Heteronormativity and prostate cancer: A discursive paper

Abstract

Aims and objectives To discuss the risks that heteronormative assumptions play in prostate cancer care and how these may be addressed. Background There is international evidence to support the case that LGBT patients with cancer are less likely to report poor health or self‐disclose sexual orientation. Gender‐specific cancers, such as prostate cancer, require particular interventions in terms of supportive care. These may include advice about side‐effect management (such as incontinence or erectile dysfunction), treatment choices and social and emotional issues. In this paper, we discuss and analyse the heteronormative assumptions and culture that exist around this cancer. We argue that this situation may act as a barrier to effective supportive care for all Lesbian women, Gay, Transgender and Bisexual patients, in this case men who have sex with men.[Correction added on 21 September 2017, after first online publication: The first sentence of the Background section has been revised for clarity in this current version.] Design Theoretical exploration of heteronormativity considered against the clinical context of prostate cancer. Methods Identification and inclusion of relevant international evidence combined with clinical discussion. Results This paper posits a number of questions around heteronormativity in relation to prostate cancer information provision, supportive care and male sexuality. While assumptions regarding sexual orientation should be avoided in clinical encounters, this may be difficult when heteronormative assumptions dominate. Existing research supports the assertion that patient experience, including the needs of LGBT patients, should be central to service developments. Conclusion Assumptions about sexual orientation should be avoided and recorded accurately and sensitively, and relational models of care should be promoted at the start of cancer treatment in an appropriate manner. These may assist in reducing the risks of embarrassment or offence to nonheterosexual patients, or to professionals who may adopt heteronormative assumptions. Relevance to clinical practice Having an awareness of the risks of making heteronormative assumptions in clinical practice will be useful for all health professionals engaged in prostate cancer care. This awareness can prevent embarrassment or upset for patients and ensure a more equitable provision of service, including men with prostate cancer who do not identify as heterosexual.

The Experiences of Gay and Bisexual Men Post-Prostate Cancer Treatment: A Meta-Synthesis of Qualitative Studies

“…Thus, clinical environments might be unaccustomed to supporting the sexual well-being of gay and bisexual men ( Rose et al, 2017 ). Although most health professionals may not be homophobic, medical culture may mirror heteronormative discourses ( Kelly, Sakellariou, Fry, & Vougioukalou, 2018 ). In their study, Sabin, Riskind, & Nosek (2015) discerned that implicit preferences for heterosexual people over gay people were pervasive among a majority of health-care providers.…”

“…As a consequence, gay and bisexual men were dissuaded from disclosing their sexual orientation, or discussing any sexual obstacles they may endure. There was associated worry of experiencing subtle or overt homophobia ( Kelly et al, 2018 ). Quantitative research also reported lower satisfaction among gay and bisexual men with prostate cancer health-care treatment compared to other survivor groups ( Hart et al, 2014 ).…”

“…Previous studies have elucidated that Black men, and other ethnicities, may express anger towards the health-care system if they felt that their physician was not supportive enough in discussing changes to their sexual practices as a result of prostate cancer treatment ( Kelly, 2009 ; Letts, Tamlyn, & Byers, 2010 ). According to Kelly et al (2018) , gay men are only one of the groups whose intimate sexual lives may be treated with some degree of taboo by health providers.…”

“…Gay men are made to feel invisible ( Rose et al, 2017 ), the assumption being made that they are heterosexual. Experiences of heteronormative discourse and practices can be particularly harmful to the psychological well-being of gay and bisexual men, especially when cancer has affected their sexual function ( Kelly et al, 2018 ). In terms of sexual intercourse, erectile function suitable for oral and anal penetration is different from that of vaginal intercourse ( Blank, 2005 ).Yet erections were discussed in terms of vaginal penetration ( Simon Rosser et al, 2016b ).…”

“…Support groups have been established in cities such as London, Manchester, Sydney, Los Angeles, and New York. Blank (2005) emphasizes that it is essential that the clinical oncology community is sensitive to the particular needs of gay and bisexual men because of their sexual orientation, while Kelly et al (2018) argue that specialist nurses must spearhead practice that promotes equality and diversity in prostate cancer care.…”