REVIEW

Sex After Prostate Cancer in Gay and Bisexual Men:

A Review of the Literature
Meghan K. McInnis, MSc, and Caroline F. Pukall, PhD

ABSTRACT

Introduction: Prostate cancer (PCa) is the most commonly diagnosed cancer among males globally, and it has
one of the highest 5-year net survival rates of all cancers. Most diagnosed individuals, therefore, must live with
the consequences of the disease and its treatments, including sexual side effects. Unfortunately, little is known
about the sexual outcomes of PCa in individuals who identify as gay or bisexual.
Objectives: To highlight the unique concerns, experiences, and needs of gay and bisexual men with PCa by
reviewing the literature on sexual outcomes in this patient population.
Methods: A literature review through June 2019 was conducted, with a focus on sexual outcomes in gay and
bisexual men with PCa; comparisons of sexual outcomes between heterosexual and gay and bisexual men with
PCa; and the health care experiences of gay and bisexual men with PCa, specifically with regards to discussing sex
with health care providers.
Results: Gay and bisexual men with PCa report a number of unique sexual concerns compared to their het-
erosexual counterparts. They face heteronormative biases and homophobia in the health care system and are
frequently dissatisfied with the information they receive with regards to PCa and sexuality.
Conclusion: There has been limited research on the experiences of gay and bisexual men with PCa; additional
research to replicate and extend upon the findings of previous studies is warranted. Research on the experiences of
PCa patients and survivors should be inclusive of participants of all sexual orientations and gender identities.
Research results must be translated into clinical practice, so that health care providers can communicate specific
and relevant information to their gay and bisexual patients. McInnis MK, Pukall, CF. Sex After Prostate
Cancer in Gay and Bisexual Men: A Review of the Literature. Sex Med Rev 2020;XX:XXXeXXX.
Copyright
2020, International Society for Sexual Medicine. Published by Elsevier Inc. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Key Words: Prostate Cancer; LGBTQ Persons; Sexual Function; Sexual Health; Health Care

INTRODUCTION
Among males, prostate cancer (PCa) is the second-most
commonly diagnosed cancer globally, the most commonly
diagnosed cancer in 105 countries (including the United States,
Canada, Australia, New Zealand, and the United Kingdom), and
the fifth leading cause of cancer death.1,2 At 98% (in the United
States), PCa has one of the highest 5-year net survival rates of all
cancers; this rate is nearly 100% for early-stage diagnoses.2 Ac-
cording to the American Cancer Society, 90% of PCa diagnoses
in the United States are at a local or regional stage, meaning that
most diagnosed individuals are not dying from the disease;
Received July 18, 2019. Accepted January 27, 2020.
Department of Psychology, Queen’s University, Kingston, ON, Canada
Copyright ª 2020, International Society for Sexual Medicine. Published
by Elsevier Inc. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
https://doi.org/10.1016/j.sxmr.2020.01.004
instead, they must live with the consequences of the cancer and
its treatments.2
Treatments for PCa can negatively impact multiple areas of
patients’ mental and physical healtherelated quality of life.
Common negative side effects include issues related to sexual
functioning and satisfaction. Given these side effects and the
prevalence and high survivorship of the disease, recent research
on PCa has focused on improving the quality of life of diagnosed
individuals. Unfortunately, a subset of the PCa patient and
survivor population is underrepresented in this literature: gay and
bisexual men. Much of the previous research on the experiences
of individuals diagnosed with PCa has either been restricted to
samples of heterosexual, cisgender (ie, felt gender matches the
sex/gender assigned at birth) participants, or else has neglected to
collect and report data on sexual orientation and gender identity.
In 2016, a review of the literature on PCa in gay and bisexual
men revealed a mere 30 studies that had been conducted since
the year 2000; most of these studies were case studies and

Sex Med Rev 2020;-:1e7 1

2 McInnis and Pukall
commentaries, and 4 were quantitative.3 14 of these 30 studies
were part of a single special issue of the Journal of Gay and
Lesbian Psychotherapy. To quote the editors of this special issue,
“If prostate cancer, in general, is off most people’s radar screen,
then gay men with prostate cancer are a truly invisible species.”4
The purpose of the present review is to provide a summary of the
literature on the sexual outcomes of PCa in gay and bisexual men.
To this end, after a brief overview of PCa treatments and their
sexual side effects, the following sections will review research in 4
broad areas: (1) sexual outcomes in gay and bisexual men with PCa;
(2) direct comparisons between the sexual outcomes of hetero-
sexual and gay/bisexual men with PCa; and (3) the health care
experiences of gay and bisexual men with PCa, specifically
regarding discussions about sex. The primary goal of this review is
to highlight the unique experiences, concerns, and needs of gay and
bisexual men with PCa, with a specific focus on sexuality.
A BRIEF OVERVIEW OF COMMON PROSTATE
CANCER TREATMENTS AND THEIR SEXUAL SIDE
EFFECTS
Common treatments for PCa include observation, radical
prostatectomy, radiotherapy (ie, external beam radiotherapy,
brachytherapy), and systemic therapies including androgen
deprivation therapy (ADT), chemotherapy, and immunotherapy
(for a recent overview of PCa treatments and outcomes, see
Weiner & Kundu, 2018).5 Observation includes watchful
waiting and active surveillance. Watchful waiting involves
symptom monitoring, with treatment only to relieve symptoms.
Patients with low-risk disease may opt for active surveillance,
which involves monitoring symptoms with the option of un-
dergoing active treatment if the disease progresses.5
Every active treatment for PCa has the potential for sexual side
effects, with the specific side effects varying by treatment mo-
dality. Radical prostatectomy involves the surgical removal of the
prostate and a portion of surrounding tissue.6 This surgery
commonly causes erectile dysfunction, as the nerves that stim-
ulate erections are located close to the prostate gland.6 Further-
more, this surgery causes retrograde ejaculation (ie, orgasm
occurs, but the ejaculate travels backwards into the bladder
instead of out of the penis).6 Nerve-sparing surgical techniques
may result in improved long-term erectile functioning, but the
use of such techniques depends on the location and aggressive-
ness of the cancer.5,6 The use of medications for treating erectile
dysfunction may also result in more positive long-term out-
comes.5 In the United States, most radical prostatectomies are
robot assisted; compared to open surgeries, there is evidence that
robotic surgeries may result in improved erectile functioning at
12-month follow-up.5
In external beam radiotherapy, radiation is produced outside
the body and targeted at the prostate, whereas in brachytherapy,
radioactive seeds are implanted directly into the prostate gland.6
The sexual side effects of radiation therapy may have a gradual
onset and worsen over time.5,6 Although radiotherapy does not
cause retrograde ejaculation, it can decrease the volume of ejac-
ulate.6 External beam radiation may penetrate the rectum,
causing soreness, diarrhea, and sometimes bleeding; these con-
sequences can make receptive anal intercourse painful.6
Finally, ADT can be used independently (particularly in pa-
tients diagnosed with metastatic PCa), or in conjunction with
surgical and/or radiation treatment.5,7 One form of ADT is
bilateral orchiectomy, which involves the surgical removal of
both testicles. Medical forms of ADT include luteinizing
hormone-releasing hormone agonists or antagonists, estrogens,
and antiandrogens.5,7 ADT can also cause erectile dysfunction,
decreased libido, and decreased penile length and volume.5,7
Other hormonal side effects, such as gynecomastia (ie, enlarged
breasts), weight gain, and body hair loss, may also impact pa-
tients’ sex lives.7
TREATMENT-RELATED SEXUAL DYSFUNCTION IN
GAY AND BISEXUAL MEN WITH PROSTATE
CANCER
Reduced sexual functioning has been found to be one of the
most prevalent and distressing side effects of PCa treatment.8 In
previous research, men have described how the loss of sexual
functioning and the changes it brought to their lives negatively
impacted their masculinity and left them feeling that they were
no longer “a whole man.”9 This perceived loss of manhood has
been echoed by participants in other studies, including in in-
dividuals who had not yet started treatment.10,11 Although
erectile aids, including injections and devices, exist, men have
expressed that using such aids can feel unnatural and remove
spontaneity from sex.9,11e13 When choosing a treatment for
PCa, men have discussed a perceived trade-off between living and
maintaining their sexual functioning.11 However, given that sex
is an important part of living, it is not a simple, straightforward
trade-off. Indeed, for many men, treatment-related sexual
dysfunction was one of their most pressing fears.11
As devastating as the sexual side effects of PCa and its treat-
ments may be, there have been few studies on the sexual out-
comes of PCa treatment in gay and bisexual men. Research that
has focused specifically on PCa in this population has suggested
that they may have different sexual concerns than their hetero-
sexual counterparts, as the sexual side effects of PCa treatments
may impact them differently. For instance, firmer erections are
required for anal penetration than for vaginal penetration.6
Therefore, treatments that work for erectile dysfunction in het-
erosexual men may not be as effective in men who have sex with
men (MSM). In one online study of gay and bisexual men with
PCa, only 27% of participants had had an erection firm enough
for anal intercourse in the past 4 weeks.14 Treatment-induced
erectile dysfunction, therefore, can force gay and bisexual men
either to change their sexual role (ie, from insertive to receptive
anal intercourse partner) or to no longer engage in penetrative
sexual activities.
Sex Med Rev 2020;-:1e7
Sex After Prostate Cancer in Gay/Bisexual Men
One study of gay men with PCa found that only approxi-
mately 40% of participants who were always the insertive partner
before treatment remained in that role after treatment, with less
than 20% reporting always being the insertive partner.15 In a
more recent study of gay and bisexual men with PCa, only
approximately 8% of participants reported currently being the
insertive partner, compared to 42% in the year before treat-
ment.16 Changing sexual role depended on treatment modality
in one study of MSM with PCa.17 Among those who had
received surgical treatment, one of 4 participants who reported
being the insertive partner before treatment remained in that role
after treatment, and zero of 3 participants who reported being the
receptive partner before treatment remained in that role after
treatment. By contrast, all 7 participants who had undergone
radiation therapy maintained their pretreatment roles after
treatment. Anecdotally, in a personal account of his experiences
with PCa, one gay man recounts how he formed a focus group
for other gay men with PCa; over the 3 years that the group ran,
no participant was able to be the insertive partner in anal
intercourse.18
For MSM, changing sexual role is not necessarily an ideal
solution to the sexual side effects of PCa treatments because
sexual role can be an important part of one’s identity (ie, being a
top vs being a bottom).15,19,20 In one study of gay and bisexual
men with PCa, men described it being difficult to switch from
being a top to a bottom, and especially so if their partner was
already a bottom.14 The treatment concerns of insertive and
receptive anal intercourse partners would likely differ, with
insertive partners being more concerned about erectile
dysfunction and receptive partners being more concerned about
anal pain and discomfort.19 Indeed, one receptive partner
described how post-treatment erectile dysfunction was not dis-
tressing to him, as erections were not important to his sex life.21
Although MSM may opt for different treatment types depending
on their sexual role, some men can be versatile and take on
either sexual role.19 Therefore, discussing patients’ sexual role
may be an important aspect of treatment planning in this
population.
Sexual dysfunction in gay and bisexual men with PCa is
predictive of worse mental and physical quality of life.16 As
reported by heterosexual men in previous research, gay and
bisexual men with PCa have described a perceived loss of
manhood as a result of treatment-induced erectile dysfunc-
tion.14 However, there may be ways in which the emotional
impacts of erectile dysfunction differ between heterosexual and
gay and bisexual men. In one previous study, participants
described how gay and bisexual men tend to remain more
sexually active as they age compared to heterosexual men; they
expected to have a long sex life and felt that PCa had interfered
with that expectation.14 This interference was perhaps espe-
cially devastating for men who had not come out as gay or
bisexual until much later in life.14,22 Sexual activity was seen as
Sex Med Rev 2020;-:1e7
3
an important aspect of the gay male identity. For some men,
erectile dysfunction led to a sort of identity crisis, while others
described no such impact on their identity. Still other men
described a re-evaluation or transitioning of their gay identity
in the face of erectile dysfunction.14
Gay and bisexual men’s view of aging in the context of
treatment-induced sexual dysfunction varies greatly. Some gay
and bisexual men attributed erectile dysfunction to aging rather
than to PCa; this attribution helped these men to accept the
change.14,22 For other men, less frequent sex after PCa treat-
ment, as well as other side effects such as incontinence and
weight gain, led to them feeling older.22 Some men, on the other
hand, felt that by maintaining their sexual activity, they could
maintain their sense of youth.22
Treatment-induced erectile dysfunction can also impact gay
and bisexual men’s relationships. Men have reported feeling
“sexually inferior” and lacking sexual confidence after treat-
ment; they may abstain from sex with new or casual partners,
leading to feelings of social and sexual isolation.12,14 During
partnered sexual activity, erections are important visual in-
dicators of pleasure and desire; although men in long-term
relationships could develop other ways to communicate their
pleasure and desire to their partners, this was more difficult to
accomplish during casual sexual encounters.14 Many men did
not want to have to explain the reason for their erectile
dysfunction to casual partners.12 Some men and their partners
focused on reframing and adapting their sexual practices,
engaging in more nonpenetrative activities, or changing the
length and intensity of their sexual encounters; participants
described how this reframing led to a more intense sexual
connection and feeling of closeness with their part-
ners.12,14,21,22 Men and their partners have emphasized the
importance of open and honest communication and nonsexual
touching to maintain intimacy in their relationships.21 Partners
described focusing more on patients’ sexual pleasure than on
their own.21 Being in a relationship could help to lessen the
impact of the sexual side effects of PCa treatment; on the other
hand, single men with PCa had difficulty finding casual part-
ners or a relationship.12 Gay and bisexual men without a PCa
diagnosis also felt that finding a partner would be very difficult
for single gay men with PCa, and even more so for men who
already had an HIV diagnosis.19
Turning to receptive anal intercourse, anal pain and discom-
fort have been commonly reported by gay and bisexual men after
PCa treatment; in one study, over half of participants reported at
least one painful receptive anal intercourse experience.14,16
Furthermore, stimulation of the prostate during anal penetra-
tion is an important source of pleasure for receptive partners;
many men described a significant decrease in pleasure as a result
of the surgical removal of their prostate.14 On the other hand, a
minority of men described discovering other sensitive areas of
their body that could bring them pleasure during sex.14
4 McInnis and Pukall
Lack of, or reduced, ejaculation may also be especially
devastating to gay men, as semen can be an important visual,
tactile, and oral erotic stimulus for this population.6 In one
personal account, a gay man explained that the sight of his own
semen was a visual cue that he had orgasmed; it was difficult for
him to adjust to no longer having this cue available to him after
his prostatectomy.23 Similarly, one gay man in an online study
referred to ejaculation as “visible evidence of pleasure,” and
partners of PCa patients reported missing it.14 For some men,
lack of ejaculation was associated with a decreased sense of
pleasure.21 Focus group participants in Ascencio and colleagues’
study expressed concern over the possibility of not being able to
ejaculate, as their own or their partner’s semen is arousing to
them.19 They believed that problems with ejaculation would
have a negative impact on their sexual satisfaction, as well as on
their relationships. On the other hand, men who took the
insertive, or “top” role, in anal intercourse have expressed less
concern about the lack of ejaculate, as it normally would not be
visible to them or their partners.14 Along with lack of or reduced
ejaculation, men have described orgasms that are shorter and less
intense than before treatment, and needing more stimulation to
achieve orgasm.12
Gay and bisexual men have described how PCa treatment has
impacted their libido, leading to a decreased sexual interest.21 In
one study, approximately half of participants reported experi-
encing little or no enjoyment in sex.14 For some men, loss of
libido led to them remaining abstinent; for others, it led to them
having sex in the absence of sexual desire in an effort to maintain
their sexual functioning.14 In some cases, this loss of libido led to
a change in identity.14
Gay and bisexual men, therefore, experience a number of
negative sexual side effects as a result of PCa treatment. Some gay
and bisexual men without PCa felt that remaining sexually intact
would be more important to them than aggressively treating the
cancer.19 In individuals who have already undergone treatment,
the sexual dysfunction they experience may cause them to regret
their treatment decision. For example, in one online study, a gay
patient with PCa stated that, if he had the chance to make a
different decision, he “would take [his] risks with the cancer, and
not have the operation.”14 Health care providers need to be
knowledgeable of the unique impacts of PCa treatment on gay
and bisexual men, so that they can provide their patients with
relevant information and help them to make a treatment decision
that is best suited to their life circumstances.
COMPARISONS OF SEXUAL OUTCOMES
BETWEEN HETEROSEXUAL AND GAY/BISEXUAL
MEN WITH PROSTATE CANCER
There has been a small number of studies that have investi-
gated sexual outcomes in men diagnosed with PCa by making
direct comparisons between heterosexual and gay/bisexual men.
The first investigated differences in diagnosis and treatment
outcomes between heterosexual and gay/bisexual men with
PCa.24 The researchers found that gay and bisexual men reported
significantly greater ejaculatory bother compared to heterosexual
men. They found no group differences in terms of whether
participants were sexually active, nor in erectile difficulties or
orgasm satisfaction.
The second study asked heterosexual and gay and bisexual PCa
patients about how often they engaged in anal sexual intercourse
before and after PCa treatment, and what role they took (ie,
insertive only, receptive only, or both).25 Before treatment, men in
both groups reported engaging in anal intercourse, in all roles,
although the proportion was greater in gay and bisexual than in
heterosexual men. For both groups, there was a reduction in anal
intercourse frequency after treatment. There was a proportion of
insertive partners who changed to being receptive partners, but no
receptive partners changed to being insertive partners. Interest-
ingly, there was a small number of both heterosexual and gay and
bisexual men who reported engaging in anal intercourse for the first
time after PCa treatment.
A third study compared heterosexual and gay and bisexual men
diagnosed with PCa on various outcomes, including sexual
changes.26,27 Gay and bisexual men reported greater concerns over
ejaculatory function. Interestingly, gay and bisexual men reported
better sexual functioning and confidence than heterosexual men.
However, it is important to note that participants in both groups
had worse sexual functioning, sexual confidence, and sexual in-
timacy compared to age-matched population norms. Therefore,
results showing that one group fares better than the other on
certain outcomes does not mean they are faring well.
Finally, a 4th study compared the use of assistive sexual aids
(eg, oral medication, penile injection, penile implant, vacuum
pump) in heterosexual and gay and bisexual men diagnosed with
PCa.13 Compared to heterosexual men, gay and bisexual men
were more likely to have tried assistive aids, and more likely to
have tried multiple types; however, there were no significant
differences between groups in terms of satisfaction with the aids.
Interestingly, gay and bisexual men who used sexual aids re-
ported significantly lower sexual functioning than those who did
not use any aid; the opposite was true of heterosexual men. This
pattern of results may be explained by the fact that gay and
bisexual men were more likely to use sexual aids to reframe their
sexual practices, in particular for activities that did not require
erections or involve anal intercourse. With regards to seeking
information on sexual rehabilitation (whether online, through
counseling, or in support groups), gay and bisexual men were
more likely to seek this information than heterosexual men.
HEALTH CARE EXPERIENCES OF GAY AND
BISEXUAL MEN WITH PROSTATE CANCER:
TALKING ABOUT SEX
As reviewed in the 2 previous sections, there is clear evidence
that gay and bisexual PCa patients have somewhat different
Sex Med Rev 2020;-:1e7
Sex After Prostate Cancer in Gay/Bisexual Men
sexual outcomes and concerns than their heterosexual counter-
parts. Ideally, health care providers should address these unique
concerns with their gay and bisexual patients and provide them
with information specific to their needs. However, not all pa-
tients choose to disclose their sexual orientation to their health
care providers, and not all health care providers ask. In a study of
LGBT (ie, lesbian, gay, bisexual, and transgender) cancer pa-
tients, 79% of individuals reported having disclosed their LGBT
identity to at least one cancer care provider and were most likely
to disclose to their primary care physician.28 Bisexual individuals
were the least likely to disclose; however, those with same-sex
partners were more likely to disclose than unpartnered in-
dividuals. Of those patients who disclosed their LGBT identity,
just over half did so by bringing it up themselves to correct health
care providers’ assumptions that they were heterosexual; only
15% disclosed their LGBT identity in response to providers’
specific questions on the subject.
In an interview study consisting of 2 gay men with PCa,
neither participant disclosed their sexual orientation to their
doctor.29 Both expressed sentiments that the health care system
displays a heteronormative bias (ie, the assumption that the
heterosexual orientation is the norm). One participant was
assumed to be both heterosexual and married by his doctor, who
asked if his wife would like to attend his appointments.
Thomas, Wootten, and Robinson conducted a study using an
online focus group methodology.20 The participants were 10
Australian gay and bisexual men who had been diagnosed with
PCa in the past 7 years. Participants felt that their urologists were
not properly prepared to treat gay patients and did not seem to
understand how their needs may be different from those of
heterosexual patients. Multiple participants changed specialists
over the course of their treatment. Generally, participants found
their health care providers conservative and heteronormative, and
even homophobic in some cases. Participants stressed the need
for health care providers to better address their emotional needs
and the psychological side effects of cancer and treatment, as well
as the need for post-treatment support.
In an account of his personal experiences with PCa, one gay
man recounts how attending a PCa support group specifically for
gay men was more helpful for him than a general support group,
as it allowed him to discuss his sexual concerns more openly and
without fear of judgement.30 He also expressed concerns with the
information he received from his health care providers. To quote
him, “I consistently have to remind all my doctors that I’m a gay
man and that means a veritable host of different circumstances
with which to contend.”30 As an example, after receiving
brachytherapy, his nurse provided him with safety warnings
against impregnating women or allowing children to sit on his
lap. When he asked for information on the safety of activities
more relevant to him, such as masturbation, oral, and anal sex,
she did not have any to give.
In another gay man’s personal account, Harris explained how
he was put in touch with a gay former patient of his urologist to
Sex Med Rev 2020;-:1e7
5
discuss the impacts of radical prostatectomy on sexual func-
tioning.18 It was this former patient who informed him about
retrograde ejaculation, something his urologist had not explained
to him. Emphasizing the importance of ejaculation in the sexual
experiences of gay men, he found the lack of information on this
side effect to be “a gross disservice.”18 Harris joined a support
group, which he described as “gay-tolerant, but not gay-
friendly.”18 Unlike Jackson, he was not able to find a support
group specifically for gay PCa patients, and so he formed his
own. MSM with PCa have reported not feeling comfortable
disclosing their sexual orientation in support groups, a reality
that further emphasizes the need for specific support groups for
gay and bisexual PCa patients.12
Additional studies of gay and bisexual men with PCa provide
further evidence that health care providers may not be prepared
to discuss the sexual concerns of this population.12,14,31 Partic-
ipants felt that health care providers were so focused on defeating
the cancer that other issues, including those related to sexuality,
had a much lower priority.31 Approximately 80% of participants
in one study discussed sex with their health care providers, but
the majority expressed dissatisfaction with the level of informa-
tion they received.14 Many men reported needing to educate
themselves, frequently attempting to apply material aimed at
heterosexual men to their own situations.12 Participants across
studies reported that health care providers frequently assumed
that they were heterosexual; whether it was providing them with
sexuality-related information aimed at heterosexual men or
assuming they had a female partner, such interactions left par-
ticipants feeling “invisible.”14,31
In terms of disclosing their sexual orientation to health care
providers, in one study of gay and bisexual men with PCa, 20%
of participants avoided doing so completely, 60% did so hesi-
tantly, and the remaining 20% were candid and open about their
sexual orientation, and undeterred by potential consequences of
coming out.31 Health care providers’ responses to participants’
disclosure of their sexual orientation varied. Some health care
providers refused to talk about issues related to gay sexuality,
even stopping participants when they tried to bring it up. Other
health care providers had no knowledge on how the experiences
of gay and bisexual men may be different from those of het-
erosexual men. However, there were some health care pro-
fessionals who engaged in open discussions with patients to
better understand their specific needs, seeking additional re-
sources when they themselves did not have the knowledge to
immediately answer patients’ questions.31
CONCLUSIONS AND RECOMMENDATIONS
In conclusion, gay and bisexual men diagnosed with PCa have
unique experiences and needs compared to their heterosexual,
cisgender counterparts. Sexuality and sexual roles are often
important aspects of gay and bisexual men’s identities, and
treatment-induced erectile dysfunction may lead to identity crises
or transitions. Relationships can also be affected, particularly for
6 McInnis and Pukall
single men seeking casual sexual encounters. Receptive anal in-
tercourse may become less pleasurable if the prostate has been
removed, and even painful depending on treatment. The lack of
or reduction in ejaculate, an important erotic stimulus, may be
difficult for gay and bisexual men and their partners to accept.
Unfortunately, research on this patient population has been
limited, and many of the studies discussed in this review consist
of case studies and small qualitative studies involving interviews
or focus groups. Although these anecdotal and qualitative studies
provide rich data on the personal experiences of gay and bisexual
men with PCa, the results obtained from these small samples
may not generalize to the broader patient population. In recent
years, there has been an increase in large-scale quantitative studies
of this population, including comparison studies between gay/
bisexual and heterosexual men with prostate cancer, and this
increase is a positive sign. Additional research to replicate and
extend upon the findings of these studies is warranted. Specific
areas for future research are suggested below.
In conducting research on gay and bisexual men with PCa, it
is important to ask about participants’ sexual role in anal inter-
course (ie, insertive, receptive, or versatile). No research to date
has directly compared the treatment concerns and sexual out-
comes between men with different sexual roles, and this infor-
mation would likely be an important component of treatment
planning in this population. For many gay and bisexual men,
switching sexual roles in the face of treatment-induced
dysfunction is difficult; still, some men are capable of versa-
tility. Previous qualitative research has demonstrated that some
men are able to adjust their sexual activities to maintain their sex
life. Future research should investigate how such flexibility in
sexual practices might influence patients’ sexual satisfaction, and
how the ability to be flexible in one’s approach to sex may differ
between gay/bisexual and heterosexual patients. One particularly
interesting finding in this area of research is that gay and bisexual
men with PCa report better sexual functioning than their het-
erosexual counterparts.26 Potential reasons for this difference
should be further explored in future research.
Gay and bisexual men with PCa have described receiving
irrelevant or poor-quality information from their health care
providers, including information about sexual outcomes. Addi-
tional research on the specific information that gay and bisexual
PCa patients want and receive from their health care providers,
whether they must ask for this information, and the quality of
the information they receive could help to inform standards of
practice for treating this patient population.
Finally, few studies have included the partners of gay and
bisexual men with PCa. PCa is often referred to as a “couple’s
disease”, and there is an existing body of research on the partners
of heterosexual men with PCa. Similar research on the experi-
ences of the partners of gay and bisexual men will help to further
illustrate the impacts of PCa and its treatments on patients’
sexual and relationship satisfaction.
It is important that research on the experiences of those
diagnosed with PCa, as well as other patient populations, be
inclusive of participants of diverse sexual orientations and gender
identities. At a minimum, this inclusivity would involve col-
lecting information on participants’ sexual orientation and
gender identities, allowing them to self-identify with the labels
that best fit their experiences. Even in research studies without a
goal of making comparisons between sexual orientation or gender
identity groups, this inclusive practice will allow for better
characterization of research samples.
Perhaps most importantly, the knowledge gained from
research studies needs to be translated into clinical practice. Gay
and bisexual PCa patients have described a lack of information
relevant to their specific needs. Health care providers need to be
aware of existing research on the unique concerns of gay and
bisexual patients and be able to communicate this specific and
relevant information to their patients. Future interventions can
be specifically tailored to address the concerns of gay and bisexual
patients, with the ultimate goal of improving cancer care and
quality of life. At the very least, health care providers should be
careful not to make assumptions about their patients’ sexual
orientations or relationships. By asking about patients’ sexual
orientation and showing a willingness and openness to talk about
sexual concerns, health care providers can hopefully help their
gay and bisexual PCa patients to feel less invisible in the cancer
care system.
Corresponding Author: Caroline F. Pukall, PhD, Department
of Psychology, Queen’s University, 62 Arch St., Kingston,
Ontario K7L 3N6, Canada. Tel: 613-533-3200; Fax: 613-533-
2499; E-mail: pukallc@queensu.ca
Conflict of Interest: The authors disclose no conflicts of interest.
Funding: This work was supported by a Prostate Cancer Canada
Movember Discovery Grant (grant number D2017-1850).
STATEMENT OF AUTHORSHIP
Category 1
(a) Conception and Design
Meghan K. McInnis; Caroline F. Pukall
(b) Acquisition of Data
Meghan K. McInnis; Caroline F. Pukall
(c) Analysis and Interpretation of Data
Meghan K. McInnis; Caroline F. Pukall
Category 2
(a) Drafting the Article
Meghan K. McInnis; Caroline F. Pukall
(b) Revising It for Intellectual Content
Meghan K. McInnis; Caroline F. Pukall
Category 3
(a) Final Approval of the Completed Article
Meghan K. McInnis; Caroline F. Pukall
Sex Med Rev 2020;-:1e7
Sex After Prostate Cancer in Gay/Bisexual Men
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