From the author's note on this article, a first hand account of the realities of anal sex.
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:
http://www.sandyford.org/media/38074/msm%20ceg%20june%202014.pdf
An interesting article from the University of Hawaii:
http://www.hawaii.edu/hivandaids/Sexual_Trauma_Associated_with_Fisting_and_Recreational_Drugs.pdf