Gay Men with Prostate Cancer

| I would hope that Drs. don't give less than appropriate and meaningful care to someone that is gay over someone that is straight. |

Sadly, outside of large medical centers in big cities, a lot of doctors do. I don't think it's necessarily prejudice against gay men specifically but more of an assumption that everyone has standard vanilla PIV sexual intercourse and that other sexual practices don't exist or aren't discussed.

The reality, at least as I've experienced it, is almost everyone has some kind of kink or sexual interest that isn't quite mainstream and those are never discussed in the context of prostate cancer recovery. For example, even a super common activity like oral sex isn't discussed in the context of climacturia for those who have had surgery and certainly not if or when it's OK to have prostate stimulation after radiation.

I get that some doctors are reluctant to discuss these topics, but at the very least there could be a handout or some type of online information that helps men facing these kinds of situations.

I'm super fortunate in that my cancer center has a sexual rehabilitation program and my doctor is fully open and non-judgmental when it comes to answering ANY questions I might have. A lot of men aren't this lucky and don't feel comfortable talking to their doctors about this stuff.

@scottbeammeup

In the course of my coming to terms with my diagnosis and trying to anticipate what issues I may confront, I’ve learned that Northwestern Medical Center in Chicago has a Gay and Bisexual Men's Urology Program, one of the few on the country.

UCLA, where I am receiving my care has a division within the urology department that focuses on penile rehabilitation and sexual health. But you are right, most centers that offer sexual health services focus on penetrative vaginal intercourse as if that were the primary goal for all men. It is not so much that the health providers are insensitive or biased to gay men (and transgender women) but that their training does not focus on culturally inclusive care or how to talk comfortably to sexual minorities about their practices and needs.

Please know that after a prostatectomy you have over a 50% chance of getting an erection, with the odds being much better if you take Sildenafil or Tadalafil. Trimix also works but you need to inject it into your penis and may have an erection that lasts for hours. If you choose to go with ADT, your testosterone will go down to nothing and you will have erectile disfunction, hot flashes, frequent crying, depression and a lot of other side effects, both physical and psychological. Tough choices, but the good news is that either treatment can keep your cancer from killing you. Also know that you can still have orgasms whether you get an erection or ejactulate or not.

If all else fails, you can get an inflatable penis prostheses, which is saline filled tubes inserted into your penis with a reservoir somewhere in your abdomen and the control mechanism in your scrotem. It is all inside your body and works wonderfully. I had one implanted and I only wish I had gotten it sooner.

Also be aware that whatever treatment you choose, the old adage “use it or lose it” definitely applies. Blood flow to your penis is critical and needs to be maintained to combat atrophy.

Thanks for starting this conversation rbtsch1951. I’m grateful for the responses that follow your initial post.

I'm glad to see there's some discussion of this topic that is specifically aimed at gay men. I think there is a difference between us and our hetero brothers, but it's hard to pinpoint it. I can only speak for myself, but I think that the difference between gay and heterosexual men managing the side effects (especially erectile dysfunction) is that gay men may be in more reflective, perhaps even comparative sexual relationships with their partners. We mirror one another anatomically. Both partners are expected to have an erect penis, and there's something discouraging about the disappearance of that visible, tactile sign of reciprocity, if that makes sense. That's not to say that something rewarding can't happen, but it definitely is taking some getting used to for me. At first my concern was that I wouldn’t be able to fully please someone without an erection. Now I realize that I won’t enjoy it either. I hope to hell I get my mojo back.

I'm 63 and otherwise in very good health—gym, eat. right, healthy ticker, etc. I was diagnosed over a period of several months beginning about 12 months ago (multiple PSA tests, MRI, biopsy and PET/CAT scans to confirm that—yep—I had cancer). My diagnosis was a Gleason score of 3+4=7 and I was identified as having "intermediate favorable risk" with the exception of a cribreform element that can behave a bit more aggressively.

My oncologist scheduled my surgery for October 2025, so it's been four months as of this writing. A month before the big day, my partner of seven years left and never came back. One minute I was asking him to help out a bit more around the house, and the next he was gone. No discussion, just decided he couldn’t stick around. The double whammy was tough but I'm doing fine, perhaps because I was knocked senseless by having both things happen in such close succession (trauma has its benefits, I guess). I'm seeing a tiny (excuse the pun) bit of progress toward regaining erectile function, but it's slow going. I keep reminding myself that it's only been four months. In an effort to allay anxiety after being diagnosed, my doctor said a few things to me:

"You're a robust, young man!"
"We spared both nerves!"
"There was no evidence of cancer outside the prostate capsule!"
"We achieved the best possible outcome!"

All of this sounds really promising. So, why are boners still elusive? Who knows? I can have an orgasm but it’s a silly spectacle with a flaccid penis. It will feel even sillier with someone else in bed with me. It’s also a bit more difficult without being hard.

Here's where I need some help. I'm newly single again, and am having a tough time deciding how to navigate meeting new people and cultivating new relationships. I'm almost exclusively a top, so I've been fixating on the potential change to my self-perceived sexual identity. I've shared the facts with some men who have expressed interest in me and have been on a date or two. Most men are astonishingly understanding and encouraging, but I'm not sure how to build trust in such a vulnerable situation and I don’t really know how to enjoy sex without the great signifier—an erect penis. Therein lies the rub (sorry—had to say it).

Have any of you embarked on new same-sex relationships (I envy those of you who are married to understanding partners!) while managing the side effects of surgery? How did you get things on track? Did you wait until your erections returned, and—if that never happened—what changes did you make to fully enjoy sex again? Also, if you know of any other support groups for gay men, I'd love to hear about them.

Thanks,
Rob

@jimgaudette Not all of us have all of those side effects while on ADT. I think we should be mindful of speaking in the first person sharing our experiences rather than telling others "you will" is a very important concept here. I had soft wood, 2 grade 1 hot flashes, no crying, some dysthymia which I overcame with exercise. Exercise was my secret sauce dealing with ADT. An hour of steady state MTB riding in our state forest helped me feel better for hours. Also allowed me to connect with others so that I didn't feel isolated.

@rob1638 Sorry your partner left you sex seems more important in our world.