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Medical exams of anal sex

Medical exams of anal sex

Cichowitz C, Rubenstein L, Beyrer C Forced anal examinations to ascertain sexual orientation and sexual behavior: An abusive and medically unsound practice. PLoS Med 15 3: March 16, Copyright: This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The authors received no specific funding for this work. I have read the journal's policy and the authors of this manuscript have the following competing interests: Not commissioned; externally peer reviewed Summary points It has been reported that, in at least nine countries, forced anal examinations are used to investigate or punish alleged same-sex behavior between consenting men or transgender women.

In these settings, forced anal examinations are usually performed by healthcare providers at the request of law enforcement officials, and are procedures entirely distinct from those used legitimately in clinical care.

Such examinations constitute acts of torture under the United Nations Convention against Torture. Due to the possibility of coercion, individual physicians may face challenges resisting requests to perform such procedures, although they are abusive, medically unindicated, and yield no helpful information. Healthcare providers, professional organizations, and normative agencies, including the World Health Organization, all have an important role to play in bringing about an end to this practice.

In October of , the Tanzanian government forced the closure of internationally supported HIV testing and treatment centers designed to serve key populations, including sex workers and men who have sex with men MSM [ 1 ]. This controversial decision and the larger ongoing government crackdown on lesbian, gay, bisexual, and transgender LGBT communities in Tanzania have garnered the attention of public health officials and international journalists, who have expressed concerns about their health ramifications and associated human rights violations [ 2 — 4 ].

It has been reported that Tanzanian physicians, under the direction of law enforcement, have subjected men accused of same-sex behavior to forced anal examination in order to determine their sexual orientation [ 4 , 5 ].

One victim described being arrested at a birthday celebration and taken to a hospital, where a doctor performed an anal examination in front of a police officer that left the man feeling as if he had been raped [ 4 ].

The situation in Tanzania is not unique. Over the past seven years, forced anal examinations have reportedly occurred in at least nine countries, without clinical indication, to aid in the prosecution of alleged same-sex behavior between consenting adult men or transgender women [ 5 , 6 ].

The consequences of successful criminal prosecution may be severe; for example, in Tanzania, homosexuality can be punished by 30 years up to a lifetime in prison [ 7 ]. In several countries, forced anal examinations are reported to have been performed by healthcare providers at the request of police or other security operatives and consist of procedures entirely distinct from any examination of the anus, anal canal, or rectum used in clinical care [ 6 ].

In clinical care, anal examinations are routinely preformed for specific indications and to answer carefully formulated diagnostic questions. They provide necessary information in the workup and treatment of highly prevalent conditions, including prostate cancer, anal fissures and fistulas, hemorrhoids, and gastrointestinal bleeding.

During examination, individuals may be stripped, compelled to assume humiliating positions, and examined in front of others, without consent or under coercion. Bad science and false evidence The earliest recorded tests purported to detect homosexuality were described by a 19th century French forensic doctor who erroneously claimed that six criteria could be used to identify homosexuality on examination [ 9 ].

More recently, in Egypt, physicians have attempted to determine this through electromyography, sonography, and manometry of the anal sphincter, pelvic floor, and rectum, respectively [ 9 ]. These investigations are methodologically flawed, medically unsubstantiated, and constitute grave ethical violations. The so-called research is often conducted on prisoners or detainees and confers harm with no potential for individual or societal benefit [ 9 ]. In , the Office of the United Nations High Commissioner for Human Rights recommended that forced anal examinations be banned worldwide [ 10 ]; subsequently, a joint UN statement was released denouncing the practice [ 11 ].

In , an independent panel of forensic experts including doctors, psychologists, and psychiatrists issued a statement unequivocally refuting all claims that anal examination can identify sexual practices [ 12 ]. The statement discredited the most commonly cited reason for conducting exams—to determine anal sphincter tone. The panel highlighted the fact that there are no standardized ways of determining anal tone with digital rectal examination, that there are high levels of normal variability within the population, and that numerous conditions may affect anal tone, independent of any practiced behaviors.

Additionally, the panel described some of the negative consequences of the exams, including pain; trauma to the anus, anal canal, or rectum; humiliation; and shame [ 12 ]. It is likely that forced anal examinations produce a profile of psychiatric morbidity similar to rape or sexual harassment, both of which are associated with a heightened risk of suicidality and post-traumatic stress disorder [ 12 , 13 ].

Ethical ramifications Central to the practice of medicine is the Hippocratic Oath, to first do no harm. In the case of forced anal examination, a routine clinical practice is transformed into a direct punishment, conducted with the intent to harm members of the LGBT community.

A malicious procedure is employed without medical indication or forensic justification. Forced anal examinations require physicians to disregard their obligations to exercise independent professional judgment and to base their interventions on sound clinical knowledge.

These professional obligations are especially important when an individual is in state custody, their choices are constrained, and the risks of harm are great. Recognizing this, the WMA passed a resolution denouncing forced anal examinations to substantiate same-sex activity and called for an immediate stop to medically useless exams that are outside accepted standards of practice [ 16 ].

Healthcare workers may face challenges in resisting state-sponsored medical ethics and human rights violations [ 17 , 18 ], particularly when states are using providers to achieve political ends and oppress a vulnerable population.

For this reason, the importance of the recent WMA resolution cannot be overstated as a means to resist efforts by governments to coerce health professionals to perform these examinations. Scope of the problem and recent progress Over the past seven years, several countries have reportedly used the findings of forced anal examinations as official evidence in legal proceedings [ 6 ].

In Egypt and Tunisia, forensic medical specialists submit a report describing the results of the exam as evidence to be used in court, and similar procedures have been used in Cameroon, Zambia, and Lebanon.

In Uganda, Kenya, Tanzania, and Turkmenistan, exams may be used in conjunction with an investigation or conducted unofficially to harm or punish suspected individuals [ 6 ]. Little is known about the true prevalence of this practice, but the fact that it is codified in legal systems, used in multiple countries, and is the subject of both human rights and news reports suggests an immediate need for advocacy and intervention.

Encouragingly, three of the nine countries reported to have used forced anal examination have made significant progress toward ending their use [ 5 , 6 , 19 ]. In each country, activists, human rights workers, and healthcare providers have partnered together to initiate change. In Lebanon, advocates successfully built public support and pressured the Lebanese Order of Physicians and the Ministry of Justice to promulgate guidelines prohibiting the use of forced anal exams [ 5 , 19 ].

In Kenya, the Kenyan Medical Association released a statement condemning any and all types of forced anal examination despite directives from law enforcement officials [ 19 ]. In Tunisia, the government banned the practice after physicians repeatedly refused to administer the exam and human rights groups advocated for policy change [ 5 , 19 ].

Time to act These three countries and the movements within them offer hope and tangible examples for how citizens, healthcare professionals, and allied organizations can stand together. Individual providers asked to perform forced anal examinations should resist the practice whenever possible, even when they themselves are being coerced or intimidated to conduct these examinations.

Professional organizations and normative agencies may be better positioned to circumvent the challenges facing individuals. These organizations often have great influence on local governments and ministries of health and regularly set standards of practice.

They should use their power and influence to more effectively oppose this practice and promote adherence to professional and ethical codes. We believe that the global medical community should actively support individuals targeted by forced anal examinations and partner with colleagues and professional organizations in countries that perform these exams to end their use.

Normative agencies, including the World Health Organization, should condemn forced anal examination and call for its global ban, publicly declaring that these exams amount to torture and cruel, inhuman, and degrading treatment. It is time to unite in action and bring about an end to this egregious practice. The United Republic of Tanzania: Forced anal examinations in homosexuality prosecutions.

Same-Sex Practicing Men in Tanzania from to

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Female Rectal Examation by Dr Mark H Swartz



Medical exams of anal sex

Cichowitz C, Rubenstein L, Beyrer C Forced anal examinations to ascertain sexual orientation and sexual behavior: An abusive and medically unsound practice. PLoS Med 15 3: March 16, Copyright: This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The authors received no specific funding for this work. I have read the journal's policy and the authors of this manuscript have the following competing interests: Not commissioned; externally peer reviewed Summary points It has been reported that, in at least nine countries, forced anal examinations are used to investigate or punish alleged same-sex behavior between consenting men or transgender women. In these settings, forced anal examinations are usually performed by healthcare providers at the request of law enforcement officials, and are procedures entirely distinct from those used legitimately in clinical care.

Such examinations constitute acts of torture under the United Nations Convention against Torture. Due to the possibility of coercion, individual physicians may face challenges resisting requests to perform such procedures, although they are abusive, medically unindicated, and yield no helpful information.

Healthcare providers, professional organizations, and normative agencies, including the World Health Organization, all have an important role to play in bringing about an end to this practice. In October of , the Tanzanian government forced the closure of internationally supported HIV testing and treatment centers designed to serve key populations, including sex workers and men who have sex with men MSM [ 1 ].

This controversial decision and the larger ongoing government crackdown on lesbian, gay, bisexual, and transgender LGBT communities in Tanzania have garnered the attention of public health officials and international journalists, who have expressed concerns about their health ramifications and associated human rights violations [ 2 — 4 ].

It has been reported that Tanzanian physicians, under the direction of law enforcement, have subjected men accused of same-sex behavior to forced anal examination in order to determine their sexual orientation [ 4 , 5 ]. One victim described being arrested at a birthday celebration and taken to a hospital, where a doctor performed an anal examination in front of a police officer that left the man feeling as if he had been raped [ 4 ]. The situation in Tanzania is not unique.

Over the past seven years, forced anal examinations have reportedly occurred in at least nine countries, without clinical indication, to aid in the prosecution of alleged same-sex behavior between consenting adult men or transgender women [ 5 , 6 ].

The consequences of successful criminal prosecution may be severe; for example, in Tanzania, homosexuality can be punished by 30 years up to a lifetime in prison [ 7 ]. In several countries, forced anal examinations are reported to have been performed by healthcare providers at the request of police or other security operatives and consist of procedures entirely distinct from any examination of the anus, anal canal, or rectum used in clinical care [ 6 ].

In clinical care, anal examinations are routinely preformed for specific indications and to answer carefully formulated diagnostic questions.

They provide necessary information in the workup and treatment of highly prevalent conditions, including prostate cancer, anal fissures and fistulas, hemorrhoids, and gastrointestinal bleeding. During examination, individuals may be stripped, compelled to assume humiliating positions, and examined in front of others, without consent or under coercion. Bad science and false evidence The earliest recorded tests purported to detect homosexuality were described by a 19th century French forensic doctor who erroneously claimed that six criteria could be used to identify homosexuality on examination [ 9 ].

More recently, in Egypt, physicians have attempted to determine this through electromyography, sonography, and manometry of the anal sphincter, pelvic floor, and rectum, respectively [ 9 ]. These investigations are methodologically flawed, medically unsubstantiated, and constitute grave ethical violations.

The so-called research is often conducted on prisoners or detainees and confers harm with no potential for individual or societal benefit [ 9 ]. In , the Office of the United Nations High Commissioner for Human Rights recommended that forced anal examinations be banned worldwide [ 10 ]; subsequently, a joint UN statement was released denouncing the practice [ 11 ].

In , an independent panel of forensic experts including doctors, psychologists, and psychiatrists issued a statement unequivocally refuting all claims that anal examination can identify sexual practices [ 12 ]. The statement discredited the most commonly cited reason for conducting exams—to determine anal sphincter tone. The panel highlighted the fact that there are no standardized ways of determining anal tone with digital rectal examination, that there are high levels of normal variability within the population, and that numerous conditions may affect anal tone, independent of any practiced behaviors.

Additionally, the panel described some of the negative consequences of the exams, including pain; trauma to the anus, anal canal, or rectum; humiliation; and shame [ 12 ]. It is likely that forced anal examinations produce a profile of psychiatric morbidity similar to rape or sexual harassment, both of which are associated with a heightened risk of suicidality and post-traumatic stress disorder [ 12 , 13 ].

Ethical ramifications Central to the practice of medicine is the Hippocratic Oath, to first do no harm. In the case of forced anal examination, a routine clinical practice is transformed into a direct punishment, conducted with the intent to harm members of the LGBT community.

A malicious procedure is employed without medical indication or forensic justification. Forced anal examinations require physicians to disregard their obligations to exercise independent professional judgment and to base their interventions on sound clinical knowledge.

These professional obligations are especially important when an individual is in state custody, their choices are constrained, and the risks of harm are great. Recognizing this, the WMA passed a resolution denouncing forced anal examinations to substantiate same-sex activity and called for an immediate stop to medically useless exams that are outside accepted standards of practice [ 16 ]. Healthcare workers may face challenges in resisting state-sponsored medical ethics and human rights violations [ 17 , 18 ], particularly when states are using providers to achieve political ends and oppress a vulnerable population.

For this reason, the importance of the recent WMA resolution cannot be overstated as a means to resist efforts by governments to coerce health professionals to perform these examinations. Scope of the problem and recent progress Over the past seven years, several countries have reportedly used the findings of forced anal examinations as official evidence in legal proceedings [ 6 ].

In Egypt and Tunisia, forensic medical specialists submit a report describing the results of the exam as evidence to be used in court, and similar procedures have been used in Cameroon, Zambia, and Lebanon.

In Uganda, Kenya, Tanzania, and Turkmenistan, exams may be used in conjunction with an investigation or conducted unofficially to harm or punish suspected individuals [ 6 ]. Little is known about the true prevalence of this practice, but the fact that it is codified in legal systems, used in multiple countries, and is the subject of both human rights and news reports suggests an immediate need for advocacy and intervention.

Encouragingly, three of the nine countries reported to have used forced anal examination have made significant progress toward ending their use [ 5 , 6 , 19 ]. In each country, activists, human rights workers, and healthcare providers have partnered together to initiate change. In Lebanon, advocates successfully built public support and pressured the Lebanese Order of Physicians and the Ministry of Justice to promulgate guidelines prohibiting the use of forced anal exams [ 5 , 19 ].

In Kenya, the Kenyan Medical Association released a statement condemning any and all types of forced anal examination despite directives from law enforcement officials [ 19 ].

In Tunisia, the government banned the practice after physicians repeatedly refused to administer the exam and human rights groups advocated for policy change [ 5 , 19 ]. Time to act These three countries and the movements within them offer hope and tangible examples for how citizens, healthcare professionals, and allied organizations can stand together. Individual providers asked to perform forced anal examinations should resist the practice whenever possible, even when they themselves are being coerced or intimidated to conduct these examinations.

Professional organizations and normative agencies may be better positioned to circumvent the challenges facing individuals. These organizations often have great influence on local governments and ministries of health and regularly set standards of practice. They should use their power and influence to more effectively oppose this practice and promote adherence to professional and ethical codes.

We believe that the global medical community should actively support individuals targeted by forced anal examinations and partner with colleagues and professional organizations in countries that perform these exams to end their use. Normative agencies, including the World Health Organization, should condemn forced anal examination and call for its global ban, publicly declaring that these exams amount to torture and cruel, inhuman, and degrading treatment.

It is time to unite in action and bring about an end to this egregious practice. The United Republic of Tanzania: Forced anal examinations in homosexuality prosecutions. Same-Sex Practicing Men in Tanzania from to

Medical exams of anal sex

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5 Comments

  1. Sometimes it keeps me up at night when I think about it. PLoS Med 15 3: Little is known about the true prevalence of this practice, but the fact that it is codified in legal systems, used in multiple countries, and is the subject of both human rights and news reports suggests an immediate need for advocacy and intervention.

  2. However, the victory is only partial: During examination, individuals may be stripped, compelled to assume humiliating positions, and examined in front of others, without consent or under coercion. She put two fingers inside me.

  3. Qortbawi told the BBC: Forced anal examinations are a form of cruel, degrading, and inhuman treatment that can rise to the level of torture.

  4. Shadi was arrested at his home in Jounieh by military intelligence officers and then transported to the Sarba military intelligence branch in Jounieh. These examinations often involve doctors or other medical personnel forcibly inserting their fingers, and sometimes other objects, into the anus of the accused.

  5. Chloe told Human Rights Watch that police interrogated her, beat her, and took her and Eric to Muyenga Dispensary for forced anal examinations.

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