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)Printer Friendly Page Read the Original Article
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
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?
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 to kill cancer cells may be harmful to sex partners during anal intercourse. Gay and bisexual men with 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 ) 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 cancer-specific care.
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 cancer issues for LGBTQ+ patients varied.
- Over half (53%) did not believe that health concerns related to cancer of gay and bisexual men are different than straight men.
- Most (63.6%) believe anal stimulation of the is a source of sexual pleasure. However, fewer (56%) believed that asking about sexual satisfaction after 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 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.
What does this mean for me?
This study shows that not all urologists are equally knowledgeable or talk about sexual health concerns with gay or bisexual men who have cancer.
If you are a gay or bisexual man with cancer, ask your doctor about their familiarity with issues around LGBTQ+ sexual health. When discussing cancer treatment, clarify potential side effects and ways to manage those issues with your doctor. If your doctor does not seem comfortable discussing these issues with you, check out our resource tab to find a list of LGBTQ+-friendly doctors and medical centers.
Cavello, J. Providing a Tailored Approach to Cancer Care for Gay and Bisexual Men. The ASCO Post; October 25, 2022.
Xu AJ, Panken EJ, Gonzales-Alabastro CD, et al. Urologists and Lesbian, Gay, Bisexual, Transgender, or Queer Patients: A Survey-based Study of the Practice Patterns, Attitudes, and Knowledge Base of Urologists Toward Their Lesbian, Gay, Bisexual, Transgender, or Queer Patients. Urology. 2023 Jun 5;S0090-4295(23)00458-2. [published online ahead of print, 2023 Jun 5]. doi:10.1016/j.urology.2023.05.019
Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.
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The following resources can help people from the LGBTQ+ community find compassionate care.
Finding LGBTQ+-friendly care
- National LGBTQ Cancer Network Database of LGBTQ+-Welcoming Cancer Screening Providers
- National LGBTQ Cancer Network Database of LGBTQ+-Welcoming Cancer Treatment Providers
Other ways to find experts
- Register for the FORCE Message Boards and post on the Find a Specialist board to connect with other people who share your situation.
- The National Cancer Institute (NCI)-designated comprehensive cancer centers provide cutting-edge cancer care. They receive funding from the National Cancer Institute to provide community outreach and inclusive care.
The following organizations offer peer support services for people from the LGBTQ+ community.
- FORCE holds virtual support meetings organized by and for members of the LGBTQ+ community. Check our National Meetings page for the next scheduled meeting.
- The National LGBT Cancer Network offers cancer support group meetings.