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from Medical Issues
Health Risks: Fisting and other Homosexual Practices
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.
References:
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Andersson, G., Noack, T., Seierstad, A., & Weedon-Fekjaer, H.
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Aragon, T. J., Vugia, D. J., Shallow, S., Samuel, M. C.,
Reingold, A., Angulo, F. J., & Bradford, W. Z. (2007). Case-control study
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& Mays, V. M. (2003). Prevalence of mental disorders, psychological
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Cochran, S. D., Ackerman, D., Mays,
V. M., & Ross, M. W. (2004). Prevalence of non-medical drug use and
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Diggs, J. (2002). The health risks of gay sex. Corporate Resource Council: Retrieved January 12,
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J. D. (2007). Prevalence of bacterial vaginosis in lesbians and heterosexual
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Fergusson, D. M., Horwood, L. J.,
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Gilman, S. E., Cochran, S. D.,
Mays, V. M, Hughes, M., Ostrow, D., & Kessler, R. C. (2001). Risk of
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identity. AIDS and Behavior, 11(2),
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& Morgenstern, J. (2007). Accounting for the social triggers of sexual
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Bijl, R. V., & Schnabel, P. (2001). Same-sex sexual behavior and psychiatric
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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.
Selected articles:
An Ethical Checkup for the CDC and Massachusetts Department of Public Health
http://www.narth.com/docs/ethicalcheck.html
The Health Risks of Gay Sex, by internist John R. Diggs, Jr., M.D.
http://www.corporateresourcecouncil.org/white_papers/Health_Risks.pdf
Gay Teens and Attempted Suicide
http://www.narth.com/docs/gayteens.html
Risky Sex and the Adolescent Brain: Implications for School Counseling Programs
http://www.narth.com/docs/implications.html
Homosexuality and Mental Health Problems
http://www.narth.com/docs/whitehead.html
From the Gay and Lesbian Medical Association: Health Risks for Gay Men
http://www.glma.org/index.cfm?fuseaction=Page.viewPage&pageID=690
Canadian Gay Group Wants Age Of Consent Lowered
http://www.narth.com/docs/lowered.html
Study Indicates Gays and Lesbians Prone To Psychological Symptoms and Substance Abuse --But School Harassment Rates Not Higher for Gay Males
http://www.narth.com/docs/symptoms.html
The American Journal of Public Health Highlights Risks of Homosexual Practices
http://www.narth.com/docs/risks.html
Updated: 5 February 2010
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