Topic: Sexual health concerns of gay and bisexual men with prostate cancer
Prostate cancer therapy can affect gay and bisexual men differently than heterosexual men. Many urologists do not routinely address these unique concerns. Selecting providers who understand the concerns that are unique to gay and bisexual patients and asking questions about sexual health concerns may improve these patients' healthcare experiences. (Posted 9/21/23)
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RELEVANCE
Most relevant for: Gay and bisexual men diagnosed with prostate cancer.
It may also be relevant for:
- people with prostate cancer
- transgender people
- people newly diagnosed with cancer
Relevance: Medium-High
Quality of Writing: High
What is this study about?
The study looked at the attitudes, training and experiences of doctors when treating gay and bisexual people who have cancer.
Why is this study important?
Prostate cancer treatment includes medications, radiation and surgeries that can affect the sexual health of patients. Side effects include leakage of urine (incontinence), erectile dysfunction, reduced sex drive and loss of ejaculate. These side effects may affect gay and bisexual men differently than heterosexual men. Radiation therapy using implants that are placed within the prostate to kill cancer cells may be harmful to sex partners during anal intercourse. Gay and bisexual men with prostate cancer also have specific psychological and emotional concerns related to the effects of treatment on their sexual health.
Certain medical options may be used to improve these sexual side effects. However, many urologists (doctors who specialize in treating the urinary and reproductive systems, including the prostate) do not routinely talk with their gay and bisexual patients about sexual health. In turn, these patients may not feel comfortable discussing sexual health concerns or seeking care. This can lead to negative health outcomes.
Researchers designed a survey of urologists across the U.S. to understand their knowledge, comfort and practice patterns when treating LGBTQ+ patients, including prostate cancer-specific care.
Study findings
Over 150 urologists were surveyed. Among the surveyed urologists, 86 percent were heterosexual, 12 percent identified as gay and less than 1 percent identified as bisexual.
Most urologists did not routinely collect information on patient sexual orientation.
- Over half (58%) did not ask about sexual orientation on intake forms.
- Over half (60%) did not ask about sexual orientation when taking a personal history.
- Most asked about sexual orientation if it was “immediately relevant to a clinical problem.”
Half of the surveyed urologists believed that knowing their patient’s sexual orientation was not necessary for the best care.
- Older physicians were more likely to believe that knowing their patient’s sexual orientation was necessary, but younger physicians were more likely to have intake forms that included sexual orientation and to directly ask about sexual orientation while taking a history.
LGBTQ health training was limited for most of the urologists surveyed.
- Most urologists had 1-5 hours of training on LGBTQ+ health.
- Nearly 20% of respondents reported having no LGBTQ+ health training.
- Most (74%) believe more educational events on LGBTQ+ health are needed.
Knowledge and recommendations about prostate cancer issues for LGBTQ+ patients varied.
- Over half (53%) did not believe that health concerns related to prostate cancer of gay and bisexual men are different than straight men.
- Most (63.6%) believe anal stimulation of the prostate is a source of sexual pleasure. However, fewer (56%) believed that asking about sexual satisfaction after prostate cancer treatment was important for men who have anal sex.
- Most (~60%) understood that LGBTQ+ patients avoid accessing health care due to difficulty communicating with providers.
- Nearly 65% of respondents knew that gay and bisexual men are at increased risk for anal cancer.
- Only about 20% of respondents knew that the absence of ejaculation was more bothersome for gay and bisexual men than for straight men (60% reported not knowing whether this bothered their gay or bisexual patients).
- Advice about resuming sexual activity varied: one-third of urologists indicated prostate cancer patients could resume anal intercourse 4-6 weeks after treatment, one-third recommended waiting until 6-8 weeks after treatment and one-third recommended waiting 8 weeks or more after treatment.
