When he learned that South Dakota is poised to become the latest state to face a legal challenge against its same-sex marriage ban, Steve Hickey was inspired to take action.

The Republican state House representative and pastor submitted a letter to the editor this week to the Argus Leader, South Dakota’s largest newspaper. He titled it “A One Way Alley for the Garbage Truck” and challenged the “medical and psychological communities” to weigh in on the matter.

“I’m asking the doctors who practice in our state, is the science really settled on this issue or is it more the case that you feel silenced and intimidated?” Hickey wrote in the letter, which he posted on his Facebook page.

He didn’t waste any time getting to the point.

“Certainly there are board-certified doctors in our state who will attest to what seems self-evident to so many: gay sex is not good for the body or mind,” he wrote. “Pardon a crude comparison but regarding men with men, we are talking about a one-way alley meant only for the garbage truck to go down. Frankly, I’d question the judgment of doctor who says it’s all fine.”

On Wednesday, TPM spoke to Brenda Wade Schmidt, an opinion writer for the Argus Leader who accepts and rejects letters to the editor. At the time, she said she hadn’t decided whether or not to publish Hickey’s letter. The newspaper has certainly run letters of that ilk before — a reader in February wrote on behalf of “God-fearing moral citizens who know it is patently wrong for men to have sex with other men.”

But on Thursday, Schmidt said she spoke to Hickey about some concerns, namely that it was long at more than 600 words and that the language may not be appropriate for the newspaper. She said it was unclear if Hickey will submit a revised letter.

Hickey told TPM on Wednesday he was driven to write the letter after Nancy Robrahn and Jennie Rosenkranz, a lesbian couple from Rapid City, S.D., announced their intention to become the first state residents to challenge its gay marriage ban. The couple was married on Saturday in Minnesota in a wedding that was officiated by Minneapolis Mayor Betsy Hodges, setting the stage for South Dakota to become the 29th state with a marriage equality court case.

It could be the latest conservative state to see a voter-approved constitutional amendment struck down by a judge, giving fuel to gay marriage opponents like Hickey.

Recent decisions on amendments in Utah and Oklahoma delivered victories for marriage equality in states where opposition to gay nuptials and attitudes like Hickey’s remain widespread. A survey from an in-state pollster last year found a majority of South Dakotans still opposed to same-sex marriage and Hickey is confident that if the constitutional ban were brought to a statewide vote, as it was in 2006, it would pass again.

To that end, Hickey’s letter echoed two of the central complaints raised by conservatives as the marriage equality movement has steadily gained momentum nationwide.

He lamented a scenario in which “unelected judges” could overturn the will of the people and argued that LGBT advocates are intimidating opponents. And if he can’t win the debate on traditional and legal grounds, Hickey said he was turning to science.

Hickey wrote that it shouldn’t be considered “hate for a physician to speak up about something that is harmful to human health.”

“It is not unloving to tell people you don’t have to have sex with and marry someone to love and be loved by them,” he wrote. He also expressed disappointment at the South Dakota High School Activities Association’s consideration of a policy change that would allow transgender students to to participate in activities based on their gender identity.

There’s little ambiguity in his positions, but it’s still hard to make sense of Hickey’s arguments.

In his phone interview with TPM, he acknowledged that heterosexual couples “absolutely” participate in anal sex, too, but then proceeded to focus squarely on the “health of homosexuality.”

He wrote in the letter that “historically, homosexuality has been a notable marker of the downfall of past civilizations” and he told TPM that gay marriage will cause society to “decline morally.” Yet, he insisted it’s really a public health issue. Hickey told TPM it’s obvious that anal sex isn’t good and urged the medical community to back him up. But he’s dismayed that doctors are, according to him, discouraged to tell the truth.

“Most groups are just quiet and silent on it because of the intimidation factor and the only group that’s raising a stink is a religious group, and I acknowledge in [the letter] that people are sick of hearing about that,” he told TPM.

“And that’s fine, so I said let’s talk about it from a medical vantage point. I do believe, and I’ve heard enough medical people talking about the intimidation factor and silencing that’s going on. And you just don’t talk about it. You know, you practice medicine and it’s an issue of politicized medicine and junk science and agenda-driven studies. When the average person can just, you know, what’s self-evident is that [anal sex] isn’t good.”

At one point in the interview, Hickey described same-sex marriage as an “incredibly important, all-impacting social policy.” Later, he told TPM that “it’s not going to change my day” if the state’s ban is overturned. And even though he introduced an anti-gay bill this year that ultimately failed in the legislature, Hickey strongly objected to the notion that it’s one of his most important issues.

“It’s not a very important issue to me! I’ve told people this isn’t in my top five of legislative priorities,” he told TPM “This thing is not being pushed by me. They’re the ones.”

He suggested that Robrahn and Rosenkranz have been manipulated by lawyers who are eager to make headlines. According to the Associated Press, their case has been taken up by a Minneapolis attorney after the couple was unable to find a lawyer in South Dakota.

“We’ve got two happy lesbian ladies who have been living together for years out in Rapid City being talked to by lawyers saying, ‘Hey, we need a case.’ This is a strategically timed, well-planned attempt to challenge one of the remaining states’ constitutional amendment on marriage,” Hickey told TPM.

“So they’re provoking this and are we just supposed to sit by and say ‘OK, it’s only a matter of time’? I contend that it’s not good for society, it’s not good for the human body, family, kids. And may the best ideas win.”