The Lebanese Medical Association for Sexual Health (LebMASH) has recently learned that a Forensic physician in Lebanon, Dr. A. M. has conducted anal tests on several individuals to determine their sexual orientation.
LebMASH is extremely concerned to hear that this practice, “the anal test”, continues to take place in Lebanon especially given that:
- This test is antiquated and does not yield any useful information about a person’s sexual orientation or behavior.
- This test can be harmful physically and psychologically to the person receiving it.
- The order of physicians in Lebanon banned this test in an official Memo in 2012.
- The test is unethical, violating a major component of the Hippocratic Oath: non-maleficence or “first, do no harm”.
Before we discuss the anal test itself, it’s important to understand that male homosexuality has three different aspects to it:
- Sexual orientation: the sexual and/or emotional attraction to another person of the same sex and the desire to be with this other person.
- Sexual behavior: the actual sexual acts that involve two men and can include kissing, body contact, oral sex, mutual masturbation, anal stimulation, and anal intercourse.
- Sexual identity: identifying socially as being homosexual or gay.
A person can have a homosexual sexual orientation but not engage in sexual behavior with other men and without identifying as gay. Another person can have a homosexual sexual orientation and engage in sexual behavior with other men but not identify socially as gay. And finally, a person can have homosexual sexual orientation, engage in sexual behavior with other men, and identify socially as being gay.
The so-called anal test for homosexuality involves the insertion of a metal object into a man’s anal canal through the anus allegedly to find out if this person is homosexual. Homosexuality, just like heterosexuality, is a very complex construct and can’t possibly be determined by a simple test.
The only “medical” reference to the use of the anal test in relation to homosexuality is a paper published by a French medico-legal expert named Auguste Ambroise Tardieu back in 1857. Tardieu claimed that “chronic sodomites” have certain specific penile and anal physical characteristics that are unique to them.
Today, over 150 years later, we know that what is mentioned in Tardieu’s study is not true. Adult men who engage in consensual anal intercourse do not have any permanent penile or anal characteristics that are unique to them. Therefore performing an anal test on them is futile.
The anus is the external opening of the anal canal, which is the terminal part of the human colon. The anus has 2 sphincters: the internal anal sphincter that is an involuntary muscle and the external anal sphincter that is a voluntary muscle (i.e. can be opened and closed at will by the person).
If we examine the report of Dr. A. M. more closely, we can see in more details how misguided he is about both normal anal anatomy and homosexuality. In his report, Dr. A. M. mentions that there was “no evidence of accumulation, tear or redness”. Normal homosexual anal intercourse between two consenting adults does not lead to “accumulations, tears or redness”. Even if there was evidence of any of these findings on an anal exam, these findings can be attributed to a number of medical conditions such as an anal abscess, an anal fissure, constipation or hemorrhoids all of which can cause changes in the anal mucosa.
Dr. A. M. also mentions in his report that “the anal sphincter is functioning normally”. Adult men who engage in consensual anal intercourse, even if it is on a regular basis, do not have abnormalities in the functioning of their anal sphincters. The anal sphincters have the natural ability to expand when needed (for example to receive anal intercourse) and return to their normal size and tone afterwards. This is seen every day when passing a bowel movement. The internal anal sphincter relaxes naturally and the external sphincter is voluntarily relaxed to allow for defecation. However, following this, both sphincters return to their normal tone and functioning.
Performing an anal test on someone to find out information about someone’s sexual orientation or behavior is not only futile, but can also be very harmful physically and psychologically.
Physically, inserting a metal object into an anal canal in an uncontrolled location such as a police station can place the person at risk for infections such as Human Papilloma Virus (HPV) and Hepatitis, to mention a few. Inserting an object as small as a finger into one’s anal canal by a Forensic doctor can cause excruciating pain and/or tears, even for someone who regularly engages in anal intercourse. The difference is that when engaging in normal anal intercourse, the individual has the chance to gradually and voluntarily relax the anal sphincters, as well as many muscles that exist in the perineal area, in order to receive anal intercourse, that is perceived as pleasurable by this individual. On the other hand, and similar to being raped, inserting an object as small as a finger into someone’s anal canal without their consent and without giving them the chance to gradually relax their muscles will lead to the opposite scenario, i.e. to further contracture of the anal sphincters and perineal muscles, and therefore will lead to severe pain and possible injury.
Psychologically, subjecting someone to this anal test discussed here can lead to severe psychological trauma similar to the trauma that individuals can endure after being raped. In addition to the shame and humiliation, the individual subjected to this cruel procedure is at risk of developing Post Traumatic Stress Disorder (PTSD) and possibly sexual dysfunction by being unable to receive normal consensual anal intercourse or even anal stimulation in the future.
LebMASH calls on the Lebanese Order of Physicians (LOP) to take responsibility for the actions of one of its members by enforcing disciplinary measures on Dr. A.M. to reinforce LOP’s ban on these tests issued on Aug. 7, 2012.
LebMASH reiterates its position regarding homosexuality being a normal variation of human sexuality and therefore not a medical or psychiatric condition that requires diagnosis or treatment.
LebMASH is happy to provide LOP members and especially to Dr. A.M. cultural competency training and consulting for issues related to sexual orientation and gender identity.
LebMASH urges the LOP to issue an official statement, similar to those issued in July of 2013 by the Lebanese Psychiatric Society and Lebanese Psychological Association, asserting that homosexuality is not a disease and that homosexuality is a normal variant of human sexuality.
We also call on the law enforcement agencies in Lebanon to abide by Lebanon’s commitment to the Universal Declaration of Human Rights, especially Article 5 the part relating to humane treatment of people in custody. We call on those agencies to respect people’s right to the integrity of their bodies.
LebMASH calls on lawyers and judges to stop using Article 534 of the Lebanese penal code to criminalize homosexuals since the sexual act between two consenting adults of the same gender is not “against nature.”