Homosexuality: A Doctor’s Perspective

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] the term “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

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 job. The owners of the house would leave home every morning and would return at late in the evening. In their absence Prakash would use cooking oil as a medium and force anal sex on Jagan. Since Jagan was helplessly dependent on Prakash he 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 hospitalised.

Anal sex as an experiment

Vinod and Swapnil, two 18-year-old boys were working in a private office. In the absence of senior employees. they would watch porn together. One day they consensually attempted anal sex with each other and invited 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 consensual anal sex with some of his male office colleagues. His wife was oblivious about this. 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 positive. Amol tested positive for these four STDs too. It was obvious that Amol had contracted 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 above cases, 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  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 stools. 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.