The effects of radical prostatectomy on gay and bisexual men's mental health, sexual identity and relationships: qualitative results from the restore study

Abstract

The effect of prostate cancer treatment in gay and bisexual men is an under-researched area. In 2015, we conducted in-depth telephone interviews with 19 gay and bisexual men who had undergone radical prostatectomies. Across the respondents’ five emotional themes emerged: (1) shock at the diagnosis, (2) a reactive, self-reported “depression”, (3) sex-specific situational anxiety, (4) a sense of grief, and, (5) an enduring loss of sexual confidence. Identity challenges included loss of a sense of maleness and manhood, changes in strength of sexual orientation, role-in-sex identity, and immersion into sexual sub-cultures. Relationship challenges identified included disclosing the sexual effects of treatment to partners, loss of partners, and re-negotiation of sexual exclusivity. Most to all of these effects stem from sexual changes. To mitigate these negative effects of radical prostatectomy, and to address health disparities n outcomes observed in gay and bisexual men, all these challenges need to be considered in any tailored rehabilitation program for gay and bisexual men.

Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: A scoping review

“…We identified 14 studies that characterized the mental health impact and degree of adjustment to cancer . In 1 large survey study of individuals with a history of cancer that compared SGM with propensity score‐adjusted heterosexual peers, SGM survivors reported higher rates of depression and relationship difficulty .…”

“…Nine studies in the review focused explicitly on sexual functioning among SGM survivors or included satisfaction and/or adjustment to sexual functioning after cancer . One study of the impact of cancer on sexual performance in SGM couples found that pain and other symptoms of cancer were associated with impaired sexual functioning, including a decrease in arousal and desire .…”

Sexual minority men and the experience of undergoing treatment for prostate cancer: An integrative review

“…GBQ men identify the prostate as a sexual organ that is directly related to sexual pleasure (Filiault, Drummond, & Smith, ; Rosser et al, ; Ussher et al, ; Ussher, Perz et al, ; Ussher, Perz, Rose, Kellett, & Dowsett, ). For example, in one of the articles that reported on a qualitative study, a GBQ man said that “[The prostate] is a very sensitive part of a man's body, and it is a great part of the enjoyment of anal sex” (Ussher, Perz et al, ).…”

“…Adverse effects that directly affect sexuality post‐treatment are loss of libido, urinary and bowel incontinence, anal irritation and discomfort, erectile dysfunction, decreased penile size, and ejaculation and orgasmic dysfunction (Lee et al, ; McConkey & Holborn, ; Torbit, Albiani, Crangle, Latini, & Hart, ; Ussher et al, ; Ussher, Perz et al, ). These adverse effects have a profound, often permanent and unanticipated impact on GBQ men's sexual practices (Rosser et al, ). This quote exemplifies the impact:

If you have any chance of going home with somebody, if you want to leave and do that, you can’t drink a lot beforehand because you don’t want to pee in the guy’s bed.

…”

“…Articles reported that adverse effects often force men into a sexual role change. For example, a partner whose sex role in the relationship was to be a penetrative partner may become now a receptive partner, or vice versa (Lee et al, ; Rosser et al, ). As well, Ussher, Perz et al () report that while some men are able to renegotiate their position in anal sex, others are not, due to the simultaneous adverse effects of erectile dysfunction and anal irritation, for instance.…”