Sexual issues like erectile dysfunction (ED), low libido, ejaculatory disorders, and orgasm difficulties are common after prostate cancer treatment. However, gay and bisexual men may feel the impact differently than straight men do.
For men who engage in anal sex, getting a rigid erection is especially important. Without it, anal intercourse becomes problematic. Men who have sex with women can still have vaginal intercourse with a weaker erection, but this is not as easy for men who have sex with men.
In addition, men who have anal sex often identify with different roles during the encounter. The “top” is the insertive (penetrating) partner, and the “bottom” is the receptive (penetrated) partner. If a top is unable to achieve an erection, he may have to switch his role. Some men are comfortable with this change, but others are not.
Receptive anal sex partners can also have difficulties. Some prostate cancer treatments, like radiation, can affect the anus. As a result, a man playing a bottom role may find penetration painful. In addition, if his prostate gland has been surgically removed, he might miss the pleasure of that stimulation.
Men with prostate cancer who lose erectile function and have anal pain may be unable to have anal sex at all.
Not all gay and bisexual men have anal intercourse. Many enjoy oral sex and mutual masturbation.
Men who have their prostate glands removed are unable to ejaculate. For some men, ejaculating – and seeing the ejaculate – brings sexual pleasure and some reassurance that the sexual encounter was satisfying. Men who cannot ejaculate may miss this aspect of sex, and their partners may worry about being inadequate.
Gay couples who would like to have children may also struggle with the lack of ejaculation.
Men may also discover that their orgasms become either more or less intense after prostate cancer treatment. Others find that it takes more time or stimulation to reach orgasm.
Leaking urine during orgasm can also occur, leading to anxiety and embarrassment.
Depression, anxiety, and a sense of lost masculinity often accompany the sexual effects of prostate cancer treatment. For some men, being gay and having sexual relationships is a large part of their identity, so losing the ability to experience sex the way they used to is a profound loss.
Some men feel uncomfortable discussing their sexuality with their healthcare providers and often choose to hide their homosexual relationship. Consequently, they will not get appropriate advice for their sexual problems. Others may feel reluctant to start sexual relationships with new partners.
Gay and bisexual men who struggle with sexual changes after prostate cancer treatment should know that they are not alone. Support can come from many sources, including healthcare providers, counselors, sex therapists, friends, family, and peers in the community.