After prostate cancer treatment, men who have sex with men (MSM) have sexual concerns that aren’t always addressed by healthcare providers and standard assessment tools, according to researchers from Canada and Australia.
Most approaches target heterosexual men, the researchers explained. As such, they are not always helpful for MSM.
The study, published online in November in the Journal of Sexual Medicine, kicked off a multi-phase effort to create a validated tool to evaluate sexual issues of MSM after prostate cancer treatment.
Sixteen MSM between the ages of 58 and 71 (mean age: 65) were interviewed by the research team, answering questions on sexual function, relationships, and emotional health. Their mean age at prostate cancer diagnosis was 59 years. Half of the men were in non-monogamous relationships. Four were single and four had an exclusive partner.
The scientists identified several themes.
Erectile dysfunction (ED) was a widespread concern. Some men felt reluctant to initiate new relationships or casual sexual encounters and worried that a partner would misinterpret their lack of erection.
“I’m always a little embarrassed that I can’t achieve an erection, because partners wonder what’s going on,” explained Charles, a 71-year-old respondent. (Names of all participants were changed to protect their privacy.)
Men needed to make adjustments in their sexual routines, especially if they engaged in anal sex. Some who were accustomed to the insertive role needed take the receptive role.
Incontinence was also a problem, particularly during oral sex. Isaac, age 65, said, “I don’t really want to engage anybody with oral sex who, you know, is gonna be swallowing this stuff [urine] without knowing it.”
Some men noted that their orgasms felt different. While many respondents could still reach orgasm, those orgasms were not as satisfying as they were before prostate cancer treatment. Reduced ejaculate volume could be troublesome and anejaculation was “demoralizing,” the authors wrote.
Men reported difficulties with relationships after treatment, noting themes of isolation, lower self-esteem, and failure. Those who were in stable relationships appeared more able to adapt. But because sex is an important part of starting new relationships, many felt left out.
Finally, the men described poor support systems for MSM with prostate cancer. Most did not know another MSM with the disease. Some felt uncomfortable sharing their orientation with their healthcare provider and, if they did, felt that their doctor did not address their particular needs. Support groups tended to focus more on heterosexual relationships.
“I got all this information that would cover everybody that ever had prostate cancer, but it was not specific to me,” said Adam, age 62.
Awareness among healthcare providers is one step toward individualizing treatment for MSM. The development of support groups specific for MSM with prostate cancer – in person or online – could be one option to consider, the authors said.
They added, “Our study points to the need for targeted oncological and psychosocial support for MSM with [prostate cancer], simply because no patient, including those in the MSM community, should face the most commonly diagnosed male cancer without adequate and appropriate services and support.”
Resources
The Journal of Sexual Medicine
Lee, Tsz Kin, MD, MSc, et al.
“Impact of Prostate Cancer Treatment on the Sexual Quality of Life for Men-Who-Have-Sex-with-Men”
(Full-text. First published online: November 4, 2015)
http://onlinelibrary.wiley.com/doi/10.1111/jsm.13030/full