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A Closer Look at Dr. James Holsinger’s “Pathophysiology of Male Homosexuality”

Jim Burroway

June 11th, 2007

President Bush’s nomination of Dr. James Holsinger to be the next Surgeon General continues to raise concerns among several leading gay rights advocates. Alarms first went up when we learned that Holsinger co-founded a church which sponsors an ex-gay ministry. That discovery reinforced other well-known facts about his tenure on the United Methodist Judicial Council, where he opposed the 2004 decision to allow Rev. Karen Dammann, a lesbian, to continue serving as a minister. He also backed the defrocking of Rev. Beth Stroud, another lesbian minister, and he supported a Virginia pastor who barred an openly gay man from church membership.

Most of those concerns, by themselves, have little direct bearing on his future role as Surgeon General. We should remember that Dr. C. Everett Koop was also an evangelical Christian, and he was able to aside whatever qualms he may have had to become a outspoken advocate for sanity during the AIDS crisis. Not only that, but Dr. Koop battled powerful forces within the Reagan administration to do this, and he created many enemies among his fellow social conservatives. Dr. Koop showed considerable medical integrity and moral bravery in standing firm against the pervasive stigma which gay men were experiencing at the time.

But there is troubling evidence which suggests that Dr. Holsinger is no C. Everett Koop. Holsinger wrote a 1991 white paper for the United Methodist Church’s Committee to Study Homosexuality titled, “Pathophysiology of Male Homosexuality,” (PDF: 752 KB/8 pages) where he tries to give a scientific opinion that gay male relationships are inherently inferior because “when the complementarity of the sexes is breached, injuries and diseases may occur.”

That paper, dressed up as a considered medical opinion backed by a bibliography drawn from professional sources, would likely appear to be rather impressive to the lay reader (as most members of the committee were). But a closer examination of that paper reveals very little of scientific value. Worse, it shows a startling eagerness to pull evidence out of context to provide damning evidence against gay men, while willfully ignoring counter evidence in the same literature which essentially destroys the core of his arguments.

Holsinger’s Scientific Evidence

Holsinger began his “scientific” examination by recounting the reproductive role of male and female genitalia. He then went on to observe that the rectum doesn’t perform such a role, and is, in his estimation, unsuitable for intercourse. He cited Agnew (1986)1 to say:

The rectum is incapable of mechanical protection against abrasion and severe damage to the colonic mucosa can result if objects that are large, sharp or pointed are inserted into the rectum (Agnew 1986.)

As you can surmise from the quoted text, Agnew’s paper deals largely with foreign objects, not intercourse. But before the reader can notice this discrepancy, Holsinger quickly dropped the subject of foreign objects (he will return to it later) to begin a broader outline of conditions “found in homosexually active men.” Holsinger quoted Owen (1985, although the paper is missing from Holsinger’s bibliography):2

Four general groups of conditions may be found in homosexually active men: classical sexually transmitted diseases… enteric diseases… trauma… and the acquired immunodeficiency syndrome (AIDS).

This much is true. These conditions may be found among some homosexually active men. They may also be found in heterosexually active men and women. But to justify his singling out of gay men, Holsinger cited another study to say that STD’s are “strongly correlated to sexual lifestyle,” and presents a large number of statistics for an impressive list of diseases. Unfortunately, the statistics were given without context, leaving the impression that they are representative of all gay men.

But what is that context? It turns out that these statistics came from one lone study consisting of a convenience sample of 365 male patients, all of whom attended a single urban STD clinic in Copenhagen over a seven month period in 1983.3

This is not a representative study at all. It’s not even a representative study of gay men in downtown Copenhagen. It tells us nothing about rural or suburban Danish men. More importantly, it doesn’t tell us anything about gay men who don’t need the services of an STD clinic. It doesn’t even tell us anything about gay or straight men who attend other STD clinics besides the single clinic that performed this study. It is, at best, a snapshot of a small population from one urban center over a short period of time, taken eight years before Holsinger’s paper was written.

This of course means that if you study people with STDs, whether they are gay or straight, you will find people with STDs. Holsinger uses the behavior of one particular sample of men who expose themselves to the risk of STDs to denigrate all gay men (and lesbians!). This study says nothing of those whose “lifestyle” choices do not lead to contracting STDs. And of course, Holsinger’s arguments don’t address whatever responsibility heterosexuals overall have for the 64% of this particular Copenhagen sample who were exclusively straight and were treated for STDs.

After dealing briefly with sexually transmitted diseases, Holsinger introduced the squeamish subject of anorectal trauma, again implying that it is a common condition among gay men. He opened this line of argument by repeating this statement from Bush (1986):4

Consensual penile-anal intercourse can be performed safely. Few anorectal problems and no evidence of anal-sphincter dysfunction are found in heterosexual women who have anal-receptive intercourse. However, forceful anal penetration without lubrication against a resistant sphincter will result in abrasive trauma, causing fissures, contusions, thrombosed hemorrhoids, lacerations with bleeding, pain, and psychic trauma.

Notice what’s going on here. If intercourse is consensual, then everything’s okay. After all, they see few problems among straight women. But if it’s not consensual then damage can occur. This statement seems to preclude the possibility that gay men can have consensual sex, doesn’t it?

Holsinger seems to agree. The entire premise of his “scientific” evidence is not based on the ordinary bonds of affection that arise between committed gay and lesbian couples. Nor is it even based on the ordinary physical expressions of that love that occur in a mutually supportive and consensual basis. Instead, all three sources that Holsinger quoted from in this section (Bush, 1986; Geist, 1988; and Agnew, 1986)5 describe conditions that were found among men and women treated in emergency room settings. And much of the evidence provided in the Bush and Geist papers were the result of sexual assault, not consensual sex. It’s no wonder Holsinger is able to find so many alarming medical problems. But what does his evidence have to do with gay and lesbian couples in love? Well, the answer is simple. It’s no more relevant than the serial rapist is to the average loving heterosexual couple.

Holsinger then returned to the topic of foreign objects which were removed in emergency room settings. But he utterly failed to recognize, as Geist did, that many of these patients were heterosexual men and women. From Geist, Holsinger undoubtedly read that:

Anal erotic practices are incorrectly presumed by many to be limited to male homosexuals. A significant number of heterosexual men, heterosexual women and lesbian women also enjoy and practice anal sexual stimulation. Bolling’s mid-1970s study, which included a wide cross-section of gynecology clinic patients, revealed that 25 per cent practiced analingus. Eight percent of the women included anal intercourse as a regular part of their sexual repertoire.

Most of Geist’s paper describes injuries resulting from heterosexual activities, including vaginal and anorectal injuries to women during consensual activity. The paper also includes a large section describing injuries sustained during adult heterosexual rape and child sexual abuse. None of that was even hinted at in Holsinger’s paper. Instead, Holsinger cherry-picked from all of this evidence a few short passages to lambaste consensual relationships among gay men.

An Oddly Padded Bibliography

It’s at this point in the paper where Holsinger brought up the practice of “fisting”:

The most severe type of anorectal trauma follows fist fornication which during the 1970s was practiced by approximately 5% of the male homosexual population.

Five percent of a small minority seems hardly worth mentioning, but Holsinger went ahead and talked about it anyway. And this is where his bibliography gets interesting. His bibliography includes a letter to the editor by Carlo Torro with the eye-catching title, “Delayed death from ‘fisting’,” a letter that Hollinger didn’t refer to in the text of paper.6

And why didn’t Holsinger describe the contents of the letter? The reason is obvious. The letter describes a woman who had died of sepsis as a result of engaging in this practice with her husband! Of course, there’s no hint of this in the letter’s title. The only possible reason for Holsinger to include the letter in the bibliography is to gain whatever advantage he can from the letter’s title.

This is probably among Holsinger’s most egregious abuses of the medical literature. He has already denigrated consensual relationships of gay men by using examples drawn from emergency room traumas that include heterosexual couples. As if that weren’t enough, Holsinger padded his bibliography with an entry that has nothing to do with gay men whatsoever.

And that’s not just a one-time “mistake” either. He padded his bibliography again with another paper that he didn’t reference in his article, one by David B. Busch and James R. Starling, titled, “Rectal foreign bodies: Case reports and a comprehensive review of the world’s literature.”7 Given the title of the paper and the context in which it appears in Holsinger’s bibliography, one might assume that the paper presents case reports from all over the world of gay men sticking things inside themselves.

Well, they’d be wrong. The authors introduce their report with two case cases, both of whom were straight. One was a 39-year-old married man with a perfume bottle inserted in his rectum. Busch and Starling used these two examples to illustrate an important point:

As in the great majority of published cases, both patients reported no history of a gay life-style. It does not seem possible to generalize about the sexual preferences of male patients (ratio of heterosexual, bisexual, and homosexual patients) presenting with rectal foreign bodies, since very few of the reports provide such information. … Obviously both anal intercourse and foreign body insertion involve stimulation of the same area of the body, but the literature fails to provide sufficient information from which to draw any conclusions about whether foreign body self-insertion is in fact predominantly performed by men practicing anal intercourse.

It’s not unusual for bibliographies to include sources which aren’t referenced in the body of a paper. Bibliographies often provide additional reference material should someone want to investigate further. But one would expect the bibliographic entries to be relevant, and these two entries clearly are not.

So why did he include these two papers in his bibliography? Did he suppose the other members of the UMC committee would look up these bibliographical references for further study? The answer is more likely that he assumed that they wouldn’t. After all, very few people do. And so adding these two provocatively-titled entries to his bibliography is all the more suspicious, especially now that we’ve seen how selectively he quoted from the studies that he did mention in his text.

Holsinger closed his “scientific” portion of his paper with a discussion of anal cancer, which is more common among gay men than straight men. At that time, it was strongly suspected that the human papillomavirus (HPV) was the culprit. What we now know is that those same HPV strains are also responsible for causing cervical cancer. In fact, for gays and straights alike, the single greatest risk factor for contracting HPV is sex with men, who are the primary carriers of HPV. While we know this to be true today, it may not have been so clear in 1991. So I’m willing to give Holsinger something of a pass on this one.


The whole point of Holsinger’s paper is to draw a sharp contrast between gay relationships and heterosexual relationships. But to do so, he culls his evidence largely from papers which describe injuries from nonconsensual intercourse to denigrate consensual relationships, he describes odd sexual practices that are enjoyed by heterosexual couples to denigrate the minority of gay couples who indulge in those same practices, and he misleads his readers by padding his bibliography with more references to papers explicitly describing injuries experienced by heterosexual men and women to imply that they describe gay men instead.

In other words, to describe gay sexual acts, more often than not he turned to papers which describe injuries sustained through heterosexual activity. And then he used this evidence from heterosexual activity to say that “when the complementarity of the sexes is breached, injuries and diseases may occur as noted above.” But what does this evidence suggest about “complementarity” in heterosexual relationships? Holsinger doesn’t answer.

But worse, Holsinger made the fatal error of ignoring the bonds of affection and devotion that arise in gay and lesbian couples. He reduced the rich complexity of their relationships to pipe fittings and how they interlock with each other. But the interlocking parts that fit together in relationships are those parts that fit sublimely. They have absolutely nothing to do with pipes or connectors or any other analogies drawn from the local Ace Hardware store.

Whatever pretensions Holsinger may have had to presenting a scientific argument, this paper does not rise to that level. In fact, Holsinger deployed many of the same tactics other anti-gay extremists use in writing common anti-gay tracts. The result is not science, but propaganda.

The Human Rights Campaign’s Joe Solmonese, in opposing Holsinger’s nomination, points out that, “it is essential that America’s top doctor value sound science over anti-gay ideology.” This paper shows no evidence that Holsinger holds to such values. What he wrote was no error, nor is it a simple misreading of the medical literature. In fact, it is simply impossible to write what he wrote by accident or in error.

Holsinger wrote this paper as part of a church inquiry where the greater considerations for Truth ought to hold sway. This makes Holsinger’s actions all the more disquieting. If he’s willing to commit an act of false witness on behalf of the church — in the service of his God — what assurances can we have that he will act differently on behalf of the nation?


1. Agnew, Jeremy. “Hazards associated with anal erotic activity.” Archives of Sexual Behavior, 15, no. 4 (1986): 307-314. [BACK]

2. Owen, William F., Jr. “Medical problems of the homosexual adolescent.” Journal of Adolescent Health Care. 6, no. 4 (July 1985): 278-285. [BACK]

3. Christophersen, Jette; Menné, Torkil; Friis-Møller, Alice; Nielsen, Jens O.; Hansted, Birgitte; Øhlenschlæger. “Sexually transmitted diseases in hetero-, homo- and bisexual males in Copenhagen.” Danish Medical Bulletin 35, no. 3 (June 1988): 285-288. [BACK]

4. Bush, Robert A., Hr.; Owen, William F., Jr. “Trauma and other noninfectious problems in homosexual men.” Medical Clinics of North America 70, no. 3 (May 1986): 549-566. [BACK]

5. Agnew, Jeremy. “Hazards associated with anal erotic activity.” Archives of Sexual Behavior, 15, no. 4 (1986): 307-314.

Bush, Robert A., Hr.; Owen, William F., Jr. “Trauma and other noninfectious problems in homosexual men.” Medical Clinics of North America 70, no. 3 (May 1986): 549-566.

Geist, Richard F. “Sexually related trauma.” Emergency Medicine Clinics of North America 6, no. 3 (August 1988): 439-466. [BACK]

6. Torre, Carlo. Letter to the editor: “Delayed death from ‘fisting’.” American Journal of Forensic Medicine and Pathology 8, no. 1 (March 1987): 91. [BACK]

7. Busch, David B.; Starling, James R. “Rectal foreign bodies: Case reports and a comprehensive review of the world’s literature.” Surgery 100, no. 3 (September 1987): 512-519. [BACK]



Bruce Wilson
June 11th, 2007 | LINK

Great writeup ! – I’ll promote it today.

June 11th, 2007 | LINK

Jim you are a god. This is gold.

The Volokh Conspiracy
June 11th, 2007 | LINK

A junk-science Surgeon General?…

President Bush’s recent nomination of Dr. John Holsinger for Surgeon General has drawn a lot of criticism. In 1991, Holsinger wrote a paper for ……

June 11th, 2007 | LINK

Thank you, Jim. A lot of the terminology went right over my head when I tried to read his article so further explanation was helpful. Good job!

June 11th, 2007 | LINK

This is a great article and I have referenced it on my blog. Obviously, Holsinger is utterly unfit to be Surgeon General.

What astounds me the most about Christianist like Holsinger is the way the deliberately misquote and mischaraterize the research of others to achieve their own homophobic agenda. What happened to obeying the Commandment not to bear false witness?

Lynn David
June 12th, 2007 | LINK

Holsinger as Surgeon-General is just as dumb as the Pentagon’s work on a ‘gay-bomb.’

Great article, Jim! You really called it on what his article really means in terms of his religion. Holsinger is no better than Cameron.

Timothy Kincaid
June 12th, 2007 | LINK


Brilliant, as usual.

Please (please, please) forward your analysis to the staff of the Senators on the committee. I would LOVE to hear the him try and justify his paper – especially the woman who died from septis and explain how this relates to his premise that disease results from non-complementarity of the sexes.

June 12th, 2007 | LINK

If Holsinger’s insinuation is indeed that heterosexual anal penetration is healthy and homosexual anal penetration is not, then he deserves to be criticized. I wonder, though, do you deny that insertion of the penis into the anus as part of sexual activity carries a vast amount more health risks and dangers than penis insertion into the vagina? That fact would seem to be pretty indisputable by any but the most extremist ideologues. Honest sexual education to young people should *certainly* inform them that *any* anal sexual activity, homosexual or heterosexual, carries health risks and dangers well above and beyond the risks already run in promiscuous heterosexual activity (e.g., infection from fecal matter, much easier transmission of STDs because of the greater likelihood of em. Do you disagree with this?

June 12th, 2007 | LINK

that’s ‘greater likelihood of blood.’

Timothy Kincaid
June 12th, 2007 | LINK

I wonder, though, do you deny that insertion of the penis into the anus as part of sexual activity carries a vast amount more health risks and dangers than penis insertion into the vagina? That fact would seem to be pretty indisputable by any but the most extremist ideologues.

No. I don’t think this has been established.

There are health risks associated with all sexual activity… or indeed with almost everything we do in life. However, monogamous sexual expressions of affection do not increase anyone’s risk of STDs. And If anal sex is accompanied with adequate lubrication and a condom, I don’t believe that there is a significant increase in health risks.

As for fecal matter infection, this is the first I’ve heard of it.

Perhaps there is some increased risk of some specific health issues, but certainly not “vast”.

And, as many women will tell you, it highly decreases the likelihood of unwanted pregnancy.

June 12th, 2007 | LINK

This is frankly the kind of reasoning that is not tremendously helpful. “there are health risks associated with all sexual activity”–and therefore those risks are equal for ALL kinds of sexual activity? Surely you see that doesn’t follow, no?

When the attempt is made to turn the anus into a sex organ, fecal matter is introduced into the equation, however ‘monogamous’ and ‘affectionate’ the anal sex participants are. Fecal matter is literally crawling with bad stuff. The medical literature is filled with information on the various bad things that can come from ingesting it or otherwise being exposed to the bacteria contained therein through, say, lesions in the penis (which occur even with lubrication, and condoms break).

Even in the best case scenario, which you give (condom and lots of lubrication), anal sex is significantly more of a health risk than protected vaginal sex because of the simple facts of what is involved–the anus, and hence feces. Why is this so hard for you to admit? I don’t even say that that risk is X Y or Z in quantitative terms, simply that in comparative terms it is certainly higher. The CDC has had information on this on its website, noting that the risk of transmission of enteric infections is particularly high among men who have anal sex:…mm5433a2.htm. MOre, given the fragile nature of the anal tissue, transmission of HIV is indeed quite higher here than in vaginal sex–again, condoms break.

Add in too the risk of physical injury, which, whatever the homosexual and pro-anal sex heterosexual lobbies would have one believe, certainly happens too. Why else would health sources on anal fistula and other anal abrasions and tears note that doctors should inquire if patients suffering from these problems engage in anal sex:…/9446.html. It’s because health professionals know that sticking rather large objects into the anus that aren’t supposed to be there, like sticking pencils into one’s ear, is likely to provoke problems.

Regarding the “many” women who you seem to think will cheer the advantages of anal sex, I think it much more likely that most of the minority of heterosexual women who claim to engage in this activity (and btw we have no good information regarding how many women actually do) do so because of the desires linked to power and domination of their boyfriends/husbands/partners, not because of any purported birth control advantages or any great pleasure they take from it.

June 13th, 2007 | LINK

Anal cancer positively correlated with anoreceptive intercourse:…full/12/5/524

Anal warts positively correlated with anoreceptive intercourse (and condom use of no demonstrable positive effect in prevention):…00000003/art00005

Jim Burroway
June 13th, 2007 | LINK


Anal cancer is positively correlated with anoreceptive intercourse, as are anal warts. That is true, which is why I did not dispute that portion of Holsinger’s paper — or did you not read it? Anal cancer and anal warts are caused by HPV, which also causes genital warts and cervical cancer. That’s the whole reason behind the recent push to disseminate an HPV vaccine.

In other words, cervical cancer is positively correlated with vaginal intercourse. As are the whole constellation of infections known collectively as vaginosis.

ATR, what you are doing is pretending that the cases seen in emergency rooms and STD clinics are representative of gay men overall. They are not. If you insist that we accept that they are, then I would have a right to demand that you also accept that the body of literature of straight men and women in STD clinics and emergency room settings represent the heterosexual population. In which case, I invite you to defend your practices against those who appear at your local STD clinic and emergency room.

Of course, to do so is preposterous because the very premise of it is illogical. You — and I — are not walking petri dishes. We are people. And I don’t know about you, but I am now 46 years old. The only health consequences of anything that I’ve experienced in my entire adult life is an elevated blood pressure. I blame my Dad’s family’s history of heart disease. No other “consequences” for me. No injuries, no STD’s. And as I look around among my friends and colleagues, I know that my experience isn’t unusual.

And that’s the point of this message. I know you don’t want to hear it. It’s easier to deal with us as petri dishes than people. But I would challenge you to at least try.

Otherwise, we can pull out competing medical studies until we’re blue in the face. I’m not willing to see this thread devolve into that sort of useless cat fight. If that’s what you want to do, you’ll have to do it elsewhere. I’ll just refer you to my collection of studies on heterosexuality which can be found here.

June 13th, 2007 | LINK

Why do you think statistics about the risks of anal sex say anything at all about YOU or your ‘friends and colleagues’? That you personalize the discussion is a strange reaction, and a very unscientific one–are you a scholar or a doctor? I’d doubt it, given that you go to that place as a ‘response’ to the discussion.

Are you not familiar with the idea that someone in category A (which is a category of persons far more susceptible to encountering virus X than people in category B) can still be free of virus X, and yet this fact does not discount the statistical generality of individuals in category A having higher risk? Of course I don’t know about your personal health history, and it has nothing to do with this discussion. I’m talking about the long list of studies that indicate that anal sex increases one’s risk of a large number of very nasty conditions, and peripherally the extremist side of the homosexual lobby’s seeming inability to accept this simple medical fact. It does your side in the debate no service that you want to argue against what is so clear in the literature.

The paranoia of ‘you want to deal with us as petri dishes’ is just stupid. You don’t know anything about me or my politics regarding homosexuality. For the record, I don’t care a damn if grown men want to stick their penises or anything else up each others butts all day and all night. I work in academia and am SURROUNDED by homosexual men and women and I have never in my life said anything to any of them about their sexuality, wouldn’t dream of it, don’t fricking care–let them be sure their medical coverage is adequate to handle the risks they are running and let them go to it. So long as they do their jobs at work, I have no problems with them and zero interest in their private lives.

What I do care about, and it is my right as a citizen to have such cares, is that accurate medical knowledge be communicated to young people as part of the educational process (‘accurate’ as in ‘neither Christian wackjob propaganda nor extremist sexual libertarian wackjob propaganda’).

I also care about social policy that reinforces institutional structures that have a proven history of success in the business of child-rearing and I care to try to prevent some minority of people in this society from using the nation’s children as guinea pigs in a vast experiment in social engineering. I care about trying to do what I can to slow or even reverse the runaway drift of this culture in the direction of ‘it’s all about me and my happiness and screw society’ narcissistic hedonism and to restore some measure of communitarian responsibility.

If you think that means I see homosexuals as ‘petri dishes,’ then whatever. You reveal your intolerance.

June 13th, 2007 | LINK

And btw I wouldn’t so proudly parade that silly little ‘Risks of Heterosexuality’ thing you put together as some convincing bit of argumentation, logical acuity, rhetorical skill, or whatever. Any reader with a high school education ought to be able to see in about three seconds the massive fallacy on which it rests.

One can hardly reasonably talk about the ‘risks to society’ of the sexual practice that is responsible for literally REPRODUCING society–if we were to outlaw heterosexual activity because of the risks entailed, then we should die out as a species. Any risks entailed are by definition worth running because of the vast benefit to the human world that procreative sexuality produces. Do you not see that?

The ‘homosexual risk’ literature, whether grounded in reliable science or not (and I freely admit that too much of that stuff is done by the Christian lunatics who wouldn’t know facts if they were nailed to the cross and killed before their very eyes), begins from the indisputable foundation of the reproductive incapacity of homosexual sex. The simple flipping of the scenario therefore does not logically make sense, and reads as transparently foolish.

Jim Burroway
June 13th, 2007 | LINK

ATR, I think we’re at an impasse.

The article I linked to was clearly marked as a parody. I really wish you could have read it because it illustrates many of the same methods that Holsinger himself used when he wrote his article — now that we are finally back to the original subject of this thread.

Which gets back to my point. Okay, I personalized it. But I think its important to remember we’re talking about people. All you want to talk about are people in STD clinics and emergency rooms. It’s all Holsinger talked about it.

All I’m saying is if we’re talking about people like you or me, then we have to go to sources that reflect people like you or me.

Holsinger ostensibly wrote about gay men. He didn’t. He wrote about people in STD clinics and emergency rooms. He just didn’t tell us about it.

And you’re angry that I revealed exactly what he didn’t write about ordinary gay people. That instead, he only wrote about gay and straight people in emergency rooms and STD clinics.

If you missed the point, I’ll say it again. He wrote about people — gay and straight — in emergency rooms and STD clinics. Not you, and not me. But he lied about it and said it was gay people he was writing about.

That’s the point. Any academic should be able to see that. If not, then God help our colleges and universities.

June 13th, 2007 | LINK

Yeah, I agree that we’re at an impasse, and I think it’s because you don’t seem to want to accept that there exist plenty of data (I’ve linked to some of them here) to show that the “ordinary gay people” you seem to think don’t suffer from the health risks of anal sex in fact do–and so do heterosexual people who engage in this practice. And certainly you must know that a lot of the “ordinary gay people” and ‘ordinary’ heterosexual people who practice anal sex are PRECISELY the kinds of people who wind up in STD clinics and emergency rooms. The idea you seem to have that this population is so clearly differentiable from the “ordinary” population is a bit strange. And who are the “ordinary gay people” anyway? When did you get permission to make that definition? Don’t you think there are two or three other homosexual men out there, men very different from you in some ways, who, like you, would like to define it as ‘people like me’?

I don’t care very much about Holsinger, and everything I’ve said here has been about the broader issue of whether or not there are scientific data to show that anal sex entails serious health risks. What interested me in your and other reactions to him was more about you than him.

If you are stuck on Holsinger and want to stay with that in order to avoid the larger issue I’m talking about, that’s certainly within your rights. My point in the context of the post you made is that too many people like you, in engaging in at least partially legitimate criticism of people like HOlsinger, like to pretend that the critical points you score on religious fundamentalists who don’t know the science make it possible then to spin the facts any old way you’d like–and you’d apparently like to spin them in such a way as to make the health risks of vaginal sex more or less equal to those of anal sex.

The facts however are not on your side and you probably know it, but you are apparently very eager to avoid admitting that. I won’t claim to be able to get inside your head to see if that’s deception (lying) or something else (i.e., I’ll be fairer with you than you are being with Holsinger).

June 13th, 2007 | LINK

Let me add a note regarding your sense that the people in the Copenhagen STD clinic/emergency room have nothing to do with ‘ordinary gay people.’ (This is the weakest of the several points you make in your review of Holsinger).

How do you know that? How do you know that this population is neatly distinguishable from the ‘ordinary’ population? I don’t have the study in front of me, just Holsinger’s ref to it, but there would seem to be nothing there to legitimate such a claim.

Believing such a thing would require us to believe some things that we have much evidence against, e.g., that people who engage in ‘safe sex’ never have accidents with condoms, that people who claim to be monogamous always actually are, etc.

Beyond that, how do you make sense of the fact that the Cophenhagen study showed clear and significant differences regarding rates at which the homo- and heterosexual populations they looked at showed evidence of various health problems? In other words, even if one believes your claim that what they were looking at were not ‘ordinary’ homosexuals and heterosexuals, but only ‘deviant’ homosexuals and heterosexuals who engage in non-safe sexual practices, one still has to explain away the significantly greater degree of health risk for homosexual men (“The total burden of infections expressed as the actual number of infections was largest among homosexuals, 40.4%, 22.4%, and 5.3% having one, two, and three infections respectively”).

Isn’t it significant for the case for the increased risk of anal sex (which is the primary activity separating most homosexual men from most heterosexuals) that we find this kind of distinction between homosexual and heterosexual populations, even if the two populations are taken as subgroups within their larger sexuality groups that are unrepresentative of those larger groups in at least some ways?

I’ll emphasize again something else that you seem to have little (read: no) interest in speaking to–pointing out that Holsinger illegitimately tries to distinguish the health risks of homosexual and heterosexual anal sex is perhaps telling in criticizing his prejudices, but it says nothing to the issue of whether or not anal sex GENERALLY entails elevated health risks (of the kind noted in the Cophenhagen study Holsinger cites).

That’s the point I entered on, trying to see if one could at least get acknowledgement of that fact, or if instead one would get the kind of denial Timothy Kincaid evinces above and then be dumped into the same bag with Holsinger and the other religious fanatics simply for pointing to empirical evidence and going ‘Lookey there.’

Jim Burroway
June 13th, 2007 | LINK

Again, I’ll point out that yes, there are risks to anal sex. It is impossible to say otherwise. There are also risks to oral sex and vaginal sex. When Timothy pointed that out, you decided that reasoning was “not helpful.”

I fully believe the facts really are on my side. I’ve been spending far too much time at the library over the many years to believe otherwise. It is also why I sign my full name to everything I have ever written — no pseudonym, no initials.

You say, “and certainly you must know that a lot of the “ordinary gay people” and ‘ordinary’ heterosexual people who practice anal sex are PRECISELY the kinds of people who wind up in STD clinics and emergency rooms.” I’m simply trying to point out that ordinary people who practice vaginal intercourse also end up in the emergency rooms and STD clinics. But again, you find that “not helpful.”

And I agree. None of this is helpful. Why? Because again, I think that heterosexuals who end up in emergency rooms and STD clinics have nothing to do with you, your dignity, or your place in society. I think you can agree with me on this.

I only ask — no, expect — that the same hold true for us.

Jim Burroway
June 13th, 2007 | LINK

As for the Copenhagen study, I can pull out similar studies which show higher rates for some serious STDs for straights than gays. That’s the whole problem with convenience samples. You said you were an Academic. Surely you know that.

In fact, most of Holsinger’s artcle had very little to do with anal sex — outside the Copenhagen statistics. It had to do with foreign objects, fissures and fisting. And that, my friend, was mostly about the heterosexuals.

I can find plenty of studies which show that heterosexuals have greater incidences of some STDs than straight people. In fact, I referred you to my parody in which I used those studies to show how tracts like this one are put together. Do you know how hard it was to find them? It wasn’t hard at all. But pointing that out just seemed to make you angrier. Well, welcome to my world.

I think it’s time to draw this to a close. Obviously you’re as stuck on anal sex as I am on Holsinger’s misleading use of medical “evidence” from heterosexuals to blast gays. I think you’ve exhausted this as well as I have.

June 13th, 2007 | LINK

Well, I will end this then. You are apparently not interested in really having a discussion about this, as you have AGAIN eluded speaking to the single issue that I’ve raised–why is it that homosexual men have a HIGHER “total burden of infections” if vaginal sex and anal sex are roughly equivalent in their risk?

You use various bits of not all that clever wordplay to avoid this–talking about studies that show that heterosexuals have greater risk for “some” STDs than homosexuals, etc. But simply repeating over and over again that mantra that ‘there is no health risk difference in vaginal sex and anal sex’ does not make it so, no more than your friend’s silly attempt at equating pregnancy and STDs in his intervention here. I have no doubt that your fans here will not notice that, but recognize that honest participants in an intellectual debate DO note such things.

IF you have any references to studies that make the same claim the Copenhagen and other studies do in reverse, that is, that the TOTAL BURDEN of sexual infection (not ‘some,’ but the TOTAL BURDEN) is higher for heterosexual populations than comparable homosexual male ones, then by all means PRODUCE THEM. I’d be very, very interested in seeing them–whether you believe it or not, I am driven by empirical evidence on this, not ideology. I just don’t think you have that empirical evidence.

You apparently fail to understand how the burden of evidence is accrued in academia. Simply being able to produce a study by someone somewhere making your point does not close the case (and, note, you have not even done that yet). The wingnuts who are convinced human-made global warming was invented by scientists looking for big grants do that all the time–I wonder if you know you share that argumentative strategy with them. The way in which proof emerges in a scientific community is through the creation of consensus–not unanimity, and not ‘no outliers’ but CONSENSUS.

The consensus as I have been able to determine (funny that you imagine you are the only one who reads much about this kind of stuff) is in agreement with that Copenhagen study, i.e., homosexual men who engage in anal sex have a HIGHER BURDEN of infection than others who do not.

A final point on ‘rights’ and sexual activity. Rational societies weigh social burdens and social benefits of the elective activities of individuals (as opposed to the increasingly irrational societies in the modern West which simply chalk up a new ‘right’ every time some individual wants to do something that s/he likes to do, whatever its impact on the community). As I noted in my response to your ‘parody,’ the consideration of any ‘rights’ to engage in sexual activity ought to include a discussion of the demonstrable negative and positive social effects of that activity. On this matter, vaginal sex has it all over anal sex, as the former reproduces society materially. The latter, so far as I can tell, produces nothing more than the individual gratification of the participants, and it is quite debatable that those benefits outweigh the social costs in disease and medical expense.

As for anonymity, do you really believe that you get courage points for publicly being on the ‘Gay? Fine by me!’ bandwagon? Puh-leeze! WHere I work, it is essentially taboo to publicly have any other position, and there are more than a few of my colleagues who I have no doubt would like to expand the campus definition of hate speech to include ANY dissent on the same sex marriage issue, however well-reasoned and dispassionate.

I’m tenured now, so I don’t worry (much) about it, but at the same time I see absolutely no reason to make it easy for angry lunatics to bombard my work email with their pathetic nonsense because they cannot accept the existence of people who disagree with them, and in my experience there are always at least a few angry lunatics hanging around most sites like this one.

Jim Burroway
June 13th, 2007 | LINK

You apparently fail to understand how the burden of evidence is accrued in academia. Simply being able to produce a study by someone somewhere making your point does not close the case

And yet, the nominee for our nation’s health advocate did just that.

You’re concerned about comparative burdens of STD’s, and then you justify Holsinger’s use of a convenience sample to use comparative burdens as evidence of the inferiority of gay relationships. But if comparative burdens are a valid yardstick, then should we look at comparative burdens of STD’s among African-Americans when compared to society as a whole and knock their dignity as individuals? Rural southerners have a significantly higher burden of STD’s compared to American elsewhere. Do we denigrate their place in society and compare their “couplings” to pipe fittings? Of course not. But these are exactly the same kind of arguments you and Holsinger use to justify some self-appointed pontiffs to place these evidences on a scale and shout “ah-hah!”, as when you say:

The latter, so far as I can tell, produces nothing more than the individual gratification of the participants, and it is quite debatable that those benefits outweigh the social costs in disease and medical expense.

There it is. It’s not love, it’s “Instant gratification” and “social costs of disease and medical expense.” That’s what we boil down to, as far as ATR is concerned.

And that wraps this up between ATR and me. Aren’t the rest of you glad of that?

David Hearne
June 14th, 2007 | LINK

“…in my experience there are always at least a few angry lunatics hanging around most sites like this one.”

That’s what we call irony around these here parts.

There’s much to cherish in the posts of ATR — his disparagement of wingnuts while employing wingnut rhetoric; his insistence of personal OK-ness with gays while imagining horrid things about them; his scholarly usage of ‘puh-leeze!’ and caps lock (particularly in his warning cry of ‘SURROUNDED’ as if he were sweating and shifting his eyes); and, of course, his pretense of desiring rational debate while clearly looking for a fight.

You handled him well and calmly, Jim. I would have been yelling ‘stow it, dumbass!’ long ago.

David Hearne
June 14th, 2007 | LINK

Excuse me. You handled him well and calmly, Mr. Burroway. I don’t know you well enough to use first names.

June 14th, 2007 | LINK

There’s yet more to cherish in the tactics of cowards who have nothing to say about facts and prefer to make comments on the use of CAPS by the mobilizers of those facts as though that were a meaningful intervention. Hearne shows himself as yet another supremely delusional person who can’t tell the difference between an anus and a vagina and who should probably just be quiet.

“Stow it, dumbass”–now there’s someone who clearly wants a “rational debate,” eh David? You’re CLEARLY a more reasonable and scholarly voice than someone who would use the term ‘puh-leeze,’ aren’t you? I haven’t the slightest doubt that you wouldn’t know a ‘rational debate’ if it hit you in the face.

But thanks for representing the other voice of the extremist homosexual lobby that I’ve come to know: angry illiteracy. Mr. Burroway has already nicely represented its first voice: determined refusal to speak to facts that are inconvenient.

Jim Burroway
June 14th, 2007 | LINK

Well, the reason I didn’t call him a dumbass is because he isn’t one. Whatever disagreements we may have — and there are certainly plenty — there was never any name calling.

And there’s no reason to start it now.

And not to single anyone out, I’d like to post a reminder. This site has a comments policy. And while I’m rather lenient, I’m an equal-opportunity enforcer.

Jim Burroway
June 14th, 2007 | LINK

And let me amend that a bit: When I said there was no name calling, I mean there was no personally-directed name calling. I think we both tossed around a few adjectives here and there which came pretty close however.

ATR and I both will be taking a time out for the next couple of days.

greg swiderski
June 14th, 2007 | LINK

Did you see Stephen Colbert Wednesday, 13 June (repeated today, Thursday am and pm)? Stephen’s Word for the day was pathophysiology.

Jim Burroway
June 14th, 2007 | LINK


I did, and laughed all the way through. Thanks for reminding me.

David Hearne
June 15th, 2007 | LINK

To Mr. Burroway —

If I violated your comments policy, I apologize for it. I have a shorter level of tolerance for people like ATR. I don’t engage in a rational debate with him because I don’t see him as capable of making one or even interested in it. I’m also more accustomed to rowdier venues, and it shows. But this is your house, and we play by your rules.

To A of TR —

I’m willing to meet you again, sir, on a field of your choosing. Pistols at dawn!

Timothy Kincaid
June 16th, 2007 | LINK

Because I was the target of ATR’s scorn, I feel I should at least touch on some of his comments.

ATR works under the premise that his statements should be accepted at face value. Take as just one example the following assertion: “lesions in the penis (which occur even with lubrication, and condoms break).”

This is provided as though it is accepted fact. The implication is that lesions on the penis are so common as to be a relevant factor in bacterial disease transmission. No references are provided to support this startling presumption.

Well ATR is partially correct – though he got his facts wrong. In Africa and Asia there is indeed a problem with HIV tranmission from women to men during vaginal sex due to lesions on the penis. But they are generally the result of pre-existing STDs and not as a consequence of the sexual act itself.

But as for bacterial transmission resulting from anal sex and the confluence of lesions and breaking condoms in the United States… well, let’s just say that this hasn’t occured to the point where it has become relevant to the conversation.

But more disturbing than ATR’s willingness to fling unsubstantiated claims into the mix is 1) his willingness to extrapolate attributes from the clearly-nonrepresentative sample to the populations at large, 2) his refusal to separate anal sex per se from anal sex in certain circumstances, and 3) his false pretenses. Let me explain (the numbers tie):

1) As Jim clearly explained (and anyone rational can understand) the STD rates of those at STD clinics are not indicative of STD rates for people who are NOT at STD clinics. Yet ATR demanded that this was, indeed, the case and argued “How do you know that this population is neatly distinguishable from the ‘ordinary’ population?”

2) ATR argues that anal sex increases the risks of anal cancer and other various STDs. Yet the transmission of STDs requires the presense of STDs.

For that married couple who practice anal sex and who have never had another sexual partner, there simply is no way that anal sex can increase these risks. The act of anal sex does not spontaneously generate a virus.

And as for “sticking rather large objects into the anus”, well I don’t know if ATR is trying to compliment those who participate in anal sex, but in anal sex which involves a penis, in most cases that which goes in is not generally significantly larger than that which might be expected to pass out on a regular basis. (I hope that wasn’t too graphic or tasteless).

But ATR (and Holsinger) would have us believe that anal sex per se has the same risks as anal sex involving large foreign sharp pointed objects.

3) ATR would have us believe that his objection is to anal sex and not to homosexuality. His pretense is that he opposes heterosexual anal sex equally. But when looking at the entirety of his rants, it’s clear that they are not rants against anal sex, but rather rants against homosexual men. Look, for example, at this word choice: the extremist homosexual lobby. The only people who use this word combination are anti-gay activists. It does not occur elsewhere. Those who do not participate in conservative Christian activism are unlikely to have ever heard that combination and never use it.

Then look at ATR’s angry response to the suggestion that all sex is dangerous. Vaginal sex is forgivable for being dangerous because it results in procreation – in other words because it is heterosexual.

So when ATR makes the claim “You don’t know anything about me or my politics regarding homosexuality.” he’s mistaken. I think I have a pretty good idea about ATR’s politics.

Finally, let me say that there may indeed be some risks of anal sex that are not present in vaginal or oral sex – even for those who are monogamous and have had but each other as partners. But these risks have not been demonstrated either by Holsinger nor by ATR.

To oppose homosexuality per se, they have to impose on homosexuality the assumption that it always includes anal sexs. And to oppose anal sex per se, they have to impose on it the assumption that it is always in the presense of a virus or the use of large sharp objects. None of their arguments can stand alone.

And this is simply unacceptable in either a medical doctor or an academic. It is sad that those who are trained to be objective have such deep-seeded biases that they are compelled to toss out the rules of logic and good research.

James Ross
July 24th, 2007 | LINK

I applaud your critique of the scientific soundness of Dr. Holsinger’s paper. However, this entire controversy has raised a question in my mind. Since it is an obvious biological fact that the rectum is not part of the mammalian reproductive system. what does a scientific description of consensual anal intercourse reveal about it medical speaking? Is it healthy? What are the risks, if any?

Timothy Kincaid
July 25th, 2007 | LINK

James Ross,

As with all sexual interaction, indeed all human interaction, there are risks associated with anal intercourse.

The most commonly discussed risks are those related to transmission of infections – which are not truly the result of anal intercourse, per se, but the result of a lack of monogamy.

There are very few risks to “normal” anal sex provided that adequate amounts of lubricant are used and there is sufficient pre-insertive preparation. Although some anti-gay or anti-sex sites make bizarre scare claims, regular anal sex between monogamous partners who are free from infections have minimal risks.

This information is very readily available on a number of health sites on the internet. When perusing them, it is wise to avoid anti-gay political sites as they are not scientific or factual, and to be careful to distinguish between SDI risks (e.g. HPV transmission) and actual anal sex risks.

While this question is worth asking, sadly it was not one answered by Holsinger’s paper.

July 10th, 2012 | LINK

I’m bi, vanilla, and THIS is among the TRUTH of why gays are not accepted, NOT for basic, regular human behavior. You cannot get a legit, real masculine man, for similar reasons, and stick anything in your asses, due to obsessive-compulsive behaviors, are self-centered, facetious, and imitate all the bad traits of Hollywood women, and you expect to be taken as a sane adult?!?
If you don’t look inward, in your community, and clean up the nasty-assed fickle, inhuman messes, prevalent, do not expect society to accept you, or to stop being attacked, OR to ever have a real, legit, true man, which none of you ever have, or ever will, as the last 40 years proves. BET THAT LAST ONE HURTS THE WORST, COZ ALL YOU CAN GET IS NASTY-ASSED BAD REP.S, TO THE COMMUNITY, SUCH AS YOURSELVES.

Timothy Kincaid
July 10th, 2012 | LINK

And again this proves my contention that TRUTH never contains any truth.

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