The effects of radical prostatectomy on gay and bisexual men's sexual functioning and behavior: qualitative results from the restore study

Abstract

To advance research on the sexual effects of prostate cancer in sexual minorities, we conducted telephone interviews with 19 gay and bisexual men (GBM) who had undergone radical prostatectomies. Challenges to sexual functioning included anatomical penile changes, loss of ejaculate, climacturia, and erectile dysfunction. All sexual behavior with other men, not just insertive anal sex, was affected, across all stages of the sexual response cycle. Rather than narrowly focusing on erectile functioning, rehabilitation for GBM needs to be comprehensive in addressing anatomical changes, sexual behavior comprehensively, and functioning across the sexual response cycle. Seven recommendations for practitioner education are identified.

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

“…After treatment, study authors recorded that there was an overall decrease in sexual activity ( Lee et al, 2015 ), with reported experience ranging from temporary minor challenges to chronic, permanent ED ( Simon Rosser et al, 2016b ). There was reduced erectile functioning ( Hartman et al, 2014 ), with erections described by Simon Rosser et al (2016b) as more fragile. Erectile function rendered men vulnerable to failing to perform sexually ( Lee et al, 2015 ).…”

“…Erectile function rendered men vulnerable to failing to perform sexually ( Lee et al, 2015 ). The inability to get an erection led some men to give up on the possibility that they might recover from such changes ( Lee et al, 2015 ), with one man opining that “If I lose the erection, it’s hard to get it back” ( Simon Rosser et al, 2016b , p. 440). Some men in the study by Lee et al (2015) were reticent to disclose details of their PC and its treatments during sexual encounters, and were concerned that potential partners might misinterpret the lack of an erection as lack of interest.…”

“…Distress related to ED appeared to be dependent on the patient’s sexual preference as a penetrator, which was compromised by the inability to sustain an erection ( Hartman et al, 2014 ). Evidence from the studies suggests that sexual dysfunction may force men to change their roles ( Lee et al, 2015 ), as some men reported their inability to penetrate as “devastating,” with some switching roles to be the receptive partner ( Simon Rosser et al, 2016b , p. 439), and one man opining to Hoyt et al (2017 , p. 6) that “being a top was part of my identity.” This was also true in the study by Thomas et al (2013) where one participant had to change from being an insertive to a receptive partner due to ED. Simon Rosser et al (2016b) noted that gay and bisexual men would adopt novel substitution behaviors to circumvent penetration, including using dominant-submissive role play to maintain the role of ‘top’.…”

“…Some spoke of confiding in partners, others to friends and social groups, but generally less, it was disclosed, with family ( Capistrant et al, 2016 ). Participants in two studies reported trying one or more sexual aids, with two couples turning to erectile aids, and one man using Viagra to help him return to his role as penetrator ( Hartman et al, 2014 ; Simon Rosser et al, 2016b ). Being the insertive partner was a priority for some, with one man admitting “I can’t really be a top in anal sex unless I take the extra erectile enhancement or dysfunction medication” ( Lee et al, 2015 , p. 2381).…”

“…Being the insertive partner was a priority for some, with one man admitting “I can’t really be a top in anal sex unless I take the extra erectile enhancement or dysfunction medication” ( Lee et al, 2015 , p. 2381). One author observed that men also used erectile pornography to sustain sexual interest ( Simon Rosser et al, 2016b ). Another study reported that some men adapted by making adjustments to their sexual positions, or by using sex toys ( Hoyt et al, 2017 ).…”