Gay Men's Health: An Introduction

As the new millennium dawns, it is an excellent time and opportunity for gay men to assess our health status -- physical, emotional and spiritual -- and see if changes need to be made in attitudes or behaviors that have the potential for enriching our lives and moving us forward to a place where we would like them to be.

Many serious issues confront gay men -- many are well-adjusted and enjoying life while others are in varying degrees of trouble ranging from temporary problems to life-threatening illnesses and many suffer from a lack of self-esteem which can fuel dangerous addictions and leave lives shattered.

Gay men's health covers a lot of territory and issues and the mere thought of the rigors of adequate self-care can understandably be overwhelming to many men but the American Psychiatric Association no longer considers homosexuality an aberration, perversion or mental disorder and postulates that the greater commitment to a homosexual or gay identity, the greater the gay man's psychological well being. Additionally, albeit slowly and painfully, influential segments of heterosexual American society are recognizing gay rights in a way that was unheard of 40 years ago and while homophobia is constantly present, many gays are able to be open about their sexual orientation in their jobs (as well as with their families) and same sex benefits are being extended to gay couples by a number of influential corporations. Improvements have been made but gay men are still persecuted and reviled by many and, like other disempowered minorities, encounter unique and difficult problems, as well as challenges and opportunities.

What are issues that comprise or affect the health of gay men?

They are numerous and though they will be listed separately, psychological difficulties affect physical well-being and vice versa. In a sense everything is connected like an intricate tapestry. For a gay man to achieve good physical health and emotional stability and reasonable contentment the threads have to be woven together to make the tapestry a whole piece -- some of the corners being left undone and ignored can lead to the whole tapestry unraveling. Gay men have the same health issues as their heterosexual counterparts and at age appropriate times (or if unusual symptoms develop) should have physical examinations as a routine matter of course.

Gay men need to develop a relationship with a health care provider who is nonjudgmental, not homophobic and is experienced in dealing with particular health issues that are likely to affect gay men. Too may times homophobic practitioners rush gay men out of their medical offices and do not indicate that certain procedures or follow-up is necessary because they are uncomfortable dealing with the gay patient.

The American Association of Physicians for Human Rights conducted a survey of their own membership and 67% of members revealed that they knew firsthand cases of gay or bisexual men who had been given substandard care or were even refused care because of their sexual orientation alone, and to add fuel to the fire, a full 88% of respondents heard their colleagues make disparaging remarks about their gay or bisexual patients. Sobering, isn't it? Would you like to be treated by a health care provider who will not do his or her best for you because of homophobia? It cannot be stressed enough that you need to find a health care provider who will treat you with the dignity and empathy you deserve and who will give you care with the best of his or her professional ability.

Health issues that gay men face can be unique (much as African Americans or Native Americans have health problems that particularly affects them as a group). Do not be ashamed if you have physical ailments or a disease associated with being gay. Advocate for yourself and take care of yourself to the best of your abilities. You deserve it.

Diseases or physical disorders or infections that affect gay men disproportionately (but not exclusively) include:

HIV infection and AIDS
other sexually transmitted diseases (STDs) including:
herpes -- genital and oral
hepatitis A and B (vaccine preventable)
syphilis
gonorrhea
urethritis (which if untreated can lead to urethral stricture, epididymitis and abscess in the scrotum)
genital warts (condyloma acuminatum)
crabs (pediculosis pubis)
scabies
hepatitis C (possible)
molluscum contagiosum
"bugs" that can invade your gastrointestinal tract and are most often the result of oral/anal contact and include parasitic infections such as giardia and amebiasis and bacterial pathogens such as campylobacter, salmonella, and shigella

All of the above diseases need to be treated -- they cannot be ignored -- not only for your own sake but for the health of your sexual partners as well for they are communicable diseases. You've got them from somebody and you can give them to someone else.

In addition gay males are affected by ano-rectal disorders (though not necessarily the result of anal intercourse) that include:

anal fissures
hemorrhoids
anal abscesses
fistula-in-ano
anal skin irritation or itch

The penis can be infected bacterially by balanitis and the penis can be injured by:

phlebitis (blood clotting usually due to receiving rough and persistent oral sex)
phimosis and paraphimosis (disorders of the skin in uncircumcised males -- circumcision may be considered if the disorders persist)
priapism -- or the inability to lose an erection even after sexual feeling is gone. This condition can be caused by improper use of cockrings or drugs such as cocaine, alcohol and Viagra.

When engaging in rough or S&M type sex, especially when your judgment is impaired by drugs or alcohol, you may become physically injured or catch an STD.

Engaging in any sexual act, from pure vanilla to the rough side, could lead to catching an STD, especially when your judgement is impaired with drugs or alcohol.

Learn about how you can best protect yourself when having sex. Learn about proper condom usage, hygienic use of sex toys, how to be pierced properly (if you are interested) and learn what risks are attributed to specific sexual acts. Learn about what is referred to as the pyramid of safer sex. Gay males may suffer from premature ejaculation or impotence. Don't think that the problem is just in your mind -- it may or may not be. Don't be embarrassed to seek help and find out the reason why -- many men have shown marked improvement with these disorders after medical or therapeutic treatment or a combination of both -- depending on the underlying cause.

There are complex and life-changing issues associated with:

coming out to parents, friends and employers
living, loving and working in a homophobic environment

Depression is common among gay men -- no wonder -- with the fear of AIDS hanging over our heads, living with HIV or AIDS and the attendant physical and emotional stresses that accompany it -- anger, sadness, hopelessness (and often a newfound strength and spirituality). The grieving process from losing friends and loved ones is emotionally wrenching and after a time can become numbing. We need as much help to deal with the constant barrage of crises in our lives as possible. If you are depressed seek help. An understanding therapist working with you can be invaluable when you are in a state of sadness, anger, confusion or crisis. We need to get things off our chest and antidepressant medication may be indicated and could improve your attitude, functioning and quality of life.

Teenaged gay males have a high attempted suicide rate -- sometimes they are abandoned by family and have to eke out a living on the street where they are prey to violence, rape, drugs and disease and in short time, with drug habits to pay for, can turn into predators themselves. Likewise, elderly gay men can feel isolated and lonely in a culture at large that doesn't value the elderly. Unfortunately there is plenty of elder discrimination in "gay society" where all too often youth and good looks are overvalued. Certain gay men try to conform to a current look or vogue and shun others who do not "live up to the standard", probably because as a shunned and stigmatized minority they want to belong to a group of pack so badly that they shun others in the process. Gay men can fall into the unhealthy roles of victims and victimizers.

Additionally, in each gay man's quest for emotional and sexual fulfillment, hard choices must be made about monogamy vs. promiscuity -- choices that are often made after much trial and error and ambivalence. The results of these choices also can lead to loneliness and isolation.

Fortunately in most cities there are centers which provide programs for gay men to participate in as a group -- an alternative to the eventual deadening "bar scene". These programs exist not only for teenagers or older gay men but for every age group and feature activities you can participate in from sports to singing as well as self-help and recovery programs. Find out what services your gay community offers you. It is a chance to bond with other gay men in a nonsexual way and break your sense of isolation.

As with other oppressed minorities who have issues of low self-esteem, many gay men quite naturally have an internalized homophobia that is one of the factors why addiction is rampant. This issue facing many gay men is quite simply an issue of life and death. Besides the ability of any addiction to take over your life and ruin it, these addictions thrive in the deadly world of AIDS where the wrong decision made when we are not sober can kill us. Don't be an addictions statistic. Get help for yourself.

Addictions affecting gay men include:

sex addiction
alcohol abuse
romantic obsession
abuse of prescription drugs obtained legally or illegally (such as Valium and Xanax)
illicit drug use -- recreational, illicit drugs that are currently used by gay men and can cause dependency or physical and emotional harm include:
amyl nitrate (poppers)
cocaine (sniffed, smoked -- crack-cocaine -- or injected)
injecting speed or steroids, often in combination with other drugs
marijuana abuse (marijuana today is much stronger than in the 60s and can lead to missed work from tiredness or become the gateway to harder drugs)
crystal meth
Special K
Ecstasy
Viagra (when combined with amyl nitrate can be deadly)
heroin (sniffed, smoked or injected)
GHB

If you have an addiction problem -- and a number of gay men are cross-addicted, i.e. carrying not one but several monkeys on their backs -- seek help from a reassuring, nonjudgmental health care provider who can refer you to the appropriate professionals for the help you need.

Gay men have shown incredible spirit in dealing with difficult problems. We at Always Your Choice take the issue of gay men's health very seriously and are committed to building a comprehensive web site that addresses health issues important to you.