Flexibility in Men's Sexual Practices in Response to Iatrogenic Erectile Dysfunction after Prostate Cancer Treatment

Abstract

IntroductionProstate cancer (PCa) treatments are associated with a high incidence of erectile dysfunction (ED). Interventions to help men with iatrogenic ED have largely focused on penile tumescence adequate for vaginal penetration. Less research has been undertaken on sex practices other than penile/vaginal intercourse.AimThe aim of this study was to explore forms of sexual practice engaged in by men following treatment for PCa. We focused in particular on anal intercourse (AI) as practiced by both nonheterosexual (i.e., gay-identified men and other men who have sex with men) and heterosexual men. We sought to determine how common AI was subsequent to PCa treatment and how flexible AI practitioners were in their modes (e.g., from insertive to receptive) when faced with iatrogenic ED.MethodsAn international online survey was conducted in 2010–2011 of men treated for PCa, where participants (N = 558) were asked explicitly about their sexual practices before and after PCa treatment.Main Outcome MeasuresThe outcome measures were the numbers and percentages of men who practiced AI before and after PCa treatment as well as the percentage who changed AI practice after PCa treatment.ResultsFive hundred twenty-six men (90 nonheterosexual men; 436 heterosexual men) answered questions on AI practices. A proportion of nonheterosexual (47%) and heterosexual men (7%) practiced AI following PCa treatment, and did so in all modes (insertive, receptive, and “versatile”). Many nonheterosexual men continued to be sexually active in the face of iatrogenic ED by shifting from the insertive to receptive modes. A few men, both heterosexual and nonheterosexual, adopted AI for the first time post-PCa treatment.ConclusionsFlexibility in sexual practice is possible for some men, both nonheterosexual and heterosexual, in the face of iatrogenic ED. Advising PCa patients of the possibilities of sexual strategies that include AI may help them in reestablishing a sex life that is not erection dependent. Dowsett GW, Lyons A, Duncan D, and Wassersug RJ. Flexibility in men's sexual practices in response to iatrogenic erectile dysfunction after prostate cancer treatment. Sex Med 2014;2:115–120.

Men's Sexual and Relational Adaptations to Erectile Dysfunction After Prostate Cancer Treatment

“…), and engage in manual/anal stimulation (Richters et al, 2003). This was also the case for nonheterosexual respondents in our study (see Dowsett et al, 2014), and this may point in a general direction, if not to specific practices that might also assist other men in re-establishing sexual lives after PCa treatments.…”

“…Our own findings from this study (Dowsett et al, 2014;Wassersug et al, 2013) revealed small but important differences between these populations clinically and in terms of post-treatment sexual recovery. Since then, further research has confirmed more differences between homosexual and non-homosexual men in terms of quality of life measures, sense of masculinity and male self-esteem, sexual functioning, confidence and intimacy, dyadic communication, and psychological distress (AllensworthDavies et al, 2016;Rosser et al, 2016;Ussher et al, 2016).…”

“…The removal of the prostate could certainly alter the sensation, if not the pleasure, involved in receptive anal intercourse for men. An earlier publication from this study reported on changes in anal sex among men in this study, both heterosexual and nonheterosexual, including men from both groups who have taken up the practice after PCa treatment (Dowsett et al, 2014).…”

“…Funding was provided by the Australian Research Centre in Sex, Health and Society. Further detail on the methods and findings can be found in two earlier publications based on data collected in the survey (Dowsett, Lyons, Duncan, & Wassersug, 2014;Wassersug et al, 2013).…”

“…Earlier questions in the survey had explored penetrative sex in a variety of ways (Dowsett et al, 2014). Two of the three co-authors manually examined the responses to this question and, through a preliminary grouping of responses, inductively developed a draft coding frame using a number of themes, and in some cases subthemes, to be used in an initial analysis aided by the qualitative software application NVivo.…”