from Medical Issues
Michelle A. Cretella, MD
American College of Pediatricians
Philip M. Sutton, PhD, LMFT, LP
Editor, Journal of Human Sexuality
In recent weeks, concern has been expressed nationally about
workshops (Staver, 2010), often offered in schools, which have taught
"fisting" along with a variety of other methods of homosexual sexual
gratification to teens and young adults (including those not necessarily
identifying as homosexual) between the ages of 14 and 25. Fisting is the sexual practice of inserting a large object
or one's fist into the anus of one's sexual partner, in some cases up to one's
forearm. Are such workshops a benefit or a threat to teen health? This question
is best answered by examination of the practice of fisting itself, and likewise
the broader health risks of teaching methods of homosexual gratification to
adolescents and young adults.
From a medical standpoint anal intercourse, in contrast to vaginal intercourse, poses serious risk to its participants. The rectum differs from the vagina with respect to suitability for penetration by a penis, limb or inanimate object (Agnew, 1985; Diggs, 2002; Koop, 1990). The vagina is designed to expand, is supported by a network of muscles and produces natural lubricants. It is composed of a mucus membrane with a multi-stratified squamous epithelium that allows it to endure friction without damage. The anus, in contrast, is designed to allow passage of fecal material out of the body. It is composed of small muscles and significantly more delicate tissues. Consequently, anal intercourse often results in anorectal trauma, hemorrhoids and anal fissures. With repeated trauma, friction and stretching, the anal sphincter loses its tone. Chronic leakage of fecal material has been known to develop from penile/anal intercourse alone; for those engaging in fisting this is a more common problem (Agnew, 1985; Diggs, 2002; Wolfe, 2000). In addition, fisting places the recipient at risk for a variety of anorectal traumas.
Since fisting may result in anorectal trauma and exposure to blood, there is risk of acquiring HIV, Hepatitis B and Hepatitis C particularly if the insertive partner has cuts or abrasions on his hands (Sowadsky, 1996). The insertive partner is also exposed to fecal matter. Consequently, fisting has been associated with increased incidence of shigellosis (Aragon, 2007) and Hepatitis A (Sowadsky, 1996), two illnesses transmitted by the fecal-oral route. The greatest medical danger of anal fisting, however, involves the susceptibility to injury of the inner walls of the lower colon. This tissue is very easily torn, but may not be recognized by the individuals involved. Such an injury can lead to an overwhelming infection of the abdominal cavity called peritonitis which may result in death (Diggs, 2002; Wolfe, 2000).
Fisting is unfortunately only one of a number of practices of homosexual gratification taught at workshops such as those sponsored by GLSEN (MassResistance, n.d.; Staver, 2010; Whiteman, 2000). It is important also to review the general health risks of teaching adolescents and young adults that such behaviors are "natural and normal." Clinical experience and scientific research show that regardless of age, homosexual forms of sexual gratification place individuals at significantly greater risk for experiencing a number of physical and psychological health problems - some of which are life-threatening - as compared with individuals who engage in typical heterosexual behaviors.
Medically, men who have sex with men (MSM) are disproportionately at risk for sexually transmitted infections (STI) and HIV (Diggs, 2002). The U.S. Centers for Disease Control and Prevention's Division of HIV/AIDS Prevention estimates that gay and bisexual men (men who have sex with men or MSM) in the United States are 50 times more likely to contract HIV than are heterosexual men (Lansky, 2009). This is largely due to having multiple sexual partners and engaging in risky sexual practices, including a high incidence of anal intercourse within this population (Diggs, 2002). For example, the estimated HIV risk with a single sexual exposure through receptive anal intercourse (2%) is 20 times greater than for receptive vaginal intercourse (0.1%), (Pinkerton, Martin, Roland, Katz, Coates, & Kahn, 2004).
Semen has immune-suppressant activity that increases the chance of sperm fertilizing a woman's egg during vaginal intercourse. If released in the rectum, however, semen makes this already vulnerable tissue more prone to both infection and the development of cancer - rectal carcinoma in MSM results from infection with a highly carcinogenic strain of HPV (Diggs, 2002). Of greater concern is that despite knowing the high risk of contracting HIV, many MSM repeatedly indulge in unsafe sex practices such as "bare-backing," i.e, deliberate, "unprotected" anal intercourse (Parsons & Bimbi, 2007; Parsons, Kelly, Bimbi, Muench, & Morgenstern, 2007; van Kesteren, Hospers, & Kok, 2007.) Homosexual women are also at higher risk for STI and other health problems than are heterosexual women (Evans, Scally, Wellard, & Wilson, 2007.)
The negative consequences of homosexual behaviors are not limited to the physical harms noted above. Compared to their heterosexual peers, homosexual high school students and young adults (fourteen to twenty-one years old) in New Zealand, which has a culture highly tolerant of homosexuality, had significantly higher rates of major depression, generalized anxiety disorder, conduct disorder, nicotine dependence, other substance abuse and/or dependence, multiple disorders, suicidal ideation, and suicide attempts (Fergusson, Horwood, & Beautrais, 1999).
In general, compared to heterosexually behaving adolescents and adults, having same-sex sexual partners is associated with substantially greater risk for mood disorders, anxiety disorders, psychological distress, substance use disorders, for suicidal thoughts and suicidal plans, suicide attempts, unstable relationships and lower levels of quality of life (Andersson, Noack, Seierstad, & Weedon-Fekjaer, 2006; Balsam, Beauchaine, Rothblum, & Solomon, 2008; Cochran, Keenan, Schober, & Mays, 2000; Cochran, Sullivan, & Mays, 2003; Cochran, Ackerman, Mays, & Ross, 2004; de Graaf, Sandfort, & ten Have, 2006; Drabble & Trocki, 2005; Gilman, Cochran, Mays, Hughes, Ostrow, & Kessler, 2001; Herrell, Goldberg, True, Ramakrishnan, Lyons, Eisen, & Tsuang, 1999; Jorm, Korten, Rodgers, Jacomb, & Christensen, 2002; King, Semlyen, Tai, Killaspy, Osborn, Popelyuk, & Nazareth, 2008; Mathy, Cochran, Olsen, & Mays, 2009; Russell & Joyner, 2001; Sandfort, de Graff, Bijl, & Schnabel, 2001; Sandfort, de Graaf, & Bijl, 2003; Sandfort, T. G. M., Bakker, Schelievis, & Vanwesenbeeck, 2006.) The findings are consistent both for countries like Denmark, the Netherlands, New Zealand, Norway and Sweden where homosexuality is more socially accepted, and for the U.S. where it is less accepted.
While the seriousness of such health risks may not be minimized, neither may the vulnerability of teenagers and young adults to being taught ways of behaving that put them at significant risk. NIMH scientist Dr. Jay Giedd, M.D. has reported that as humans develop, their brains' "frontal cortex area — which governs judgment, decision-making and impulse control — doesn't fully mature until around age 25" (Voit, 2005). In other words, "the frontal lobes, the very area that helps make teenagers do the right thing, are one of the last areas of the brain to reach a stable grown-up state" (Strauch, 2003, p.16.) As a result, while physically, "the teen years and early 20s represent an incredibly healthy time of life, ....the top 10 bad things that happen to teens involve emotion and behavior." Because "the brain is pretty adept at learning by example," something "that parents" can and do do to influence "their children's brain development" is "modeling." The teenage "brain is pretty adept at learning by example," so parents- and the other adults involved in the lives of teenagers- teach healthy ways of behaving by showing and giving good examples of how to live (Voit, 2005), and unhealthy behaviors by showing or giving poor examples.
Conclusion: An adolescent's desire to prevent or cease experiencing serious medical, psychological, and relational health risks is sufficient reason for him or her to seek and receive competent psychological care to minimize or resolve the desires, behaviors and lifestyles associated with such increased risks. The concerns of parents, family members and friends of persons whose sexual behaviors and/or attractions leave them at risk for such harms are understandable and scientifically and clinically justified. Regardless of venue, the health and well-being of young persons is best served by sex education that is consistent with established clinical experience and scientific research.
Note: NARTH has released a more extensive review of the health risks associated with the behaviors of homosexual gratification in Volume I of the Journal of Human Sexuality (NARTH, 2009; cf. http://www.narth.com/docs/journalsummary.html for a summary or to obtain a complete copy of this document.) The U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC) provides updated information on specific health risks related to homosexual behaviors, cf. http://www.cdc.gov/std/hiv/default.htm.
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The following articles and their links are just a sample of over 80 articles on the NARTH Web-site (http://www.narth.com/menus/medical.html) written on various aspects of the medical and mental health risks associated with homosexual behaviors.
An Ethical Checkup for the CDC and Massachusetts Department of Public Health
The Health Risks of Gay Sex, by internist John R. Diggs, Jr., M.D.
Gay Teens and Attempted Suicide
Risky Sex and the Adolescent Brain: Implications for School Counseling Programs
Homosexuality and Mental Health Problems
From the Gay and Lesbian Medical Association: Health Risks for Gay Men
Canadian Gay Group Wants Age Of Consent Lowered
Study Indicates Gays and Lesbians Prone To Psychological Symptoms and Substance Abuse --But School Harassment Rates Not Higher for Gay Males
The American Journal of Public Health Highlights Risks of Homosexual Practices