Threat of Sexual Disqualification: The Consequences of Erectile Dysfunction and Other Sexual Changes for Gay and Bisexual Men With Prostate Cancer

Abstract

Gay and bisexual (GB) men with prostate cancer (PCa) have been described as an “invisible diversity” in PCa research due to their lack of visibility, and absence of identification of their needs. This study examined the meaning and consequences of erectile dysfunction (ED) and other sexual changes in 124 GB men with PCa and 21 male partners, through an on-line survey. A sub-sample of 46 men with PCa and seven partners also took part in a one-to-one interview. ED was reported by 72 % of survey respondents, associated with reports of emotional distress, negative impact on gay identities, and feelings of sexual disqualification. Other sexual concerns included loss of libido, climacturia, loss of sensitivity or pain during anal sex, non-ejaculatory orgasms, and reduced penis size. Many of these changes have particular significance in the context of gay sex and gay identities, and can result in feelings of exclusion from a sexual community central to GB men’s lives. However, a number of men were reconciled to sexual changes, did not experience a challenge to identity, and engaged in sexual re-negotiation. The nature of GB relationships, wherein many men are single, engage in casual sex, or have concurrent partners, influenced experiences of distress, identity, and renegotiation. It is concluded that researchers and clinicians need to be aware of the meaning and consequences of sexual changes for GB men when designing studies to examine the impact of PCa on men’s sexuality, advising GB men of the sexual consequences of PCa, and providing information and support to ameliorate sexual changes.

Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care: A systematic review and meta‐synthesis

“…Two of these articles described separate analyses drawn from the same parent study . The 6 included articles with exclusively male participants focused on sexual minority men with prostate cancer . Two of these articles described different analyses arising from the same data set .…”

“…Health‐care professionals were frequently perceived to be reluctant to discuss LGB sexuality (“My health care providers seemed more uncomfortable than me to discuss prostate cancer and sex.”, p10). In some cases, this ranged from “oversanitized” discussions of sexuality and sexual concerns to discomfort and open refusal to discuss LGB sexual matters raised by patients.…”

“…The theme “heterocentric care” arose from the findings of 9 articles . Assumed heterosexuality was widely reported (“He said, ‘Would I like to bring my partner along.…”

“…The overarching theme “unmet needs” is distinct in that it includes specific areas of need clearly articulated by participants within the included studies. Seven articles contributed to this theme …”

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, ). Another man said:

I always saw my prostate as a pleasure centre.

…”