As stated in a featured research article presented at Microbicides 2010, The International Conference on Microbicides: “In the United States alone, receptive anal intercourse is practiced in up to 90 percent of gay and other men who have sex with men, according to International Rectal Microbicides Advocates.” Because of this fact, HIV in the US has become primarily a problem centered on homosexual men; with over 60% of new infections among gay males. According the CDC: “Unprotected anal sex is a high-risk practice for HIV infection, with receptive anal sex having the highest risk. Unprotected anal sex also places MSM (men who have sex with men) at risk for other sexually transmitted infections such as syphilis, chlamydia, and gonorrhea. Although condoms can reduce the risk for HIV transmission, they do not eliminate risk and often are not used consistently. Some MSM attempt to decrease their HIV risk by engaging in unprotected sex only with partners perceived to have the same HIV status as their own. However, this practice is risky, especially for HIV-negative MSM, because MSM with HIV might not know or disclose that they are infected and men’s assumptions about the HIV status of their partners can be wrong.” Regarding condom use by gay men, a study published in the medical journal “Clinics in Colon and Rectal Surgery” found that: “Condoms protect against HIV but are ineffective in preventing the transmission of many other STIs that spread by skin-to-skin contact. A condom doesn’t cover the base of the shaft, pubic region, or scrotum, which are all places STIs can reside and spread during intimate contact. Moreover, condoms are often put on just for penetration and many STIs pass during foreplay when close contact or other types of sex occur…Patients may also insert dangerous objects into their rectum for erotic stimulation. In addition to the inherent risks of tearing, perforation, or losing the object, patients must also be aware of the risk of STIs that can spread when partners share toys. It is not uncommon for MSM to use (and occasionally abuse) enemas for hygiene or autoerotic activity. These practices and others may perforate or tear the delicate tissues in the anus and rectum…”

Author’s note: Anal sex is always painful the first few times; as the passive partner, you are inevitably tense, nervous, and anxious. Yet, in the gay male community, this becomes all a part of the initiation ceremony; a rite into manhood usually performed by an older and more experienced male. Blood typically accompanies this practice; heightening the pseudo-occultist experience of blood-brotherhood; also, hence the extremely high rates of continuing HIV infections among gay males. As one physician explained: “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…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 feces to re-route into the abdominal cavity…This can cause serious surgical complications. One may lose control over the anal sphincter causing continuous involuntary leakage of fecal matter. There is also the increased risk of hemorrhoids, 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.” The very real incidence of anal trauma in gay men recently compelled several public and professional medical organizations, including the New York City Department of Health and Mental Hygiene, the Department of HIV Medicine in London (UK) and The American Society of Colon Rectal Surgeons, to call for further studies and to issue directives warning members and other healthcare researchers and professionals: in New York City, the rampant rise of unprotected anal sex among the cities’ gay male population; the incidence of patients suffering injury from an aggressive form of anal intercourse combined with drug use at one UK hospital; and the curious rise in Proctitis among American gay men.

In the pre-HIV era, the various gastrointestinal and rectal maladies in male homosexuals seen by physicians and proctologists were collectively referred to as “gay bowel syndrome.” I experienced this first hand, as the constant ritual of anal cleansing, douching, enemas, and penetration, caused the already naturally dry and thin-skinned rectum to become perpetually red, irritated, and swollen. Diarrhea was a relentless affliction; some rather active gay men who otherwise were beautifully muscular and apparently healthy-looking took to wearing diapers – especially during intense work-outs or weight-lifting scissions at the gym, as the increased pressure often caused abnormal leakage. Visits to a San Francisco proctologist were frequent, and his waiting room, crowded with other gay men, sometimes turned into a place to meet and talk as there was always someone I knew – also there waiting to see the doctor. Though, not everyone with this secret problem was single and adventurous; one such friend – a sincere guy who had been in a monogamous relationship for a couple of years, was continuously left with painful anal fissures. After I left the lifestyle, and went back home, my smaller town doctor still knew of my past – as soon as he saw the ravages of what had been my backside. By then, my hemorrhoids were protruding severely – and thus began a few years of one painful surgery after another. During that time, I was constantly walking about with suppositories, frequently with embarrassing stains soaking through my pants, my underwear had to be continually bleached to remove blood stains, and I stunk from fecal matter seeping out. It was a little foreshadowing of purgatory – and, I kept saying to myself: “It hadn’t been worth it.”

In the 1990s, there was pressure from the gay political power brokers for medical journals and doctors to abandon the term gay bowel syndrome altogether; a rather insignificant occurrence, yet, it does reveal an underling ambition among those who wanted to see a more normalized public perception of gay male sex; and, as one attorney argued, in front of the Supreme Court, there was once “an incorrect understanding that gay couples were fundamentally different than straight couples.” Only, they are “fundamentally different;” as heterosexual sex in marriage does not result in a higher rate of injury and disease.

Thorough information report regarding the peculiar physical abnormalities in gay men caused by homosexual sex; from the National Health Service of the UK: msm ceg july 2015

“Sexual trauma associated with fisting and recreational drugs.”
Cohen CE, et al.
Sex Transm Infect. 2004 Dec;80(6):469-70.

“Of the 1,190 (68%) participants who reported engaging in receptive anal sex in the last 4 weeks, 59% indicated having some degree of anal pain during and after sexual intercourse…A majority of 72.8% had sexual intercourse with a man “at least” once a week. More than one-third of the responders declare to have had more than 50 sex partners in their lifetime. One in four MSM indicates having had sex with more than 100 men in their lifetime.”
“The Gay Men Sex Studies: Anodyspareunia Among Belgian Gay Men”
Johan Vansintejan, MD, et al.
Sex Med. 2013 Dec; 1(2): 87–94.