Box Turtle Bulletin

What Is “Gay Bowel Syndrome”?

Jim Burroway

April 11, 2007

In 1976, an article appeared in the Annals of Clinical and Laboratory Science entitled, “The Gay Bowel Syndrome: Clinico-Pathologic Correlation in 260 Cases”.^AAA This article, the first to use the term “gay bowel syndrome,” gave a two-part definition for the syndrome: 1) the patient suffers from at least one of 22 intestinal ailments and 2) the patient is gay. Some fifteen articles appeared in professional journals over the next decade, expanding the list of medical conditions to more than fifty items, but holding the second criteria the same: the patient is gay.

Using “gay bowel syndrome” as a medical diagnosis presents several problems. First, none of the conditions described in the literature were unique to gay men. This often placed researchers in the awkward position of warning that “these diseases are not unique to this patient population,”^BBB or that “the term [gay bowel syndrome] is a misnomer, since it covers a variety of etiologically unrelated diseases…”^CCC

Second, if a straight man were diagnosed with benign polyps or hepatitis (which are among the more than fifty conditions supposedly part of this “syndrome”) he automatically escapes the diagnosis of “gay bowel syndrome.” A straight woman with hemorrhoids who participates in anal sex with her husband also escapes this diagnosis. Yet a gay man with exactly the same medical condition would supposedly be given the diagnosis of “gay bowel syndrome”.

According to the Centers for Disease Control, two-year-olds constituted the age group with the highest incidence of shigellosis in 1982 when the term “gay bowel syndrome” was still being discussed in the literature.^DDD But how would the condition, symptoms or treatment of a two-year-old be any different from a patient in a nursing home (30% of all cases that year were from resident care centers) or a gay man?

But now let’s imagine a doctor who is handed a patient’s chart with a diagnosis of “gay bowel syndrome.” Would he even begin to know how to treat the patient? Obviously not. After all, the best treatment for colon cancer is very different than that for benign polyps. And this is not a mere hypothetical exercise — there was one reported case of a gay man who had colon cancer, but was diagnosed with “gay bowel syndrome,” despite his family’s history of early colon cancer. This caused a huge delay before he received proper treatment — his cancer wasn’t discovered until he was admitted to the hospital.^EEE His diagnosis of “gay bowel syndrome” didn’t even offer a hint as to what was wrong or what the proper course of treatment should be.

Conversely, if the patient were a straight man or woman, would the prescribed treatment be any different than that for a gay man with exactly the same medical condition, but diagnosed with “gay bowel syndrome?” Of course not. A straight woman with hepatitis A would undergo exactly the same course of treatment as a gay man with the same disease. A diagnosis of “gay bowel syndrome” is clinically useless.

But that’s not all. “Gay bowel syndrome” doesn’t even fit the clinical definition of a syndrome: “A set of signs or a series of events occurring together that often point to a single disease or condition as the cause [emphasis mine].”^FFF The multitude of medical conditions which fall under the umbrella of “gay bowel syndrome” all have unrelated viral, bacterial or parasitic origins. They have nothing in common — no underlying medical cause ties them together, and there is no similar remedy for their cure or treatment. “Gay bowel syndrome” simply doesn’t meet the definition of “syndrome.”

This leaves us with the conclusion that the “gay bowel syndrome” is neither a gay condition nor a syndrome, nor does it have any useful clinical meaning. One medical professor outlined all of these weaknesses and more, clear clear back in 1985:

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.^GGG

The medical community (except for a few conservatives) has abandoned this term. Its mention in the medical literature died out by the early 1990’s, and it is now regarded as being without merit, a relic of bigotry and stigmatization. It lives on only in anti-gay literature, where it is sometimes used to justify discrimination against gay men (and oddly, lesbians, who are never mentioned in the literature describing this “syndrome”) in employment and the military.^HHH