Homosexuality: A medical doctor’s perspective

Dear Tingasiga:

The conversation about human sexuality, including homosexuality, suffers from oversimplification. One understands the difficulty many people have with calls for sober consideration of this complex subject. I was once in their shoes. My upbringing as an African heterosexual male, and my Christian faith, reinforced by my understanding of Biblical teaching, were major obstacles to my attempts to comprehend gender and sexuality issues during my early years in Canada.

Truth be told, I had a degree of homophobia that bordered on pathological. I was not alone. Many colleagues during our subspeciality training at the Hospital for Sick Children, Toronto, most of whom were foreigners like me, were homophobic. One of my colleagues, an Indian national, who had spent some years in England, was so terrified of homosexual people that he nearly assaulted an openly gay junior doctor who had walked into his room to ask him a medical question. 

That incident, and my presence in a milieu that insisted on open-minded scientific inquiry, set me on a path of learning about a subject that I soon discovered to have been of interest to scientists for over a century. Homosexuality had at one time been considered “inborn and incurable,” a form of “degeneracy and illness.” Admission into a mental asylum was the recommended intervention. 

Subsequent opinion was that it was a “curable mental illness,” a view that persisted until the 1970s. It was only in 1973 that the American Psychiatric Association declared that homosexuality was not an illness, a view that was solidified by subsequent research. In 1992, the World Health Organisation declared homosexuality to be a normal variant of human sexuality and removed it from its International Classification of Disease.  This progress within the scientific world has not been matched by the general public’s attitude. So, one understands the clash between those who, on the one hand, hold very strong views that are deeply fixed in religion, culture, and lack of information, and, on the other, those who live in the real world of clinical medicine and scientific research.

In fact, normal human sexual development, gender identity, gender role, gender expression, sexual identity and sexual behaviour are part of a very complex process that appears to begin during pregnancy, and continues through childhood and adolescence, into adulthood.  The idea that normal humans are either heterosexual males or heterosexual females, whose identity is determined by the sex chromosomes, is an outdated simplification that has yielded to discoveries about the complex processes in sexual development.

Human sexual orientation appears to be a result of genetics, other biological factors, cognitive, social, cultural, and other environmental factors. We see some very young children of heterosexual parents acting in ways that suggest a gender identity different from that assigned to them at birth based on their external genitals.

Whereas no single specific gene that determines homosexuality has been identified, some studies have suggested moderate hereditability of sexual orientation. Other studies that continue to exercise our minds include findings that: (1) homosexual men have a greater number of older brothers than do heterosexual men, with the odds of being a homosexual increasing by 33 percent with each older brother; (2) a probable role of androgen (male sex hormone) effects during pregnancy, with demonstrable differences between homosexual and heterosexual women; (3) differences between the brains of homosexual and heterosexual people, especially in the hypothalamus (a specialised part of the brain that controls, among other things, sexual behaviour) and some areas of the cortex (the higher centers of the brain.) 

Despite these observations, we still do not know the developmental mechanisms that result in heterosexuality or homosexuality. What we know is that homosexuality is not due to troubled family relationships, or “recruitment.” We also know that homosexuality is not “curable” through conversion or reparative therapy. First, you do not cure a non-disease. Second, conversion therapy is based on an unscientific assumption that people with a non-traditional sexual orientation, such as homosexuals, are psychologically damaged and that changing their sexual orientation will benefit not only the individual but also society.

These so-called therapies, which are known to be performed in more than 60 countries, include counselling (some with verbal abuse and humiliation), prayers, psychiatric medications, hormone injections, aversion therapies where nausea-inducing medications are given alongside presentation of homoerotic stimuli, and application of electric shock to the brain, or to the hands and genitals. Other methods include exorcism, ritual cleansing through beating the patient, force-feeding or food deprivation, forced nudity, solitary confinement, hypnosis, and “corrective” rape.

Besides lack of medical and scientific validity, so-called conversion therapy has potentially harmful physical and psychological consequences. It is inhuman, cruel, degrading and completely unjustifiable “treatment” that has absolutely no place in the ethical practice of medicine, or in Christian life or civilised society in general. 

In modern paediatric practice, it is mandatory that doctors respectfully talk to children and adolescents about gender and sexuality in age and developmentally appropriate ways, without biasing them. Supporting youngsters to navigate the landmines of adolescence is an opportunity to discuss real life issues, not what the doctor’s personal wishes are. Doctors should “preach” abstinence but acknowledge reality.

Medical doctors are called to serve in a respectful, unbiased, open-minded, and non-judgemental way. To professionally sound medical doctors, it does not matter that the patient presents with a lifestyle that conflicts with their personal values. They treat homosexual people and their families with respect and empathy, employing evidence-based tools to improve their health. 

Obviously, doctors need to reflect on their own values, beliefs, and attitudes, as well as their comfort and competence regarding gender and sexuality. If unfamiliar or uncomfortable with the subject, the ethical step is to refer the patient to a colleague who can provide the service.  Medical doctors have a duty to lead the way in sharing evidence-based scientific information with the public and with Uganda’s leaders. I hope it is not too late for President Museveni to seek advice and guidance from Ugandan doctors at home who have expertise in adolescent medicine, gender and sexuality studies, and mental health. The final decision regarding the Anti-Homosexuality Bill,2023, is his, but let it be based on evidence and science. Meanwhile, I do not despair. Future generations will catch up with the truth about the diversity of human sexuality. When Galileo Galilei (1564-1642), the Italian physicist, engineer, and astronomer, affirmed heliocentrism (the Earth’s daily rotation and annual revolution around the Sun), the Roman Catholic Church launched an inquisition in 1615. He was found guilty of being absurd, foolish, and “vehemently suspect of heresy”. You see, Galileo had contradicted Holy Scripture. He spent the last 10 years of his life under house arrest.

Meanwhile, the Sun and Earth ignored the Church, continuing their ancient dance, outliving many Popes and other rulers of kingdoms. Happily, in 1992, Pope John Paul II, cleared Galileo of any wrongdoing. It took 377 years for the Church to catch up with the Holy Scripture in Ecclesiastes 8: 16-17 that talks about our intellectual limitations. “When I applied my mind to know wisdom and to observe the labour that is done on earth—people getting no sleep day or night— then I saw all that God has done.

No one can comprehend what goes on under the sun. Despite all their efforts to search it out, no one can discover its meaning. Even if the wise claim they know, they cannot really comprehend it.”  We know only a very tiny bit about God’s creation.

Muniini K. Mulera is Ugandan-Canadian social and political observer.    

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