New Diagnosis

Wednesday, October 21, 2015


Dear Patrick: I am a bottom who has Crohn’s disease. All of my fantasies are about getting fucked by another man. For years I wondered why I was having trouble with my bowel, and went through a series of medications and diets to try to control it. Now my doctor has given me this diagnosis. I feel as if I am losing my identity. According to my doctor, I can’t get fucked any more because it would be bad for my body in its inflamed condition. Even if the doctor said it was okay, I am afraid it would be too painful. My fear of the consequences would probably prevent me from enjoying the best and most careful top. I find, too, that I am afraid I got this disease because I am a bottom. I am 35, and heard all my life that anal sex was wrong, unnatural, spread diseases, etc. This has depressed me so much that I don’t know if I can muster the courage to go on living with a chronic illness.


When another gay man says, “I have something to tell you about my health,” we all assume he is going to confide that he is HIV-positive. But in fact, there are many physical (and mental) conditions that can affect one’s ability to have a life that includes sexual pleasure. Evidence tells us that Crohn’s disease probably has a genetic origin, so the first thing I should make clear to you and my other readers is that you did not give yourself this health problem by getting fucked.

Crohn’s disease is an inflammation of the gastrointestinal tract that may be triggered by environmental factors that set off the immune system. The body does not recognize the normal flora and fauna in the bowel as part of its own regulatory system, and attacks itself. This damaging disease can be diagnosed at any age, although it is usually known to be present by the individual’s mid-thirties. Men and women are affected equally, but Caucasians seem to be more susceptible than other ethnic groups. It usually affects the small bowel and the beginning of the colon, but can affect any part of the digestive tract, from the mouth to the anus. Symptoms include persistent and often painful and urgent diarrhea, cramping, bleeding, rectal tears, and periods of constipation that can lead to bowel obstructions. Fistulas (tunnels of infection connecting the bowel to other parts of the body) can also develop, and require immediate medical attention. People may also experience exhaustion, fevers, night sweats, and other symptoms of a compromised immune system.

There are many kinds of Crohn’s disease so patient education is really important. Learning more about a health problem can be overwhelming, so pace yourself. But you need to know as much as you can about what is going on so you can make lifestyle changes that may help you to feel better and also make informed decisions about medication your physician may recommend. Getting in touch with other people who have the disease is also important. They can help you to form a more accurate picture of what Crohn’s is like, whether it really is manageable, and how others have survived it. Remember that this disease, like many auto-immune conditions, often has periods of remission. A miserable interval of battling active symptoms can be followed by a period of feeling much better. Remission can’t be predicted or guaranteed, but don’t make a decision on whether to go on living based on data from the very worst day of your illness.

Andrew Markle has written “Five Things Gay Men Should Know About Crohn’s Disease,” a supportive article available on-line from The Bilerico Project. He makes the valid point that a partner needs to be empathic and respect the fact that there will often be days when anal sex is just not possible. A person with Crohn’s disease has no obvious wounds, but they can experience excruciating pain. It is very important for a partner to be kind and validating when this happens. Some people with this illness can require hospitalization and even surgery, so it seems wise to cultivate a grateful attitude if you are able to work and enjoy each other’s company. Your basic personality trait of being a bottom will not change, but you may be able to find other ways to express these needs to your man, and he may be able to help you come up with ways to satisfy your desire to go under.

There is also a great blog, “HomoCrohn: Thriving as a Gay Male with Crohn’s Disease,” available at The Crohn’s Forum has an LGBT component, and a lot of other support is available on-line if you feel ready to search for it. For example, the Gay Digest on has a blog written by a gay man with digestive illness, including a section titled “Sex: Straight Up (Well, Maybe Not So Straight).” This article includes great, detailed options for having a sex life while your insides are not cooperating. The author is a strong advocate for remembering that you have a whole body. Any form of sexual pleasure can increase quality of life for people who are ill. You can still enjoy receptive anal sex if your body can tolerate it, and there may very well be times when that is okay. But if you hurt too much or there are physical problems that make it a bad idea to take a cock, you will have to explore other forms of sexuality. That might mean learning how to top from the bottom, enjoying oral sex, using your hands, letting your partner penetrate you with his finger or rim you, or using verbal fantasy as a substitute for the real thing.

When I am really, really sick, I may just want somebody to hold me, and this can be nearly as affirming as an orgasm. It can be very challenging to keep engaging with other people and not simply withdraw. But for the sake of your mental health, it is very important to not let yourself get sidelined. I personally know that living with a chronic illness that causes pain and suffering is incredibly difficult. There are mental or emotional symptoms as well as the physical ones. Don’t hesitate to get therapy or medication if you need it for depression or anxiety.

People who don’t have your health profile will be sympathetic, but they can be slow to get detailed information. Healthy people can be in denial about their own vulnerability to a physical problem. This is why many of us who are disabled become activists in the area of healthcare and the social treatment of the differently-abled, to borrow an ‘80s trope. Invisible illnesses are often the target of denial or minimalization. Real friends will believe you if you tell them you aren’t feeling good. Someone who loves you will want you to have what you need to feel better or survive a period of intense pain. A good doctor will address the pain and make sure you can control it if it becomes unmanageable.

One thing that can really hurt a person who is disabled is self-blame. I went through a period of looking for reasons why this had happened to me. And many well-meaning people were willing to supply me with punitive explanations for not being well. Did I do this to myself because I ate meat, did drugs, had too many sex partners, did the wrong things sexually, unconsciously wanted to be dependent or ill, etc., etc., etc. YOU DID NOT DO THIS TO YOURSELF. Anal sex is normal. We have pictorial evidence of anal sex among the Egyptians and the ancient Greeks, in China and in Africa. Anal sex was probably commonly used for birth control (and pleasure) by heterosexual couples for millions of years. Gay men are simply using a sex technique that is available to EVERYBODY who feels pleasure when they touch their butt. The so-called sin of sodomy got criminalized and stigmatized by medieval Christian monks who thought bodies were evil and God wanted them to be celibate. In other words, by crazy people. This disease is caused by factors beyond your control. Stop torturing yourself because self-recrimination only leads to self-hatred and more stress. Those are two things you do NOT need right now.

I have come to believe that life is a gift no matter what challenges I face. Some degree of suffering seems to be a universal aspect of having a body. Because I frequently live with pain, I have become more determined to spare other animals (human and non-human) from feeling injured or endangered. I am a long way from meeting that goal, but it gives me something to strive for that is much better than marinating in self-pity. Some of us have to wake up and get more determined than others to go on living. I hope that my personal problems have made me more compassionate and helpful. Of course, there are also days when they just make me cranky and even mean, but on those days, I try to hole up in my apartment and focus on Perry Mason reruns and making toys for my cat. You wouldn’t want to take your pain out on anybody else because they aren’t responsible for what you are going through. SO DON’T TAKE IT OUT ON YOURSELF, EITHER. You are innocent. Forgive, forgive.

You are still an attractive, desirable man who needs and deserves to have romance and desire in his life. I hope you can adjust to your diagnosis and find a way to continue to be a responsive bottom. Good bottoms are a treasure. There aren’t that many of you. So perhaps I am being selfish by hoping you will survive and perhaps even thrive.

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