Unrecognized sexual dysfunction in gay and bisexual men after prostate cancer treatment: the antecedents and impact of anodyspareunia

Abstract

Background Anodyspareunia may be an adverse outcome of prostate cancer (PCa) treatment for gay, bisexual, and other men who have sex with men (GBM). Aim The aims of this study were to (1) describe the clinical symptoms of painful receptive anal intercourse (RAI) in GBM following PCa treatment, (2) estimate the prevalence of anodyspareunia, and (3) identify clinical and psychosocial correlates. Methods This was a secondary analysis of baseline and 24-month follow-up data from the Restore-2 randomized clinical trial of 401 GBM treated for PCa. The analytic sample included only those participants who attempted RAI during or since their PCa treatment (N = 195). Outcomes Anodyspareunia was operationalized as moderate to severe pain during RAI for ≥6 months that resulted in mild to severe distress. Additional quality-of-life outcomes included the Expanded Prostate Cancer Index Composite (bowel function and bother subscales), the Brief Symptom Inventory–18, and the Functional Assessment of Cancer Therapy–Prostate. Results Overall 82 (42.1%) participants reported pain during RAI since completing PCa treatment. Of these, 45.1% experienced painful RAI sometimes or frequently, and 63.0% indicated that the pain was persistent. The pain at its worst was moderate to very severe for 79.0%. The experience of pain was at least mildly distressing for 63.5%. Painful RAI worsened for a third (33.4%) of participants after completing PCa treatment. Of the 82 GBM, 15.4% were classified as meeting criteria for anodyspareunia. Antecedents of anodyspareunia included a lifelong history of painful RAI and bowel dysfunction following PCa treatment. Those reporting symptoms of anodyspareunia were more likely to avoid RAI due to pain (adjusted odds ratio, 4.37), which was negatively associated with sexual satisfaction (mean difference, −2.77) and self-esteem (mean difference, −3.33). The model explained 37.2% of the variance in overall quality of life. Clinical Implications Culturally responsive PCa care should include the assessment of anodyspareunia among GBM and explore treatment options. Strengths and Limitations This is the largest study to date focused on anodyspareunia among GBM treated for PCa. Anodyspareunia was assessed with multiple items characterizing the intensity, duration, and distress related to painful RAI. The external validity of the findings is limited by the nonprobability sample. Furthermore, the cause-and-effect relationships between the reported associations cannot be established by the research design. Conclusions Anodyspareunia should be considered a sexual dysfunction in GBM and investigated as an adverse outcome of PCa treatment.

Discrimination against gay and bisexual patients in prostate cancer treatment: Results from the Restore-2 study.

“…Given the small number of non-White and Hispanic participants, racial and ethnic categories were collapsed into either non-White and/or Hispanic (i.e., men of color) or White, non-Hispanic. This method of combining small numbers of non-White and Hispanic participants into one group is similar to other studies (Ross et al, 2023;Umaretiya et al, 2021;Wheldon et al, 2023). Continuous age was collapsed into either 65 and younger or older than 65, which was the median age of our sample and is consistent with the Restore-1 study (Rosser et al, 2020).…”

Sexual Rehabilitation Needs of Gay and Bisexual Men With Cancer

“…These measures are based on heteronormative assumptions regarding sex, despite growing evidence that gay and bisexual men find resuming anal sexual activity following cancer treatment challenging, in part, because of anodyspareunia. 5,6…”

“…In the largest study to date of gay and bisexual men treated for prostate cancer, 1 in 7 reported severe, persistent, and distressing anodyspareunia. 5 However, despite the estimated prevalence of anodyspareunia in gay and bisexual men undergoing treatment, the concern is largely ignored in clinical consultations. When surveyed about topics discussed with cancer care clinicians before receiving treatment, only 6% of gay and bisexual men reported discussing the potential for increased pain, and 8% discussed the potential loss of pleasure during receptive anal intercourse.…”

“…Based on available data, 15% to 23% of gay and bisexual men treated for prostate cancer met the criteria for anodyspareunia based on the requirements for diagnosing genito-pelvic pain/penetration disorder. 5,6 Anodyspareunia can be notably distressing and worsen the quality of life in this population. 5 Cancer therapies, such as hormone treatment, chemotherapy, and radiation therapy, can also change prostate sensation, an important component of sexual stimulation in receptive anal intercourse.…”

“…5,6 Anodyspareunia can be notably distressing and worsen the quality of life in this population. 5 Cancer therapies, such as hormone treatment, chemotherapy, and radiation therapy, can also change prostate sensation, an important component of sexual stimulation in receptive anal intercourse. Patient-centered care for gay and bisexual men is limited by the lack of culturally relevant patientreported outcome measures, treatment-focused clinical research, and patient counseling.…”