Men undergoing vasectomies or treatment for testicular or other cancers frequently freeze some of their sperm to maintain their reproductive potential. In the same spirit, California Cryobank, a leading sperm bank with offices in Los Angeles and Palo Alto as well as Cambridge, Mass., is offering free sperm storage to any male member of the armed forces heading for the Mideast who is worried about his future fatherhood potential.

Dr. Cappy Rothman, a urologist and the co-founder and medical director of California Cryobank, says that a recent study published in the Journal of Toxicology and Environmental Health confirms the importance of storing sperm. In the study, which was conducted on laboratory rats, researchers examined three chemical agents to which military personnel serving in the Gulf War were believed to have been exposed: pyridostigmine bromide, a prophylactic treatment against nerve agents; DEET, an insect repellent; and permethrin, an insecticide.

According to the study, “combined exposure to these chemicals was implicated in the development of illnesses including genitourinary disorders among many veterans of the Persian Gulf War.” And the researchers concluded that “testicular damage was “significantly augmented when the animals were further exposed to a combination of chemicals and stress.”

Salon spoke with Dr. Rothman by phone about Cryobank’s offer and the potential threat to the fertility of military personnel.

Why have you decided to offer this service??

I am old enough — I’m 65 — to have seen men in my practice that were Vietnam veterans. I remember men who had problems with fertility. Some of them had direct damage to their genital areas from stepping on land mines. Some had spinal cord injuries that affected their ability to have an erection and ejaculate. But others had abnormal sperm production for no obvious reason. And I remember repeatedly that they said they were exposed to the exfoliant Agent Orange. And these soldiers and their families were devastated because of their inability to have children. Had they stored their sperm prior to having engaged in war, they could have come back and had lovely families.

As for the Gulf War, many of the men came back and found that they were infertile. And the study recently published in the Journal of Toxicology and Environmental Health showed that some of the agents they were given to protect them from nerve gas and insects can cause significant injury to testicular function in rats. So with our company’s history and experience, it seemed to be a nice thing and something we could easily do to offer them free storage of their sperm for one year, which usually costs $240. The expense of having us process the sperm is minimal, less than $100. We wanted to make it easy for them.

What’s been the response so far to your offer?

We announced it about two weeks ago, and the more exposure we’ve gotten, the more people are interested. About 40 or 50 men have already stored their sperm, but every day we get more and more phone calls — close to 200 so far. Some of the men call themselves, but a great deal more calls are from wives and fiancés. The maternal instinct is incredibly strong. These women want to have children.

You know, it would be nice if the Defense Department had the concept of informed consent. They should tell the troops, “Hey, guys, we hope nothing will happen, but because something could, we’re not opposed to you storing your sperm.” Just to let people know. Many of these guys don’t know. They’re too young to remember much about the Gulf War, they were not even born during the Vietnam War. If they’re told, they can say, “Gee, that’s not a bad idea, I don’t want to.” Or, “That’s something I should do.” I think that the subject would be so important that the Defense Department should establish a sperm bank for its troops. I would be happy to set it up for them.

Is the interest only among married men?

I know for sure married men are interested, and I assume some of the men are also single. If a man is married and something happens to him, his wife becomes the recipient of the sperm. She would be able to use the sperm to have his children. Now if a man is engaged, he has to specifically state that his fiancée has access to the sperm. If this is not provided for, his next of kin — his parents, for example — would be the ones who would have the right to make that decision.

Now what about female military personnel? Can they store their eggs?

There is sexual inequality there. We do not have the ability to freeze eggs as we have to freeze sperm. The science of freezing eggs is not advanced. It’s a much more invasive and difficult procedure and it’s just starting to be explored. An egg is a cell that has a very large surface membrane and contains a lot of water. A sperm is a smaller cell, it’s very condensed; it has a small surface membrane. And a man’s sperm can be routinely frozen with ease and success; we do not have the same experience with a woman’s egg. It’s much more difficult, anatomically and physiologically.

Do you find there’s a lot more concern about exposure to chemical and biological agents this time around?

Yes, there’s more concern. What some of the soldiers have said they’re concerned about is that the vaccines for anthrax and smallpox could make them infertile. I have no proof that it does, but if it’s not that, something else could. I’m sure the Defense Department was unaware before the Gulf War that giving soldiers the agents they did could result in infertility problems. And some are not necessarily concerned about a specific exposure but may have known someone who returned from the Gulf War and was infertile.

What I’m trying to express to the troops is, What’s the downside? Provide us a sample, there’s no downside. It’s not going to cost you anything to store it. You’re going to preserve your fertility. Why shouldn’t everybody do it?

If you look at ejaculation, it’s a delicate mirror of a man’s state of health. If a man is in good health, he’ll have normal ejaculate, and if he’s not, he won’t. Anything that interferes with a man’s health will affect his sperm count. So in terms of exposures, smoke from burning oil wells, nuclear waste — anything that can interfere with health can interfere with sperm count. I don’t know of any good smoke.

How long has the technology of freezing sperm been around?

In the 1920s, freezing sperm started in animal husbandry and veterinary medicine. Then, in the 1960s, it started to be used with human sperm. We’ve been around since the 1970s. We currently distribute about 2,500 ampules of [human] sperm every month to every state in the U.S. and 22 countries.

We also preserve the sperm of men who are going to be sterile. There’s a large population of men who men are undergoing vasectomies, and a large population of men who because of cancer are going to undergo chemotherapy and radiation, or are having surgical procedures that will render them infertile. So we’ve been doing this for a long time.

What if they’re not near any of your locations? What if they’re in Texas, say?

You don’t have to process or store it with us. You just have to know that it’s reasonable to do. If you’re in Texas, you can always go to an in vitro fertilization center and provide them with the specimen. They have the technology to freeze it, and then you could send it to us for the free one-year storage. We probably have some relationship with every in vitro center in the country. They know of us and can transport sperm to us. It would just cost whatever Federal Express would charge. An in vitro center could also store it, but they would charge for that.

But if you’re near one of our centers, you can either provide a sample at home in a clean container and bring it in to our offices within two or three hours. Or you can come in and use one of our masturbatoriums.

Masturbatorium?

That’s a word I coined about 25 years ago. What would you want in a room to encourage man to masturbate? We have magazines, videos. And a good lock.

But that decision, and some little-noticed rulings in other countries, have sparked hot debate, and some real anxiety, among international-custody lawyers and their clients. They worry that the determination that Israel is “at war” could be used, in future cases involving charges of international abduction, to justify preventing children from returning not only to Israel but to other countries as well.

“Everyone wants children to be safe,” says Richard Crouch, an Arlington, Va., lawyer specializing in child-custody cases. “But the more we fool around with the convention here and refuse to return kids for our own reasons, the more difficult it will be to get cooperation from other countries when we want kids returned.”

The case that led to the judge’s ruling that Israel is a war zone — the first such determination by a U.S. court — involves Robert Silverman and his former wife, Julie Schuster. The pair met in 1988 at a hotel restaurant in Jerusalem, where he was working as a cook and she as an assistant manager. She was born in the U.S., he in South Africa. In 1989, they left together for the United States and married. They lived in Poughkeepsie, N.Y., where he attended the Culinary Institute of America, and later spent time in San Francisco and Los Angeles before settling down in Plymouth, Minn. Samual, their first son, was born in 1992; his brother, Jacob, arrived three years later. In 1999, Robert and Julie sold their house and moved back to Israel — and that’s where their accounts of the marriage appear to diverge.

Robert says they both intended the move to be permanent. Julie says she held grave misgivings about her marriage and agreed to emigrate as a last-ditch effort to keep the family together — but realized immediately it was a terrible mistake. The following summer, she took the two boys back to the United States for a vacation. Only then did she inform Robert, who remained in Israel, that she had no intention of returning. The U.S., she said, would be the boys’ permanent home.

Robert, who lives in Ra’anana, a small city north of Tel Aviv, says he was devastated by Julie’s announcement. He says he simply wants his two sons back with him. “No matter what she’s said to them or done,” he says, “she can’t break the bond we have.”

But Julie says that she has no intention of letting them leave the United States again. “I’m very tired; I’m very weary,” she says. “It was never my intent to take the children away from Robert. My intent was simply to get a divorce, to not be married to him any longer.”

The two-year custody battle has been bitter, with charges and countercharges of domestic violence, emotional cruelty and infidelity. While she was still in Israel, he obtained a temporary court order forbidding her to leave the country. When he came to Massachusetts a few months ago to see the boys, she had him jailed for non-payment of child support. She says he repeatedly threatened her verbally and physically. He says she has tried to poison his relationship with the children.

The two have pursued their conflicting claims through a chain of American and Israeli courts. Finally, last May, a federal district court judge in Minnesota issued the pivotal decision — one that could affect many more families than the Silvermans. Ignoring official Israeli determinations that Robert Silverman enjoyed legitimate custody rights in Israel, Judge John Tunheim agreed with Julie’s argument that the United States was the boys’ primary residence, and he ruled that the children should stay with her.

But he included, almost as an afterthought, an explosive finding. Even if he believed that Israel was the boys’ home, Tunheim wrote, he wouldn’t send them back because the country is now, for all intents and purposes, a “zone of war”– and returning the children would expose them to serious danger.

That ruling, along with a court decision last May in Australia that also deemed Israel too dangerous for children, and similar rulings reportedly issued in Spain and Romania, could have profound implications for how countries handle future incidents of international child abduction, say legal experts. Those cases were all adjudicated under the Hague Convention.

It’s hard to imagine a worse parental nightmare than the abduction of a child to another country. It has been played out in the public eye recently in high-profile and heartbreaking cases involving American women who have charged their Saudi Arabian ex-husbands with fleeing back to their homeland, kids in tow, and forbidding the mothers all contact. But unlike the United States and Israel, Saudi Arabia is not a signatory to the Hague Convention and is not bound by its provisions. Neither is Cuba, which nonetheless loudly demanded the return of Elián Gonzalez to his father — a demand that the U.S., after long months of wavering, felt forced to recognize as legitimate.

In those cases, the conflicts have revolved around the authoritarian nature of the regime, either the one in which the children were currently living, as in the Saudi Arabian cases, or the one demanding repatriation, as in the Gonzalez situation. Unlike those disputes, Hague Convention cases have generally attracted little public attention. However, in making terrorist attacks against Israel an argument against returning children there, the recent court decisions could be used to justify not returning children to other countries as well, say some lawyers.

Around the world, more than 1,000 child abduction cases are filed under the Hague Convention every year. According to research conducted by the Centre for International Family Law Studies at Cardiff University in Wales, in 1999, for example, close to 1,300 Hague applications involving more than 2,000 children were registered by the designated central authorities in signatories to the convention. Of those, 466 cases involved the United States — as either the left-behind country or the one to which the child was believed to have been abducted — and 57 involved Israel.

Crouch and other experts wonder how Americans would react if foreign judges began refusing to return abducted children to New York or Washington, D.C., citing the Sept. 11 attacks and the terror alerts that have followed. They venture that, under similar reasoning, children would not have been sent back to England during the period when the Irish Republican Army was most active there, or to Northern Ireland at any point in the recent past. In the modern world, they ask, is any country — and especially the U.S., which has identified itself as a prime terrorist target — a safe haven for children?

The Minnesota ruling, and those in the other countries, were made possible by an exception in the procedure outlined by the Hague Convention for dealing with international custody disputes. That exception bars the return of a child to the custody of a parent if the move would expose the child to “a grave risk [of] physical or psychological harm or otherwise place the child in an intolerable situation.” Frequently interpreted to apply to harm related to the child’s personal or family circumstances, the “grave risk” can also relate to the political situation in what is generally referred to in Hague cases as “the left-behind country.”

But Crouch and other experts in international law say that the exceptions were always intended to be narrowly interpreted and invoked in only the most extreme circumstances — when a country is in such chaos that the court system has stopped functioning, for example — so as not to undermine the future viability of the convention. This is particularly important, they say, because there is no final international court of appeal. Since each case is ultimately decided by judges in the country in which the child is currently located, the treaty relies for its continued effectiveness solely on the good will of the domestic courts of each signatory nation.

Susan McKay, the Minnesota lawyer handling Robert Silverman’s case, says she knows of no statistics that specifically compare, for example, the rates of childhood death in the United States and Israel from gun deaths, traffic accidents, murder and other unnatural causes. But she argues that judges in other countries could, citing the Hague Convention rulings against Israel, point to random killings in the United States, not just the threat of terrorist attacks, as a reason not to return abducted kids. “What’s the distinction between acts of terror for political motivations versus just violent propensities or craziness, like what’s gone on with the sniper shootings in D.C. or Columbine?” she says.

Prior to the adoption of the treaty in 1980, parents in what is generally referred to in Hague Convention cases as “the left-behind country” had little leverage in seeking the return of their children. Over the past 22 years, however, hundreds of cases involving parents from all parts of the world have been resolved by courts in the countries that have agreed to abide by the procedures outlined in the convention.

“Before the convention existed, the return rate of children was basically zero,” says William Hilton, a San Jose lawyer who, like Crouch, is an expert in domestic and international child-custody issues. “The legal basis for jurisdiction was the presence of the child in a country. So prior to the convention, if a child was taken anywhere in the world, the left-behind parent’s only choice was to go to that country and litigate the issue of custody under their terms and their rules.

“Even with the convention, there are still problems,” Hilton adds, “but at least we have a way to get the kids back if they go somewhere else for Christmas break or summer vacation, or when someone just up and snatches them.”

Under the Hague Convention, each signatory nation must designate a “central authority” that handles international child-abduction cases. A so-called left-behind parent files a complaint with his or her own country’s central authority, which forwards the complaint to the central authority in the nation where the child is located. The courts in the latter country must then determine which state is the child’s “habitual residence.”

Under the terms of the convention, the country determined to be the habitual residence is where the question of custody is supposed to be adjudicated. If the courts decide that the habitual residence is the left-behind country, the convention requires the return of the child.

However, Article 13 of the convention allows for several exceptions to that rule. One is when the court in the country where the child is currently located determines that the parent seeking the child’s return did not enjoy legal rights of custody at the time of the removal. Another is the “grave risk” exception cited in the Minnesota and other recent rulings.

In the case of Israel, no judge in any Hague Convention country had ever ruled until the current intifada that the situation there was so dire that it justified not returning a child. In the United States, a key ruling took place in a 1996 case involving a dispute between Jonathan and Judith Freier over their 4-year-old daughter, Avital. Unlike the court in the Silverman case, the federal district court in Michigan determined that Israel was Avital’s habitual residence. When Judith, who was already living in Michigan, invoked an Article 13 exception, the court turned down the request.

The Michigan district court, citing an earlier appeals court ruling that the “grave risk” standard could be applied if the left-behind country was determined to be a “zone of war, famine or disease,” acknowledged that Israel was experiencing “some unrest.” But the court still determined that Judith Freier had failed to convincingly prove her case for an Article 13 exception.

“Respondent testified hearing about random violence such as car and bus bombings,” wrote the court. “With respect to Respondent’s anxiety and fear about the ongoing tension in the country, it must be noted that she has lived there for a number of years, raised children there for some fourteen years and that her parents spend extended periods of time there as well.”

McKay, Robert Silverman’s lawyer, cited the Freier ruling in arguing that Sam and Jacob should also be returned. But Judge Tunheim, finding that the deterioration of the situation in Israel had rendered the Michigan court decision moot, wrote that “the violence has permeated areas that were previously unaffected by the conflict [and] has placed civilians, including children, at much greater risk.”

To bolster his finding, the judge noted that just days before the hearing, a Palestinian gunman had killed two people, including a teenager, in a city a few miles away from Robert Silverman’s home in Ra’anana. He then went on to cite a host of newspaper articles detailing subsequent attacks.

It would be impossible to argue that the situation in Israel has improved since Tunheim issued his ruling. While the total number of civilian deaths within Israel caused by terror attacks in the last two years may not appear high in absolute terms, Israel has only 6 million people: Statistically, 350 deaths in Israel would be the equivalent of more than 16,000 terrorism-related deaths in the U.S., with its population of 280 million. Nor can statistics measure the trauma of repeated bloody attacks — on buses, at discos, restaurants, markets and streets — on the Israeli psyche. It’s easy to sympathize with judges placed in the wrenching position of deciding whether to send children back to such a troubled region of the world, one that figures so prominently, and horrifically, in the headlines.

But while the judge’s reasoning may read convincingly on paper, it outraged Robert Silverman, who says that it could encourage other parents involved in marital disputes to spirit their children away from Israel in the hopes that courts in other countries won’t order them returned.

For her part, Julie, who now goes by the last name of Schuster, declined to discuss the “zone of war” issue, accurately noting that Tunheim’s primary finding was that the United States, not Israel, is her sons’ habitual residence. “The ‘grave risk’ question is a secondary issue,” she says. “It’s not the reason they weren’t returned to Israel.”

Robert appealed the court’s ruling to the U.S. Court of Appeals for the 8th Circuit. Last month, in a 2-1 decision, a three-judge panel of the appeals court upheld the finding of the district court that the U.S. was the habitual residence of the Silverman boys. The majority declined to address the zone-of-war issue. In a strong dissent, the third judge argued that the lower court erred in its rulings on both the residence and zone-of-war questions.

McKay, Robert’s attorney, said she was very disappointed by the ruling. She has petitioned the appeals court for an en banc review, meaning that the case would be heard by the entire Court of Appeals rather than just a panel. If the full court accepts the case, it will have to assess the parents’ conflicting accounts of the family’s move abroad and decide whether the children’s short stay there qualifies, under the terms of the convention, as a transfer of their habitual residence from the United States to Israel.

But how it rules on the zone-of-war question, while not necessarily the factor that determines where the Silverman boys will ultimately live, will perhaps be watched even more closely by lawyers like Hilton and Crouch. The court is likely to review recent decisions in two other Hague Convention countries — Great Britain and France — which reached the opposite conclusion and ordered abducted children to be sent back to Israel. It will also likely review decisions by the foreign courts that have ruled, like Tunheim, against Israel.

In one of those cases, an Australian appeals court this year overturned a lower court ruling that would have required Janine Claire Genish-Grant to return her two preteen children to Israel, where their father, Moshe Genish, lives. The panel agreed with a lower court that Israel was the children’s habitual residence but rejected that court’s order that the children should be returned, ruling instead that such a move would expose the children to danger.

In so ruling, the court relied primarily on a warning issued by the Australian government advising citizens to avoid travel to Israel. The judges noted, in particular, that the advisory stated that “all population centers in Israel are at very high risk of terrorist attack” and that “targets in the past have typically been areas where large numbers of people gather.”

The ruling pointed out that the father worked at the kind of environment — a hotel and restaurant complex — named in the travel advisory as a potential target. Moreover, wrote the judges, should the children be sent back to Israel, they would have to pass through an international airport and travel within Israel by bus — modes of transportation that could place them at risk of attack.

This ruling was issued last May — months, that is, before the deadly Bali disco bombing that killed dozens of Australian citizens, who believed themselves to be far out of range of terrorist attacks.

For his part, Robert Silverman points out that, given the number of casualties in New York and Washington, D.C., on Sept. 11, future terror attacks in the United States could easily be deadlier than any perpetrated so far in Israel. To bolster his argument, he cites American officials’ own pronouncements of the country’s posture in the current tensions. “President Bush says that the United States is in a war on terror,” he says, his voice swelling with anger. “Does that mean children shouldn’t live there?”

At the time, the movie was praised for what it was: a touching coming-of-age tale that explored, with sensitivity and taste, the issue of teenage sexuality and the eternal horny-boy fantasy of being initiated by an older and experienced beauty. I cried while I watched, but mainly because I so yearned for the tender moments that Hermie found — although I craved a seducer with, unlike Jennifer, a penis I could touch, kiss and hold onto.

It’s hard to imagine that a film that spoke to my deepest longings could attain the critical acclaim and popular appeal of “Summer of ’42.” In fact, in the current era of Catholic Church sex scandals, it’s hard to imagine a film like that not being blasted top to bottom for promoting child abuse and all manner of other evils, even if it portrayed as thoroughly mutual the desire of both man and boy to find solace in each others’ bodies.

I mention “Summer of ’42″ because it’s been on my mind these past few months as I’ve watched the priest drama unfold. More than once, as I’ve read accounts of the misery wrought by these loose-fingered clerics and the bishops who enabled them, I’ve wondered about others who have chosen to remain silent — men who, as adolescents, entered willingly into sexual relations with a priest — and maybe even enjoyed it. At first I chastised myself for this notion; I was clearly a bad and unfeeling person for entertaining such thoughts. But then gay friends of mine began to broach the same idea — usually gingerly, with an undercurrent of embarrassment or guilt — and I felt relieved.

Let me state right here that I don’t at all doubt the agony suffered by the victims who have gone public. Their despair and rage is palpable and heartbreaking. And this includes those who were, at the time of abuse or later, struggling to come to terms with their own homosexuality. Gay kids are no more immune from the ravages of molestation and abuse than straight ones — and they could even, perhaps, be more easily recognizable as potential targets by older men with well-honed powers of gaydar.

But it doesn’t take a huge stretch of the imagination — at least not of my imagination, nor, as it turns out, the imaginations of other gay men of my acquaintance — to believe that there are some men whose lives were not destroyed, or may even have been enhanced, by adolescent sex with a priest. They have not gone public, nor would I expect them to, especially in the current environment. But that they exist — somewhere — I have little doubt.

Obviously, there’s never a defense for coerced sex. And just as ethical and legal guidelines restrict sexual contact between psychiatrists and their patients, or between employers and employees, priests should not be fucking their parishioners, of whatever age. After all, those relationships depend upon trust and the careful exercise of authority, which can easily be disrupted when sex enters the picture.

And yet there’s a subtle subtext beneath the general reaction to, and media coverage of, the current scandal. And that’s the notion that sex between a minor and an adult is inherently abusive and always wrong. Wrong, that is, as an unquestioned and unquestionable eternal truth, independent of time and place and context.

That’s why, in the wake of the scandal, Judith Levine has hit such a nerve with her recent book, “Harmful to Minors: The Perils of Protecting Children From Sex.” Her suggestion that children actually have sexual feelings and should be allowed a certain amount of sexual freedom has drawn denunciations from across the political spectrum. Likewise, a 3-year-old essay by Harris Mirkin, a political science professor at the University of Missouri, questioning the blanket condemnation of intergenerational sex, sparked outrage among state legislators, who promptly stripped the university of $100,000 in funding. Here is a sample of what Mirkin, a self-described heterosexual grandfather, wrote to create such an uproar:

“As is usual in sexual politics, issues are framed in terms of nature, and of absolute good and evil … Definitions are characteristically vague, so that statistics from the mildest activities can be blended with images from the most atrocious. Six and 13-year-olds are grouped in the same category (‘child’) … In the same way as adolescents are merged with little children, all sexual activity is equated with violent or coerced sexual activity … According to the dominant formulas the youths are always seduced. They are never considered partners or initiators or willing participants …”

In his essay, Mirkin compares society’s current hysteria over childhood sexual abuse and pedophilia to previous generations’ attitude toward feminism and homosexuality. No one reading his measured, academic prose with an open mind could take what he writes as an endorsement of sex between a 3-year-old and a grown man. His goal is simply to explore how behaviors that violate social norms are dismissed in ferocious terms so as to preclude any rational debate.

Cultures, as Mirkin suggests, tend to treat their own values as timeless and immutable. But most rational people, if pressed, would probably recognize the fallacy of that notion, at least in certain spheres. It’s no secret that some societies have valued erotic mentoring relationships between boys and adult men. It’s such a cliché to mention ancient Greece — there’s a lot about ancient Greece that no one would want to replicate today — but it’s the obvious case in point. Some non-Western societies have also institutionalized man-boy relations as an important milestone in the transmission of knowledge and authority from one generation to the next.

And every society has its laws. But the problem with the law, especially when it comes to sex, is that it creates rules for a realm of human experience that often defies them. Sexual relations between people are messy, chaotic and fraught with ambiguity — and every society interprets and regulates them differently. And so, in the developed world today, age of consent laws differ so wildly from country to country — even, within the U.S., from state to state — that it renders absurd the notion of some universal understanding of the meaning, and potential danger, of sex between adults and teenagers.

Let me interrupt myself for a moment here to issue what has become, in discussions of this issue, a ritual defense. It’s ridiculous to have to say this, but — for the record — I don’t support sex between young children and adults. Members of the demonized North American Man-Boy Love Association and other proponents of true pedophilia, which is generally defined as a sexual interest in prepubescents, would argue that such a thing as consensual relations can exist in such circumstances. But I don’t see how a 7-year old could possibly consent to sex in any meaningful way. As a little boy, I played doctor enough times with Dorothy, the girl next door, to understand that many small children love to explore each other’s bodies (although it may be telling that I was much more interested in exploring her butt than any other aspect of her 6-year-old nakedness). But that’s a far cry from sexual contact between an adult and a first-grader.

However, adolescence — let’s say starting at 12 or 13 for some boys, at 14 or 15 for a great many more — is a different matter entirely. Gay men compare coming-out stories like kids today trade Pokémon cards, and over the years I’ve heard many tales of teenage escapades with older men, of sex with an uncle, sex with a married neighbor, sex with an unknown man driving a shiny Chevrolet, sex with a teacher. Sex in a park at night, sex in a train station toilet, sex in a stranger’s home. Sometimes the sex was great, sometimes awful. Sometimes the experience was tender, sometimes rough, sometimes somewhere in between. Most of the time the kids wanted it, like I did; they were just a bit braver, or more desperate.

Or maybe they were simply too horny to stop themselves. Edmund White, the noted gay writer, recounts with relish how he started cruising grown men from the age of 13 or 14 at beaches and public toilets in Chicago. “I was very oversexed, absolutely driven wild by desire,” he says. “I would pick up men, and then they would abandon me as quickly as possible because they were worried that I was jail bait. The first one was a handsome architect, who actually had children older than me. I was absolutely fascinated by him, and I seduced him. I followed him to his car, walked right up to him and started talking to him. My mother was away and I said, ‘Come back to my apartment.’ And it was terrific.”

“It was terrific.” Even relaying those words — though they represent White’s honest appraisal of what he experienced — makes me feel uneasy. I am not immune to the zeitgeist or to expressions of social disapproval, and I have felt a little queasy when I’ve told people I’m writing about sex between adolescent boys and men. The words “child molester” and “child abuse” hold the same power to disturb and repulse me as they do most people — as is intended by those who wield the terms indiscriminately to refer to any sexual contact between anyone under the age of 18 and anyone older.

Gay friends warned me to be careful and judicious, not just because the notion felt threatening to them but because they were concerned about the rabid response I might receive. Straight friends have expressed shock at the very idea, although once I lay out my qualified opinions on the subject — that the point I want to make is that it’s absurd to categorically insist that every contact between men and adolescent boys is harmful and wrong — they concede that there may be room for debate, but still … And then we quickly change the subject.

The subject remains so charged that more than one academic I called to discuss the issue — men who hold fairly libertarian views on the matter — declined to do so on the record. Even men who willingly discussed their positive intergenerational experiences as adolescents requested that I use the kind of personal non-identifications — “Tony, a graphic designer” — that pepper Cosmopolitan articles about how to improve your orgasms or determine if your boyfriend is cheating on you.

For Frank, a healthcare professional in his 50s, the relationship he pursued as a 15-year-old with a family friend in his early 20s served as an important introduction to the idea that men could care for each other. “It was clear that it certainly felt good to both of us,” he says today. “In some way it was a real lifesaver, because it made me feel that love and affection and closeness and sex would be possible in my life. We both knew that we had to hide what we were doing — that it was not going to be like Johnny and Sally going on a date. But when we were together, it was like a little oasis where we could be ourselves. Had I not had that experience, I would have gone that many more years without experiencing myself the way God made me, which is gay.”

Another man, a 38-year-old small-business owner from Denver, fondly recalls the two-year relationship he had with his boss at the pancake house where he worked as a waiter. He was 15 when they had sex for the first time, he says, and it was the fulfillment of something he’d desired for years. “It was frightening and invigorating and I felt clumsy and awkward,” he says. “But he was playful and fun and very gentle. I never felt coerced. As foreign as it was to me I was very open to it. Afterwards, I felt good, like I’d experienced something I’d wanted to for a long time.”

His boyfriend, who was 29 when the relationship began, also helped alleviate the isolation he’d always felt by introducing him to a gay social circle and helping him begin a modeling career. “In high school, I had this haunting feeling that I was different, so it was really liberating to find people who were gay,” he says. “It was like, ‘OK, I’m gay, I love it.’ I wasn’t an awkward, out-of-place kid anymore. I felt appreciated for being gay, instead of being an outcast and made fun of. Suddenly I had this new self-confidence. I didn’t have to hate myself for being gay.”

These men were lucky; they met someone who took their feelings seriously. Many more, of course, have had experiences similar to Edmund White’s — they meet someone whose primary interest is sex, not romance or love. John, an aircraft maintenance worker, had his first experience when he was 13 with a man of about 30 for whom he was performing yard work. The man, who was wearing a Speedo, invited him inside and showed him books with photos of men wrestling. “He started rubbing my crotch, and I was both nervous and really excited by it,” he recalls. “But as soon as he put his mouth around my dick, I shot, and then he jacked off and I swear I’ve never seen anyone come so much. I was just amazed. I jerked off about that forever.”

John saw him once more at the clothing store where the man worked, and they had sex in one of the changing rooms. After that, they lost touch. And while John, who is now in his 40s, enjoyed the experience, he says he wished the man had talked to him more about what they were doing. “I was amazingly turned on by it, but I remember thinking a year or two later that I would have preferred some level of intellectual conversation, where he’d say something like, ‘Some guys do it with guys, some do it with girls.’ Just something to give me a context to put it all in. I wish he’d taken a more aggressive role in doing that in the moments he had me as a captive audience.”

Still, the experience didn’t exactly prevent John from pursuing other sexual contacts. For the next few years, he, like White, aggressively sought out significantly older guys. “I never felt used,” he says. “I really wanted it, and except for the first time I always felt like the aggressor. I’m not a child psychologist and I don’t mean to extrapolate my own experiences to anything else, but I do feel like American society has gone crazy over this whole childhood sex trauma stuff.”

It would be easy to dismiss these examples as carefully selected and completely unrepresentative, or as the memories and opinions of disturbed men who don’t even realize how abused they’ve been. And certainly it’s true that you can’t always trust what people claim about themselves, even if they believe what they’re saying. But since I’ve heard the same sorts of comments from so many men over the years, it’s not really possible for me to doubt their testimony. Not that it’s invariably a positive experience; it would be as ridiculous to argue that as it is to maintain that it always causes horrific trauma.

The standard argument against sex between men and adolescents is that the age gap creates a power differential that is inherently coercive, and at first blush that perspective makes intuitive sense. But the fact is that power differentials exist along an infinite number of spectrums. Rich people have more power — generally speaking — than poor people. Beautiful people have more power than plain ones — Barbra Streisand notwithstanding. Corporate executives have more power than file clerks, although perhaps Enron will change that equation. And let’s not forget that men have more power than women. So should rich, attractive, male corporate executives be barred by law or custom from having sex with poor, plain female file clerks? Following that logic, I should be allowed to fuck — or love — only my (nonexistent) identical twin brother, and only if he has exactly the same professional standing, income and haircut as me.

What’s more, some recent studies have tended to debunk the idea that intergenerational sex always has negative repercussions. In 1998, Bruce Rind, a Temple University psychology professor, and two coauthors published a review of 59 studies of college students who, as minors, had experienced sexual contact of any kind with an adult. Analyzing the data, they concluded that the assumption of harm from the experience was greatly overstated. In particular, they reported that 37 percent of boys who reported willing sexual experiences with adults recalled the experiences as positive, and a total of 66 percent experienced it as either positive or neutral. Girls, on the other hand, were more likely to respond negatively — a finding that may upset some feminists but does not surprise Edmund White.

“I think boys can sail into and out of sexual experience with less psychological damage than girls,” says White. “I think a woman talking about a 13-year-old boy having sex with a 30-year-old man will imagine a 13-year-old girl having sex with a 30-year-old man, and I do think that can be frightening. But a 13-year-old boy can be six-feet tall and have a 10-inch dick and be much stronger than the 30-year-old man.”

The Rind article provoked an outcry against the American Psychological Association, which had published it in one of its journals. Talk-radio queen and moral crusader Laura Schlessinger blasted the study, the researchers and the association, on her show and in newspaper columns. “The problem for our children and families is the reverent way the media, law, theology and the general public react to so-called psychological scientific revelations,” wrote Dr. Laura. “The public must be extremely cautious in accepting and relying upon papers that appear to counter common sense, fundamentals or morality, and long-term understanding of what is socially desirable and basically healthy for any individual.”

In other words, if a scientific, peer-reviewed study offends Dr. Laura’s sense of morality, or common sense as she defines it — as the Rind study so obviously did — everyone else should ignore it, too. Or, better yet, denounce it.

Like Mirkin and Levine, Rind and his coauthors were accused — absurdly — of seeking to legitimize pedophilia. A member of Congress even declared the study to be “the emancipation proclamation” of the pedophile movement. In fact, the outraged reaction actually obscured an important point: that many people who as adolescents have sexual relationships with adults don’t actually require massive amounts of therapy to overcome the presumed trauma.

You’d think a study that revealed that something previously believed to be uniformly harmful left no apparent negative traces — at least according to self-reports and standard measurements of psychological health — would be welcomed. In a subsequent article, Rind traced the current approach to all forms of sex involving an adult and a non-adult to the early 1970s, when the feminist movement first focused societal attention on the real problems of rape and father-daughter incest. The template of coercive sex and the obvious resulting trauma became the prism through which all “age-discrepant sexual relationships” became viewed by both researchers and the larger society, argued Rind.

“Sexual phenomena that have only age-discrepancy in common with incest are reshaped in a narrow, rigid manner to fit the demands of the incest model,” he wrote. “Media commentators conclude that willing sexual relations between adolescent boys and unrelated men are invariably profoundly damaging … Professionals reject or distort data regarding these relations that are inconsistent with the incest stereotype, reaching instead the obligatory conclusion of pervasive harm.”

For his part, Edmund White views American society’s dogmatic attitudes about sex between men and adolescent boys as a way of dealing with vestigial homophobia now that garden-variety gays have been accepted as part of the general mix. “Gays have been domesticated,” he says. “I think that ‘Will and Grace’ and all that has sufficed to turn adult gays who hang out with other adult gays into lovable sidekicks. They’re acceptable as long as they have only one partner, are faithful to that partner and are law-abiding — if they adopt one Korean girl, go to church and pay their taxes and don’t do drugs.”

But gays whose lifestyles fail to mimic those of the most staid and palatable straight folk, or those who are open and honest about their relationships with younger men, tap the homosexual dread that still exists in most people, adds White. That dread fuels the quick and dangerous labeling of these men as pedophiles. “They’re the new pariahs,” he says.

And the older straight woman who fulfills the fantasy of a teenage boy? In “Summer of ’42,” the widow Dorothy mysteriously disappears from the film after sleeping with the love-besotted Hermie. Were the movie a current hit — “Summer of ’02″ — we would have to presume that she had been locked up as a depraved child molester, never to prey again on an innocent 15-year-old boy.

The same-sex adoption situation has never been entirely clear in California because the law does not explicitly outline a procedure that allows both partners in a lesbian or gay couple to be legal parents. But for the past 15 years, gays and lesbians whose partners already have children — either through a biological relationship or an official adoption — have become “second parents” thanks to a modified version of the state’s standard adoption process.

Then, on Oct. 25, the 4th District Court of Appeal essentially ruled that second-parent adoptions contravened the law by not explicitly conforming to the procedure spelled out in state statutes. The ruling threw thousands of parents (or “parents”?) into a panic, notwithstanding the certificates of adoption that many of them have proudly cherished for years — and not to mention the bonds of love binding them to the children in their care.

The court based its ruling on statutory language that assumes that birth mothers relinquish their parental rights when they consent to letting someone adopt their child. In its recent decision, the court noted that the California Department of Social Services had found a way to approve adoptions by unmarried partners by adding an amendment to adoption documents that allows a legal parent to declare an intention to retain rather than relinquish parental rights. But that procedure didn’t satisfy the court — even though the judges recognized in their decision that this outcome was exactly what Sharon S. and her partner initially had in mind.

“California adoption laws are not to be construed liberally [even] to protect the welfare of children,” stated the majority opinion, signed by two of the judges. “The statute currently governing independent adoption mandates that the parental right of the birth parent be terminated, something that Sharon did not unequivocally agree to and that was never intended by either of the parties here.”

The one dissenting judge blasted the majority opinion as “absurd” and reprimanded his colleagues for adhering to “an overly narrow construction” of state law. This judge, stressing that many adoptions concluded in good faith over the years were now subject to legal challenge, declared that the decision “does not exist in a vacuum” and that the “ultimate … losers will be children who are the intended beneficiaries of California’s adoption laws.”

The court majority attempted to minimize the impact of its ruling by noting that, for many of the parents affected, a remedy will soon exist. This fall, California Gov. Gray Davis signed Assembly Bill 25 which, beginning in January, will grant gay and lesbian domestic partners a number of key rights, including the right to pursue “step-parent adoptions” of their partners’ children. Unlike second-parent adoptions, the step-parent procedure is clearly spelled out in adoption statutes and could not — presumably — be subject to legal challenge when used by parents of the same sex. (Until enactment of the new law, only spouses will be allowed to become official step-parents.)

But the appellate court failed to note that the option of step-parent adoption is not available to same-sex couples that have moved out of state or have already split up, whether amicably or not. It also would be of no help to families in which the biological parent has died and the non-biological parent — of now-questionable legal status — has expected to retain custody.

The decision has been appealed and so has no immediate practical impact. The losing party to the suit has requested the appellate court review its ruling, and, regardless of what the lower court decides, the case will undoubtedly be appealed to the California Supreme Court. Meanwhile, gay rights supporters in the California Legislature plan to introduce a bill that would reaffirm the validity of all past second-parent adoptions.

But whatever the practical implications turn out to be, says Kate Kendell, executive director of the National Center for Lesbian Rights in San Francisco, the immediate psychological impact on lesbian and gay families has been profound. Kendell recently spoke to Salon about the ruling — not just as a civil rights advocate but also as the non-biological mother of a 5-year-old boy.

What was your reaction when you first heard about the ruling?

My blood ran cold. I had a sense of panic and disbelief, coupled with the first palpable fear that I’d ever really felt as a lesbian parent. The idea that a right that has been so much a part of the California legal landscape could be imperiled like that was a devastating realization.

I was not worried that my own relationship with my son was jeopardized, because my partner and I are still together and we’re planning on having another child in a few weeks. This is our family, and I knew I was lucky to be in a situation where, even with judicial permission, my partner was not going to do anything to diminish my legal relationship with my son Julian, because she honors that relationship.

There’s nothing that you could take from me that would be more important to me than my relationship with my child. The fact that our relationship is legally recognized provides me — and him — with a level of security and responsibility and protection that is commonplace for a child who has heterosexual parents.

And after the immediate sense of panic subsided?

My panic was very quickly replaced by anger and indignation, which has actually not left since that moment. The decision, if permitted to stand, appears to suggest that second-parent adoptions previously granted in the state of California are invalid. In other words, the potential exists for any third party — the Social Security Administration, an insurance company, a former partner who is the biological parent — to use this decision to challenge the validity of the adoption.

I know I’m a good parent, and I know my son and I have a wonderful and mutually rewarding relationship. I don’t need anyone to tell me that, and I don’t care about their approval. What I do care about is that I have a decree from a court which recognizes that I am a legal parent, and for this court to suggest that this decree is vulnerable betrays a kind of arrogance and insensitivity that is not fitting for a judge.

The decision seemed to me to be purposefully hurtful and ignorant of the damage that the court was potentially inflicting, not even caring about the fact that these are loving, nurturing relationships that we have with our children, not acknowledging that these relationships were entitled to even the barest level of legal protection. That was the most insulting aspect of the court’s decision.

How do you react to this as an advocate for lesbian and gay rights?

Well, there’s a way in which LGBT [lesbian, gay, bisexual and transgendered] people become somewhat acclimated toward understanding and dealing with our legal marginalization, and we come to tolerate, if not obviously accept, the fact that our sexual orientation leaves us without many of the benefits and the security that other folks get to take for granted.

But this decision, rather than simply reinforcing that principle — which is a principle I know and live with every day — upped the ante by saying, in effect, “Not only are you subject to discrimination in marriage, social status, in federal protections, in other areas, but even on issues that are settled law you cannot rest easy.” And even on issues where the decisions would do enormous damage to families and children — that’s a damage that the court is willing to inflict.

It’s important to get the message out that people should not panic, and we are fully confident that this decision will not stand. But the fact it was rendered at all is astonishing. Even to a family like mine with relative security and where the couple is together, a risk still exists. For example, if my partner were to die, it’s a theoretical possibility that some other family member could challenge me for custody of Julian and challenge the legal recognition of my relationship with him. Or if I had died on my recent plane trip back from Minnesota, it is a theoretical possibility that the Social Security Administration would have refused to pay any survivor’s benefits to my son.

Is this an unusual step for a court to take in ruling on adoptions?

It’s unprecedented to retroactively apply a ruling so as to invalidate a whole class of previously authorized and legally binding adoptions — and there’s a reason for that. The fact is that, perhaps more than any other body of law, adoptions are considered sacrosanct, and once granted they are not set aside, except under the most extreme circumstances, usually fraud.

The appellate court’s position is that these adoptions never should have been granted in the first place because the process is not explicitly authorized by the statutes. Let’s assume, for the sake of argument, that this position is correct. Courts are often faced with that kind of an argument and in fact they may find that argument to be persuasive. And it would be perfectly legitimate for the court to say, “Go and sin no more, you can’t do more of these.”

But the fundamental legal principle in all adoption law is promotion of the child’s best interests. And you can read every page of that decision, and you will never find the words “a child’s best interests.” The judges could have been writing about patent law or a zoning dispute.

In fact, in other states like Illinois, New Jersey and Massachusetts, courts looked at their statutory schemes and also found that second-parent adoptions weren’t explicitly authorized. But then they looked to the primary principle of what is in the child’s best interests and found that the adoption must be allowed to proceed. Rigid statutory construction is always a secondary consideration to a child’s interests.

So was this ruling completely unexpected?

We’d heard about the case a year ago. And we were concerned that the court might henceforth prohibit courts from granting second-parent adoptions. But our concern was never that the court would invalidate previously granted adoptions. I was one of the primary people who said, “Oh, they would never do that.” I would have bet my house on it, because the fundamental principles are so strong and the countervailing chaos is so enormous that it never occurred to me that a rational court would rule that way.

So when you and other attorneys did these adoptions, you never felt they were at risk?

No, never. In some other states, like Colorado and Wisconsin, courts have ruled that second-parent adoptions were impermissible, and the court said, “You can’t do them anymore.” But in those cases the court did not suggest that previous adoptions should be rendered invalid.

The thing that’s very troubling about the case is that Sharon S. had many other options that she could have taken. Even assuming that she wanted to challenge the validity of the adoption, she could have done that and limited her argument to her specific facts. The fact that she chose a win-at-all-costs strategy, even if it meant doing damage to thousands of families in California, betrays a level of narcissism and selfishness that is beyond the pale.

What about the fact that the court suggested a remedy under the new legislation that goes into effect in January?

To suggest that that’s an actual remedy is ludicrous because for many couples it will not be. They’ve moved out of state, they’ve split up, the biological parent has died. And it remains to be seen how someone adopts their own child. I’ve already got a decree that says I’m a parent. Now I’m going to file to be a parent all over again? If so, I want my money back for when I did my second-parent adoption. I want the state to pay me back my legal fees and my fee to the Department of Social Services. That could be $3,000 to $5,000 per couple.

This ruling has no precedent in other states, but are you concerned that it might have an impact?

Yes, because there are states where second-parent adoption is still an open question. Certainly having California invalidate second-parent adoptions would not bode well for other states that would be addressing this issue. Even if a case is based on state law and cannot be used as a precedent in other states, California is viewed as a trendsetter in these kinds of social issues, so a ruling like this can certainly influence judges elsewhere, especially in more conservative states.

Here’s the reason: Human papillomavirus, or HPV, is an umbrella name for dozens of viral strains that can cause warts on different parts of the body, as well as some forms of cancer. About 20 types of HPV can lead to genital and anal infections in both women and men. Because the glands in the anus are similar to those in a woman’s cervix, HPV infection in either area can result in cancerous cell changes.

Anal sex is the primary risk factor — but not the only one — for anal HPV infection. Dr. Stephen Goldstone, a gay surgeon who specializes in rectal and anal disorders, has been promoting the idea of routine anal Pap smears for men who have sex with men for several years, along with Dr. Joel Palefsky, a professor and research scientist at the University of California at San Francisco. Dr. Goldstone, who is also the medical director of GayHealth.com and the author of “The Ins and Outs of Gay Sex: A Medical Handbook for Men,” says that although the procedure is starting to gain acceptance, even most gay doctors have still not heard of it.

Dr. Goldstone recently spoke with Salon from New York, where he maintains a private practice and is a professor of surgery at Mount Sinai Medical Center.

I’m a gay man, and before recently I’d never heard about this. Why isn’t anyone talking about it?

It’s an emerging health concern for gay men, that’s for sure. And I think it’s going to become a greater and greater problem. Everybody says, “How come I’ve never heard about it?” Part of the reason is that it probably takes 10 years or more for a normal cell to become a cancerous cell, and the people at greatest risk are those with HIV. But until the last few years, most people with HIV were not living long enough for the problem to become apparent. That’s changed in the last five years because so many people are living longer.

How widespread is the problem?

Dr. Joel Palefsky at UCSF has done some screening studies and he’s estimated that about 65 percent of HIV-negative gay men and close to 100 percent of HIV-positive men carry human papillomavirus in their anal canals. Some types of anal HPV are more likely to cause pre-cancerous cell changes, and a large percentage of the HIV-positive gay men carry that type.

As far as anal cancer, the incidence in HIV-negative gay men is 35 per 100,000, which is about what the cervical cancer rate in women was before doctors began doing routine Pap smears. The incidence of anal cancer among HIV-positive gay men is estimated to be about 70 per 100,000. These may seem like tiny numbers, but they are actually very significant because this is a disease we never really used to see. And it’s becoming more widespread, like all sexually transmitted diseases.

At this point there is no treatment that can eradicate the virus. Right now there is research taking place on both preventive vaccines, which would be administered before someone was ever infected, and treatment vaccines, which might, for example, be able to prevent the progression of an existing infection to cancer.

So is anal sex the main culprit here?

Yes. The biggest risk factors for anal HPV are multiple sexual partners and anal sex. But even if someone has never had anal sex, every man who has sex with men is at risk for it. Genital HPV can spread from skin-to-skin contact. It doesn’t require penetration. A finger can spread it, or someone might rub his penis on the outside of his partner’s anus during foreplay, and from there it’s easy for the virus to spread inside. And a condom may not be protective. It doesn’t cover the base of the penile shaft, the pubic hair or the scrotum, which are all places where HPV can be found.

Probably a majority of all men have penile HPV even if they don’t have warts there. It’s pretty rare that the virus will migrate from a man’s penis to the anus, but it can be spread to a sexual partner’s anus or vagina, and in a woman it’s easier for it to migrate from the vaginal area to her anus. That’s why women should also be screened routinely for anal HPV.

Now I’ve never had anal warts. Do I have to worry about this?

Yes. A lot of patients who come in just for screening end up having warts they didn’t realize they had. They say they don’t have anal warts, and then we find a tiny anal wart. And when people do have anal warts, we need to start taking that seriously. Many people will go to dermatologists or internists and just have their external anal warts removed. But often it’s just the tip of the iceberg, and no one looks inside.

How did you first start recognizing this as an issue?

It was about 1996 or 1997. I would be taking out anal warts and I’d send them out for analysis if they were a little funny-looking. Anal warts have been a problem for gay men for a long time but most of them never get analyzed. At that time, however, I started getting back these weird pathology reports of the kind of cellular abnormalities that can lead to cervical cancer in women.

So then what exactly is an anal Pap smear?

You do it like a regular Pap smear, except in the anus. You insert a non-lubricated swab inside the anus and it picks up a sample of the cells. The cells are sent to a specially trained doctor called a cytologist, who examines them for abnormalities. Just as in women, a Pap smear is basically a predictor of abnormality, but it’s not specific about what kind of abnormality. So if there’s an abnormal Pap smear, then we do a procedure called a high-resolution anoscopy, which is actually looking inside the rectum to see what abnormalities are there.

You can find different grades. You get atypical cells of unknown significance, which are very slightly abnormal. Then there are greater but still moderate cellular abnormalities, which is called low-grade dysplasia, and more advanced abnormalities, called high-grade dysplasia. If we see changes indicative of high-grade dysplasia, we do a biopsy and a pathologist can tell us if it’s high-grade or even cancer. Less than 10 percent of high-grade dysplasia goes on to cancer, but we don’t know which 10 percent.

So let’s say it’s high-grade. What then?

Then you treat it. If it’s a small amount of high-grade dysplasia, you can freeze it or burn it or put a little acid on it right in the office, the same way you would treat a wart. If it’s a truly invading anal cancer, the treatment is chemotherapy and radiation. But you’d like to find these people before they actually have cancer.

Joel Palefsky and I have been trying to get the word out for a while that this is a major health concern and we need to deal with it. One of the things HIV has done is made it seem like AIDS is the only illness gay men get. And in the medical community, we find that it’s possible to go to an HIV doctor and just have your T-cell count and viral load looked at and never have to take off your clothes for an examination.

But if it’s so simple, why are so few doctors doing it?

There has been reluctance, even among gay doctors with gay patients, to deal with anal-rectal disease. I get e-mails from people all over the world asking questions about rectal disease when they won’t bring it up with their own doctor. Straight docs don’t understand gay sexual practices and are reluctant to talk about it, and most people who go to HIV doctors don’t even get asked about their sexual habits.

Some doctors will not recognize it as an issue until one of their patients actually gets anal cancer. The doctor will be totally upset about it, and then will start doing anal Pap smears on other patients. One gay doctor referred someone to me who supposedly had hemorrhoids, and I examined him and found anal cancer. I called the doctor to tell him, and after that he started doing anal Pap smears on all of his other patients. Then he called me back and said, “Ohmigod, they’re all coming back with abnormalities.”

You would never blink an eye if woman said she went for a Pap smear. And if she comes back with a positive result, we don’t look at her and assume she’s promiscuous, even though it’s a sexually transmitted disease. There’s no negative social connotation for women because we know that many women get HPV with their first or second sexual experience.

But men get tremendous embarrassment from the diagnosis. They want to know, “What do I tell my partner or boyfriend?” When a patient comes to me with warts, I tell them that they probably didn’t catch it from the current boyfriend, since they can appear years after the initial HPV infection. If you’re in a monogamous relationship, you want to come home and kill your partner because you assume he’s cheating, when in reality you probably caught it during one of your first sexual experiences.

So how often should I be getting an anal Pap smear?

Primary care physicians should be doing routine anal Pap smears on men who have sex with men. HIV-positive men should have an anal Pap smear every year, and HIV-negative men every two or three years, starting in their 20s. Heterosexual HIV-positive men are also at increased risk for HPV infection, although not nearly as much as men who have sex with men. And women should have routine anal Pap smears just as they have routine cervical Pap smears because of the chances that the virus could spread.

Patients themselves should be asking for this because they have tremendous power within the medical community. We’re all healthcare consumers, and if more and more of us start asking our doctors about anal Pap smears, it will motivate them to learn more about it.