At age 20, David didn't want to deal with the fact that he might have a problem. Although he was getting married in a few hours, he had spent the previous night in bed making love to his Best Man.

David pulled himself together and went through with the marriage ceremony. For 25 years he slept only with women. He fathered two sons and eventually left his wife for another woman. When that affair ended, David, now 48, finally told his family and friends that he was homosexual.

"I desperately wanted not to be gay," David now freely admits, "so I had convinced myself that I wasn't." But when his last relationship with a female broke up, David realized that he had no desire to date other women. He also realized that he did not want to be alone for the rest of his life. "I realized," he says, "that I had to sit myself down and deal with my sexuality."

At the time, David felt he had only two choices: he could admit that he was gay and live the rest of his life as a homosexual or he could kill himself. "I wanted to live, not die," he said. "Given that choice, I had nothing to lose."

A Choice or a Predisposition?

The transformation in David's life underscores the issue of whether sexual orientation is a choice or a predisposition—a topic that invokes passionate debate among healthcare professionals and religious adherents.

The American Psychological Association defines sexual orientation as "an emotional, romantic, sexual, or affectional attraction to individuals of a particular gender." But, sexual orientation is different from sexual behavior. Sexual orientation is merely an innate attraction. This doesn't mean that people will express their sexual orientation in their behaviors. In other words, it is possible to be attracted to the same sex without acting on it.

How people develop a particular sexual orientation is not well understood, according to the American Psychological Association. However, many scientists share the view that for most people, sexual orientation is shaped at an early age by a complex interaction of various factors.

Treatment for Homosexuality?

In 1973, The Board of Trustees for the American Psychiatric Association voted to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorder and thus formally declassified it as a mental illness. Since that time, a sizable group of religious leaders, as well as a number of mental health professionals, have advocated reparative therapy, also known as conversion therapy, can change a person's sexual preference from homosexual to heterosexual. One group of about 500 mental health professionals, educators, and public officials—the National Association for Research and Therapy of Homosexuality (NARTH)—asserts that homosexuality can be treated by addressing "unwanted" homosexual feelings.

Joseph Nicolosi, PhD, a chief proponent of this viewpoint, claims that the mental health profession has abandoned the treatment of men and women who are attracted to the same sex and are unhappy by that attraction. It's his belief that when these people enter therapy, they are told to blame their unhappiness on society's homophobia, not on their homosexuality.

Nicolosi believes that extensive psychotherapy can help homosexuals realize why they have homosexual feelings, understand their relationships with their parents, and overcome what he believes is their fear of heterosexual contact. He also believes in encouraging an intimacy between men that has no sexual basis, such as joining a sports league or a men's group, to develop relationships with straight men.

A Behavior Change or an Orientation Change?

Many homosexuals feel that NARTH's position misses the point. They assert that, it's much easier to be straight rather than gay—at least in American society. Furthermore, many homosexuals go through a period of wishing they were straight. Though these men and women might even try to change their behavior, they probably never really changed their sexual orientation.

The American Psychiatric Association recognizes that although a gay person may abandon homosexual behavior, the published scientific evidence supporting the efficacy of reparative therapy as a treatment to change sexual orientation is not conclusive.

Dr. Nicolosi replies, "If these [homosexual] people are happily married with a wife and kids and they don't feel any conflict with their homosexuality, you may call it repression. I want to call it a healthy adaptation to a heterosexual world."

Being Honest With Yourself

Many healthcare professionals agree with clinical psychologist Marilyn J. Sorenson, PhD, author of Breaking the Chain of Low Self-Esteem . Sorenson doesn't believe that people who "come out" later in life have actually changed their sexual preference. She believes that most of them have finally begun to "honor" the sexual preference they had all along. She says it's not uncommon for gay people to have lived for years as heterosexuals, and then choose to live a gay lifestyle later in life.

Realizing Rather Than Changing

Judith is a case in point. She had been raised in a "fairly religious, conservative" family in the Midwest. A virgin when she married, Judith had never been excited about dating men. Although she was married for 14 years and had a child, she says she didn't feel particularly close to her husband.

For Judith, coming out was a seven-year process that began after she attended a lecture given by a gay woman. "Something just clicked," Judith now says. But not at first. She was initially reluctant to admit, even to herself, that she might be gay. She was raised believing that being homosexual meant you were mentally ill, "and I knew I wasn't crazy," she now says.

Unlike David who knew, but tried to repress the fact that he was attracted to men, Judith says that she was unaware of her homosexual orientation. She just knew something wasn't right.

What finally made Judith recognize her sexual orientation? "I realized that I needed to acknowledge who I am," she says, "I wasn't comfortable with living that other life."

Today Judith says that she's at ease with herself, having found joy and normalcy in her life.

Becoming Comfortable at Last

David and Judith are both finally comfortable with their homosexuality, and both believe that sexual preference is not something that can be changed. They both insist that the lives they lead are perfectly normal.

"I go to the movies, pay rent, and love my partner, just like heterosexual people do," David insists.

For Judith, it's all summed up in one sentence, "I don't have a lifestyle," she says. "I have a life."