Hidden, visceral and traumatic: a dramaturgical approach to men talking about their penis after surgery for penile cancer

Abstract

Drawing upon concepts of expressive equipment and body image, the aim of this study is to explore how men diagnosed and treated for penile cancer construct their penis and its surgical disfigurement (penectomy). Using maximum variation sampling with the intention to acquire the broadest range of experiences of stage of disease and treatment, 27 cisgender men (aged 48-83, x=63) who had surgical treatment consented for their data to be archived for analysis. From a dramaturgical perspective, the constructionist thematic analysis explored direct and indirect talk about the penis after surgery. The analysis showed that through graphic and sequential narratives of dismemberment revealed, participants constructed a post-surgery period in which they both wanted and did-not-want to see their penis. Additionally, participants constructed themselves managing difficult emotions through others and seeing themselves being rejected by a potentially desiring (female) Other. The findings extend research on male genitals by showing how the post-surgery penis can function as something hidden but visceral and traumatic when revealed. Importantly, this paper illustrates body image as expressive equipment where body and identity are formed in the image of manhood, which is an intersubjective (sexual) object between self and other.

The feasibility of patient reported outcome measures for the care of penile cancer

“…The IIEF has five domains; erectile function (items 1-5 & 15), orgasmic function (9,10), sexual desire (11,12), intercourse satisfaction (6)(7)(8) and overall satisfaction (13,14). Each item is answered on a Likert scale with 6 options, scored from 0 to 5, and domains are then all summed so that lower scores represent poorer function; for example, item 1 is from 0 for 'no sexual activity' to 5 for 'almost always' for how often they can get an erection.…”

“…[2][3][4][5][6][7] Men's experiences of their penis after surgical treatment, for example, can be visceral and traumatic. 8 The impact on quality of life can be challenging to tackle in urological nursing because many patients are too embarrassed 9 or traumatised 8 to talk about their experiences; or they talk in general terms 10 that is often couched in humour. 4,11,12 Consequently, there is a need to explore approaches that can support patient well-being.…”

“…Penile cancer is a rare condition that despite good survival 1 can have detrimental long‐term impact on sexual and gender identity 2–7 . Men's experiences of their penis after surgical treatment, for example, can be visceral and traumatic 8 . The impact on quality of life can be challenging to tackle in urological nursing because many patients are too embarrassed 9 or traumatised 8 to talk about their experiences; or they talk in general terms 10 that is often couched in humour 4,11,12 .…”

The feasibility of psychometric measures for body image and lymphedema for routine practice

“…Psychometric measures can aid urologic nursing. There are reports of a reluctance of men to disclose treatment effects to others, due to embarrassment, fear of appearing weak, and/or the loss of masculine capital 1 or because the impact on their body of their condition is too traumatising 2 . Mroz et al 3 found that although men did on occasion open up about their experiences; they often spoke in general terms rather than discussing detail, particularly about the emotional consequences of their physical symptoms.…”

“…Measuring genital body image could be useful across a range of urological practice. Asking patients to complete a questionnaire before an appointment could, for example, give them tacit approval 11 to talk about issues that they find sensitive because it is challenging to their sense masculinity 2,5,[15][16][17][18] enough that they can be used across a range of settings. The EORTC-QLQ and the CORE-6D are specific to caner care and psychological services respectively, although one could argue that the questions are general enough that they could be used in any clinical setting.…”