Same Cancer, Different Journey
Gay and bisexual men with prostate cancer may have unique needs that present challenges to healthcare providers and health systems in the era of "patient-centered" care. In order to provide patient-centered care, the healthcare provider must understand the patient's knowledge, perspective, cultural perspectives, and treatment preferences.
For the patient to be a partner in their care, they need to be able to trust their provider with personal information, feel respected, and be understood. Decades of research has shown that LGBTQ people often face stigma and other barriers that impact their healthcare, resulting in health disparities.
Is prostate cancer different for gay men?
While the LGBTQ community has worked for decades to advance our identities as "more than just sex," we are still faced with an identity that is framed by our larger society and is still stigmatized as difference. As gay men move through adolescence, we develop an identity and an understanding of our own sexuality in relation to other gay or bisexual men. Gay men have both an individual and collective or group identity.
For gay and bisexual men, prostate cancer makes this abundantly clear. As gay men, while we are more than our sexual lives, there is no doubt that for most of us our sexuality and how we see ourselves sexually, is a central part of our identity and self-concept. A prostate cancer diagnosis, and what happens after, can change all that, and call into question how we fundamentally see ourselves.
More questions than answers?
For non-LGBTQ people, it may be a difficult concept to understand. Do heterosexual people who are faced with a challenge to their sexual selves suddenly see themselves as fundamentally different? Until you are forced to face your sexuality and question it in relation to social norms, as LGBTQ people are, you do not have to critically examine the role of sexuality in framing your personal identity, potential group membership, sexual desire or sex acts/behavior.
In this way, prostate cancer and its treatment can be somewhat of an equalizer of men, regardless of sexual orientation. With prostate cancer, gay men, as well as heterosexual men, are confronted with an altered sense of self, a changed ability to engage in desired sexual behavior, and a loss of what makes you feel "like a man."
To date, most of the existing research, health information, and reports of healthcare provider experience are organized around heterosexual men and their experiences with prostate cancer.
A new resource
A recently-published book, Gay & Bisexual Men Living with Prostate Cancer: from diagnosis to recovery, provides a critical examination of some of these important differences. This book is essentially a compilation of 20 different articles or chapters that can appeal to many different types of readers. In short, there is something for everyone:
- Gay men who fear they may be at increased risk of prostate cancer
- Gay men who are newly diagnosed
- Partners of men with prostate cancer
- Researchers and other practitioners
Also included is a helpful glossary that a newly-diagnosed person would do well to peruse first before diving into the book.
Regardless of how much each article focuses on personal experience or narrative of a man’s prostate cancer journey, or articles that focus more on summarizing research, each chapter has unique insights to offer and supports an overall theme. The central theme is that the prostate cancer journey is likely very different for gay men than it is for our heterosexual brothers, fathers, and friends. Ways that the prostate cancer journey may be different for gay men, compared to heterosexual men, include:
- Differences in relationships
- Differences in sexual experiences and meaning of sex to personal identity
- Differences in emotional impact and quality of life
How are gay men’s relationships different?
Another unique perspective is offered by B.R. Simon Rosser, as he relates aspects of his own personal story. A situation that is unique to gay couples (although not all gay couples), as opposed to heterosexual couples, is reflected in the author's account of his own diagnosis, even though he had gone through his partner's prostate cancer diagnosis 8 years prior. He notes that even though his partner had gone through this, he still felt a sense of isolation: “it’s my body, my result, and in that sense, it’s a unique door that I must go through by myself.”1
While it may not seem obvious to all men, gay men experience sex in relationship to their sexual partner differently than heterosexual men, because gay men are familiar with how sex feels for another man. Since men have the same sexual “equipment” and sexual response, two men having sex together are more likely in tune with what their partner is feeling or not feeling based upon response and signals that they recognize in themselves.
So, what about sex?
One of the authors, Ross Henderson, asks questions that clearly represent a difference in the gay male perspective: “what about anal sex? Penetrative sex? Receptive sex? How will the absence of semen affect my orgasm? How can you reach orgasm with a flaccid penis? Will I still be a sexual man? Will I feel attractive to other men?”2
For example, men are used to “seeing” their arousal as they are feeling it, thus if they don’t see their male sex partner being aroused while they are having sex, they may feel that they are not enjoying the sexual activity. For gay men, an erection may signal to another gay man “arousal, attraction, interest and pleasure.”3 Its loss may signal a loss of perceived sexual desirability.
Men who have erectile dysfunction, regardless of the reason, may be concerned that their partner will think they are “faking it,” even if they are feeling sexual excitement and have an orgasm. As well, heterosexual men may not be as concerned about the loss of their ability to ejaculate if they are still able to achieve orgasm. But many gay men feel a sense of loss of not having ejaculated as the visible “proof” of their sexual pleasure.
More than just sex
One chapter presents very interesting data on the emotional reactions and quality-of-life differences between radiation therapy and radical prostatectomy. While it is well-known that large numbers of men experience ED as a result of their treatment for prostate cancer, there is less acknowledgment of the loss of libido or sexual desire.4 Gay men who have radiation therapy may be concerned about long-term damage to their rectal tissue caused due to proximity to the prostate, resulting in loss of sensitivity and/or pain during receptive anal sex.
The overall sense of loss that comes with prostate cancer is one shared by men, regardless of if they are gay or heterosexual. It is not just an inhibition on the ability to seek and get sexual pleasure or a change in levels of intimacy, it is a loss of our sense of self as a sexual being. Similarly, while both gay and heterosexual men may experience a loss of their sense of masculinity as a result of prostate cancer treatment, research has shown that gay men with prostate cancer have lower rates of masculine self-esteem than their heterosexual counterparts.5
Dealing with these profound changes in one's physical health, self-image, emotions, and relationships can become overwhelming. Reading other men's experiences, and how they are able to overcome their fears and continue to lead fulfilling lives, is so important to those of us who are beginning our journey or are confronted with challenging detours.
Have you made personal connections through your journey with prostate cancer?