Gay bowel syndrome
Gay bowel syndrome was a medical term first used by Henry L. Kazal and colleagues in 1976 to describe the various sexually transmitted perianal and rectal diseases and sexual traumas seen in Kazal's proctology practice, which had many gay patients.
After Kazal, the term was used sporadically in medical literature from the 1970s to refer to a complex of gastrointestinal symptoms affecting gay men. The term was first used in the pre-HIV era, by Kazal et al. in 1976. The term was not specific to any particular disease or infection, and was used clinically to describe proctitis and a variety of other complaints caused by a wide range of infectious organisms. Reported causes include herpes viruses, syphilis, gonorrhea, chlamydia, campylobacter, and shigellosis, as well as a variety of protozoal infections. The concept of "gay bowel syndrome" was later expanded to include various opportunistic cancers. Transmission of disease 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. Following the onset of the AIDS epidemic, the reported incidence of these complaints has declined, likely as a result of safer sexual practices. Those with the ano-rectal disorder experience increased incidents of diarrhea.
The term "gay bowel syndrome" is considered obsolete and derogatory by some. The McGraw-Hill Manual of Colorectal Surgery says:
Coined in the pre-HIV era, the term "gay bowel syndrome" comprised a rather unselective potpourri of unusual anorectal and GI symptoms experienced by homosexual males... with better understanding of the underlying causes, this term is outdated: the derogatory terminology should be abandoned and more specific entities and terms recognized and used.
However, the abstract for the 2014 medical journal article 'Gay bowel syndrome': relic or real (and returning) phenomenon? published in the medical journal Current Opinion In Infectious Diseases indicates:
|“||This article aims to review the term 'gay bowel syndrome', including the recent research looking at increased rates of bowel infections in men who have sex with men (MSM), particularly in light of the recent Shigella outbreaks in MSM in London and New York, and considers whether 'gay bowel syndrome' is a syndrome that really exists and is worthy of further research and specific treatment, or whether the term continues to be obsolete and not useful...
Little or no recent research exists around the concept of a specific syndrome affecting the bowels of MSM. Rather, there seems to be a clustering of diseases in certain high-risk groups, especially those in urban areas with multiple sexual partners, recreational drug use, and possible concomitant HIV infection...
All healthcare practitioners (including non-sexual health/HIV specialists) need to consider careful and thorough history taking (including sexual history) to identify those at risk.
A 1997 article in the Journal of Homosexuality concluded:
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.
Gut, a well-respected, peer-reviewed journal of gastroenterology published by the BMJ, said in 1985 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 term "gay bowel syndrome" was withdrawn as "outdated" by the Canadian Association of Gastroenterologists in 2004, and the U.S. Centers for Disease Control described the term as informal and no longer in use in 2005. The gay activist and author Michael Scarce criticized the concept of "gay bowel syndrome" in his book Smearing the Queer: Medical Bias in the Health Care of Gay Men (1999), saying that "gay bowel syndrome has been, and remains today, a powerful tool for the specific surveillance, regulation, definition, medicalization, identification, and fragmentation of gay men's bodies." Scarce's work has been cited in the Journal of the American Medical Association with a positive review.
- The gay bowel syndrome: clinico-pathologic correlation in 260 cases., Annals of Clinical & Laboratory Science 1976 Mar-Apr;6(2):184-92. Kazal HL, Sohn N, Carrasco JI, Robilotti JG, Delaney WE.
- Kazal HL, Sohn N, Carrasco JI, Robilotti JG, Delaney WE (1976). "The gay bowel syndrome: clinico-pathologic correlation in 260 cases" (PDF). Ann. Clin. Lab. Sci. 6 (2): 184–92. PMID 946385.
- Kenneth A. Borchardt; Michael A. Noble (1997). Sexually Transmitted Diseases: Epidemiology, Pathology, Diagnosis and Treatment. CRC Press. pp. 296–305. ISBN 978-0-8493-9476-8.
- Bartlett, John (March 15, 2004). "New Look at "Gay Bowel Syndrome", Etiology of Clinical Proctitis Among Men Who Have Sex With Men". Medscape.
- "Textbook of medicine", Robert L. Souhami, John Moxham. Elsevier Health Sciences, 2002. ISBN 0-443-06464-4, ISBN 978-0-443-06464-7. p. 817
- Kaiser, Andreas (2008). McGraw-Hill Manual of Colorectal Surgery. p. 205. ISBN 978-0-07-159070-9.
- Gay bowel syndrome': relic or real (and returning) phenomenon?, Current Opinion In Infectious Diseases, 2014 Feb;27(1):84-9. doi: 10.1097/QCO.0000000000000032.
- Scarce M (1997). "Harbinger of plague: a bad case of gay bowel syndrome". J. Homosex. 34 (2): 1–35. doi:10.1300/j082v34n02_01. PMID 9328857.
- Gut, 1985, 26, 869-875
- Garbo, Jon (December 21, 2004). ""Gay Bowel Syndrome" struck from textbook". Gmax.co.za. Retrieved June 24, 2009.
- Lee, Ryan (April 8, 2005). "Activist fights 'outdated' medical phrase: Effort to debunk 'gay bowel syndrome' may face new challenge". Washington Blade. Archived from the original on May 7, 2009. Retrieved June 24, 2009.
- Scarce, Michael (1999). Smearing the Queer: Medical Bias in the Health Care of Gay Men. Routledge. p. 13. ISBN 978-1-56023-926-0.
- "Gay Men's Health". JAMA. 284 (15): 1986. 18 October 2000. doi:10.1001/jama.284.15.1986-JBK1018-2-1.