. I wish all those who are critical of section 377 of the Indian Penal Code [1860] need to give serious consideration to their demands. The legal experts, social activists, gay organisations and the media cannot afford to be ignorant about possibilities such as these.

It also needs to be noted that as per Section 377 of the Indian Penal Code, anal sex is a punishable offence, even between husband and wife with mutual consent.

Medical facts related to anal sex

Anal sex is commonly practised by homosexual partners, probably as a substitute for the heterosexual sex. Some heterosexual partners also practise it, with or without mutual consent. Any sexual activity is strictly a matter of personal choice, but should be engaged with genuine mutual consent [which has not been extracted under any kind of pressure]. It is strictly your personal choice to indulge in any act you enjoy as long as you are not causing any physical or psychological harm to the other.

As a medical expert, I would like to enlighten the readers about some medical facts related to anal sex. Medical science regards anal sex as 'high-risk behaviour'. Physiologically, the anus is not designed for penetration by any hard object. As a protective reflex action, the anal sphincter tightens ordinarily if stimulated. Any attempt at penile insertion can be distressing, even if done slowly and gradually. If the penis is forced into the anus, injury is possible. The lining [mucus membrane] of the rectum is very thin, tears easily, does not heal fast and therefore is vulnerable to infections. Also, the tears can enlarge to a fissure or a crack. These are painful and slow to heal. There is also a possibility that a fistula could open up, allowing faeces to re-route into the abdominal cavity or into the vagina. This can cause serious surgical complications. One may lose control over the anal sphincter causing continuous involuntary leakage of faecal matter. There is also the increased risk of haemorrhoids, which are quite uncomfortable. Rectal prolapse—wherein the walls of the rectum protrude through the anus and hence become visible outside the body—is another surgical emergency that is seen resulting out of anal intercourse.

Some of the micro-organisms that are normally present in the anus of even a healthy individual, are known for causing severe urinary infection if they enter the urethra and urinary tract. During anal sex, the urethra actually enters the rectum, inviting infective bacteria into the urethra and thus the urinary tract. Repeated urinary infection can cause serious problems such as renal damage and even kidney failure.

Masters and Johnson in their book on Sex and Human Loving warn, that anything that has been inserted into the anus if subsequently put into the vagina can cause severe vaginal infections because bacteria are naturally present in the anus. Therefore moving from anal intercourse to vaginal intercourse is extremely hazardous.

The rate of transmission of HIV [and other STDs] through anal sex is much higher compared to other penetrative sexual acts. A condom, which is thought to be a means of so-called 'safe sex', is not designed for anal sex. Anal sex involves a totally different kind of pressure dynamics, and the latex or polyurethane condoms are not manufactured for these pressure dynamics. A condom is far more likely to get torn during anal sex [thus paving the way for the transmission of HIV/AIDS and other STDs]. Therefore I reiterate that anal sex—even with the use of a condom— is definitely a 'high-risk behaviour'.

As a society we need to learn to accept all persons with equal human rights irrespective of their choices, but we do reserve the right to reject certain behaviours that are injurious to their health and the health of others connected to them. Those choosing to be in loving same-sex relationships are no less human, and do not deserve any less respect, than anyone else. In fact, the homosexuals I have known are very warm, loving, talented, creative, and extremely intelligent persons. Talking in condescending terms to them or of them, or mollifying/placating them, reinforces a discriminatory attitude towards them. Therefore, an equal human approach must be adopted by the moral-keepers of our society and by the law of our land in this regard.

Magnifying lens over an exclamation markSpot an error in this article? A typo maybe? Or an incorrect source? Let us know!

13 COMMENTS

  1. I’m impressed with Dr. Bhonsle’s ability to professionally articulate uncomfortable truths. Denying these truths would be HARMFUL to the people politically correctness is intended to protect. Also, there are countless examples that validate Dr. Bhonsle’s assertion that sexual orientation is mutable for SOME individuals. For example, NYC mayor Bill Di Blasio’s wife was a lesbian in the 70s. Now she is married with 2 children. Of course, there are many other people who tried to change but couldn’t.

  2. This is a good article and tells the facts like it is. I don’t find this article biased or offensive, certainly not homophobic. Only that there are consequences to behaviors that are risky, as anal sex is. This practice is dangerous in my view.

  3. This is a very old article hence commenting now seems redundant but there are various issues here that really need to be addressed and a critique of this article needs to go on record even when many medical practitioners here seem to be favoring Dr. Bhonsale’s opinion. Dr. Bhonsale has knowingly or unknowingly deployed a Batsonian double bind. On one hand he repeatedly says that he supports human rights and hence political emancipation is imperative yet on the other hand he equates “gay sex”(if there is such a thing) with a deviant practice fraught with so many perils that only a fool would engage in such acts. The take away message is: of course gays are people too but then goes on to say: “I wish all those who are critical of section 377 of the Indian Penal Code [1860] need to give serious consideration to their demands” suggesting criminalizing “gay sex”.

    Of course medical experts would not be interested in knowing how they fix versions of truths as realities using their power as experts; how he has used strategic examples to make his point; and many other things that are wrong with this write up; let’s look at the medical facts. There is no denying that there are risks involved in anal sex, but there also numerous references available that talk about having safe anal sex which Dr. Bhonsale has simply chosen to remain quite about.

    In the end, Dr. Bhonsale should be glad that he is in India – he is in a land where his thinly veiled homophobia is shared by many including the state mechanisms. If he were in the US, this comment: “However, if a person truly wishes to modify his/her sexual orientation at any age willingly, it is possible to help such a person. Such change, of course, cannot be imposed on him/her. If imposed, nothing will help! His/her self-motivation plays a major role” would have led to action against him by medical ethics board.

  4. This article is hilariously unscientific. Firstly you equate homosexuality with anal sex, then paint homosexuals as rapists? I guess cases like Damini don’t count? What about the straight people who have anal sex?
    And the so called case studies you site will simply PREVENT such cases coming to light now that 377 is back in place for fear of legal repercussions, it won’t stop rape of any kind and it wont stop homosexuality.
    Your article is so dangerous and misleading, not to mention it ignores female homosexuality, how convenient! I suggest you read BORN GAY by glen Wilson and qazi rahman. You are clearly interested in propagating your political views than truths.

  5. Most of the examples mentioned by Mr Bhonsle seem to talk about forced anal sex, sex under coercion, multiple partners and sex without any form of sex education. Under those circumstances i imagine ANY kind of sex would be physically and mentally traumatic – straight or gay. To give this article any credence, it would be interesting to know what percentage of gay people in loving, caring and educated relationships experience physical problems.

  6. Hi
    This feature surprises me no end! A furious LGBT activist from India forwarded this feature to me for review, in view of my background of being sympathetic with LGBT-rights-movement. I think I am going to disappoint him and others with him with my view on this fabulous feature. This artistically written feature doesn’t say a word that could in any manner be damaging towards their efforts. The writer has taken an absolute ‘middle path’ while writing this elaborate piece. He appears undoubtedly learned and experienced in his science. His regard and care towards LGBT community is quite clear at several places in this feature.
    Truly,
    Eric Moore

  7. I am in full agreement with Dr.RN Shah. This article is one of the most unbiased article on such a touchy topic. It comprehensively covers the topic of anal sex without making it sound filthy, condemning or discriminatory towards gays. Even the cases described have people who are married and not exclusively gays. The repeated mention of even heterosexuals engaging into anal sex makes the article very objective and impartial.
    Dr. Arvind Jain, MBBS, DVD

  8. Dear Dr Shah:
    Thanks for your valuable feedback. Based on the same, we have changed the title of the article to appropriately reflect our stance. We, the editorial team at Complete Wellbeing, are all for equality of individuals, regardless of their sexual orientation. We firmly believe every individual has a right to his or her preferences in all areas of life, without exception.
    — Manoj Khatri [Editor-Publisher]

  9. I was instructed to read this article by a gay activist… calling it damaging to their efforts to have section 377 evoked. However I did not find anything that can be termed as ‘damaging’. Dr.Bhonsle has reiterated several times that he is all for equal human rights and in no manner has condemned homosexuality. On the contrary, I found the article extremely well written… whether the language, the information or the conclusion. I only wish the title of the article should have been different. One more good thing happened in a bargain… I read almost all the articles written by Dr.Bhonsle on this website and found them very profound. I was also very happy to read a very positive response from learned readers.
    Dr. R.N.Shah

  10. Dear Manoj Khatri (Editor, Complete Well-being),

    Read the complimentary copy of Complete Well-being. It was flawless. I was always looking forward to someone writing on this issue in this manner. I have no words to thank Dr.Rajan Bhonsle for doing the needful and educate aware citizens on this subject.

    He is the best doctor-writer from India, I must say!

    Thank you and best wishes for Complete Well-being.

    Dr J. Madhok, MD
    (By Email)

  11. I am practicing doctor myself. I agree with each word and each syllable in this article. I have seen the agony of several patients, men/women alike, who have suffered due to anal intercourse. Dr. Bhonsle has systematically put all the relevant points together in this feature. I have forwarded this article to several of my patients and colleagues.
    Dr. Palekar

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