Gay Bowel Syndrome: Medicine From The Lens Of History

By Medically reviewed by Panel Perubatan Hello Doktor

And NO, I did not make that name up. ‘Gay Bowel Syndrome’ is an actual name of a condition used in older medical textbooks, as newer ones shy away from using such term, calling it “Obsolete” and “Derogatory” and for a fairly obvious reason, it doesn’t bode well with the homosexual community. However, the name serves as an important reminder of the pernicious nature and conditions associated with homosexuality particularly amongst men who have sex with men (MSM). With increasing freedom of sexual expression through the early 1970’s in the larger cities of North America and Europe, the subpopulation of homosexual men began to engage in more and more sexual intercourse with large numbers of casual and often anonymous partners. Needless to say, this resulted in the increase of conventional sexually transmitted diseases (STDs) and other previously not seen condition.

Within the same decade, in 1976, Henry L. Kazal and colleagues first used this term to describe the various sexually transmitted perianal (around the anus), rectal diseases and sexual traumas seen in his many gay patients, during the stint of his proctology practice. The term was not specific to any particular disease or infection but rather, was used clinically to describe proctitis (inflammation of anywhere from colon, rectum to the anus) and a variety of other complaints caused by a wide range of infectious organisms, seen in gay patients who engaged in anal sex. The concept of “gay bowel syndrome” was later expanded to include various opportunistic cancers, similar to the ones that are usually seen in AIDS patients. It is also worth mentioning that despite the wide range of infections that this condition encompasses, HIV is not one of it, as the term “gay bowel syndrome’, was coined before the era of HIV epidemic in 1981.

How does this condition occur and spread?

Following the spur of cases of Gay Bowel Syndrome, in 1980, an emergency physican named Dr Michael Heller wrote and published a collective review entitled ‘The Gay Bowel Syndrome: A Common Problem of Homosexual Patients in the Emergency Department‘. In it, he said, “Sexual transmission of enteric diseases (diseases pertaining bacteria or infection originating from the small intestine and bowel) is neither new nor limited to gays, but the occurrence of large numbers of patients (almost all male and gay) with sexually transmitted enteric pathogens is indeed a new phenomenon.” Some of the infectious organisms identified includes (not limited to):

Infections of known importance in gay men.

  • Shigellosis
  • Amebiasis
  • Giardiasis
  • Gonococcal proctitis
  • Hepatitis B
  • Syphilis

Infections of uncertain importance in gay men.

  • Salmonella
  • “Non-pathogenic” parasites
  • Chlamydia trachomatis
  • Herpes simplex virus
  • Enterotoxogenic E coli
  • Campylobacter fetus

Heller listed down factors associated with this peculiar phenomenon below, coining anal sex as “New” sexual practices.

  • “New” sexual practices
  • Anonymity
  • Frequency of sexual contact
  • Gay baths
  • Asymptomatic infection

Transmission of diseases was considered to take place by two routes: anal sex, and fecal-oral route. Sometimes, difficulty in specifying the method may be a result of transmission by both methods (combining anal and oral sex).

What happened to the condition today?

2 things happened not long after, that made this condition, especially the name, a relic of the past – HIV and better understanding of the condition. HIV to human is like the turtle in Mario – Avoidable but annoying and they will definitely kill you if you’re not careful.

In the 1981, HIV and AIDS hit the United States, around the same time that the band Queen traveled to South America as part of The Game Tour, and became the first major rock band to play in Latin America. I specifically mentioned the band Queen because their lead singer developed AIDS in that same decade and even though he might not want to be the ‘Poster Boy of AIDS’, admittedly, when he came clean about his AIDS diagnosis, he helped to generate massive awareness on the condition that no one, celebrities or otherwise, is safe from, as there were still not much understood about the virus. Because of this massive awareness, a new culture of safe sex was resonating within the gay community. Following the onset of the AIDS epidemic, the reported incidence of Gay Bowel Syndrome complaints has declined, likely as a result of safer sexual practices.

As mentioned earlier, before the name was given, doctors were not sure what phenomenon they were dealing with but with more work being put to understand that all these infections can be differentiated and treated independently, the call to abandon the said ‘derogatory’ name was on the limelight and picked up steam swiftly.

The call for abandonment of the name came as early as 1985 when Gut, a well-respected, peer-reviewed journal of gastroenterology published by the British Medical Journal (BMJ), said that the “gay bowel syndrome” was first used to describe not a syndrome, but a list of conditions. The term hides the problems facing the gastroenterologist. Firstly, the sexual orientation of a patient may not be easily ascertainable in the setting of a general outpatient clinic. Secondly, many infections of the gay bowel are asymptomatic and are missed without full microbiological screening. Thirdly, coinfection is common and the organism isolated may not be causing the symptoms and signs. Finally, the bowel has limited and non-specific clinical and histopathological responses to many infections.

The nail in the coffin for the syndrome came in 1997 when the journal of homosexuality concluded that after delving into seminal work on the condition, it is apparent that Gay Bowel Syndrome is an essentialized category of difference that is neither gay-specific, confined to the bowel, nor a syndrome. The use and diagnosis of Gay Bowel Syndrome must be abandoned.

So if you have never heard of the syndrome today, don’t worry, a lot of medical students these days have never heard of it as well as today’s textbook no longer uses such a name.

Hello Health Group does not provide medical advice, diagnosis or treatment.

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