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Gay and Bisexual Men & Prostate Cancer

The prostate cancer journey is a personal and unique experience for each man and his circle of care. While many men may be on similar cancer journeys, there are some issues and concerns that affect some men, and some groups of men, more so than others. This section of our website will discuss some of the more common issues that gay men face when diagnosed with prostate cancer.
While there is a large body of research about prostate cancer, there is limited information focused on the experience and needs of gay men. We hope that you find answers to some questions you may have.
For simplicity purposes we use the term “gay” to describe men with sexual experience that includes sex with other men, whether they identify themselves as gay, homosexual, bisexual, two-spirited, transgender or a man who has sex with men.

Why is prostate cancer particularly important when it comes to gay men?

The prostate cancer experience differs in several ways for gay men. Some differences are simply physical while others are psychological and social.

Factors unique to gay men that will be discussed further include:
  •  The physical experience of having sex with other men
  • The social aspect of communicating your diagnosis to other men
  • Getting the support you need from healthcare professionals
  • Body image related to the prostate cancer diagnosis
  • HIV and prostate cancer diagnosis.
Physical relationships with other men
There are many prostate cancer patients that may never have any signs, symptoms or require treatment. This may be due to their particular cancer being very slow growing that it doesn’t cause problems or require treatment. Those individuals can continue to have sexual relationships with other men without having to adjust any of their usual practices.
On the other hand, for those men with more aggressive prostate cancer that require treatment, it’s critical you find out as much as you can about what side effects to expect so you can be better prepared to manage them if they appear. Some common side effects that may impact your sexual experience are:
  • Erectile dysfunction
  • Dry orgasms (no ejaculate)
  • Infertility
  • Decreased sex drive
  • Incontinence
  • Bowel side effects
  • Body image changes
  • Lowered self esteem
Erectile dysfunction
Erectile dysfunction (ED) is perhaps one of the most serious side effects to concern men. However, in gay men it may have a bigger impact on their lives if they are penetrators (“tops”) because it requires a stronger erection to penetrate an anus than a vagina. ED might affect how a man is perceived because he may seem uninterested in his partner or not aroused. It’s important to know that there are several treatments available to help treat ED. Discuss the options with your doctor.
Dry orgasms
Some prostate cancer treatments such as radical prostatectomy (i.e., surgical removal of the prostate) will lead to the inability to produce semen and ejaculate during an orgasm. These orgasms are known as “dry orgasms.” Some men, particularly gay men, find that this diminishes their and their partner’s sexual experience. It’s important to have an honest and open discussion with your partner or men you’re sexually involved with to set realistic expectations and find other ways of having a fulfilling sex life.
Some prostate cancer treatments can affect your ability to produce sperm and therefore your ability to have children. You may consider sperm banking (having some of your sperm stored in a clinic) before you begin any prostate cancer treatment. Your healthcare team can refer you to fertility clinics and talk to you about sperm banking.
Decreased sex drive (libido)
Reduced sex drive is a common physical and psychological side effect of prostate cancer treatment (especially radiation therapy). Men with prostate cancer should not have the usual treatment of testosterone therapy as it encourages cancer growth.

Consider consulting a professional counsellor or sex therapist, on your own or with your partner, especially if anxiety may be contributing to erectile dysfunction or decreased libido. A counsellor or therapist can help men reconnect, communicate and explore different ways to enjoy intimacy.
Removal of the prostate
The prostate tissue is sensitive to touch and pressure, making it an erotic zone for many men. Some men get pleasure from prostate stimulation, either through a vibrator, anal intercourse or peritoneal massage. Unfortunately, many prostate cancer treatments either remove or destroy prostate tissue, altering the sexual experience for some men who enjoy this type of stimulation.  Talk with your partner and explore different ways to feel aroused and enjoy sex.
Incontinence is the involuntary leakage of urine. It occurs when the sphincter, the muscle that controls urine flow from the bladder, weakens and cannot squeeze shut. Treatments for prostate cancer, including radiation therapy, radical prostatectomy and TURP (transurethral resection of the prostate), can cause incontinence.

 The most common types of incontinence in men with prostate cancer are:
  • Stress incontinence: the loss of urine while conducting activities that strain the bladder (for example, laughing, coughing, lifting or exercising)
  • Urge incontinence: strong, sudden urges to urinate
Treating and managing incontinence may involve:
  • Lifestyle changes: Drinking less liquid, avoiding alcohol and caffeine. Not drinking before bed and losing weight can help.
  • Medications: Drugs can help reduce bladder irritability and spasms, which reduces urinary urgency and frequency. Men who have a blockage in the urethra may benefit from medications that improve bladder emptying.
  • Exercises: Kegel exercises can help strengthen the pelvic floor muscles. Ask your doctor for advice.
  • Surgery: If lifestyle changes and medications are not sufficient, surgery may be necessary. Talk to your doctor about your options.
Bowel side effects
Several treatments for prostate cancer affect the wall of the rectum, which can cause bowel inflammation, urgency to eliminate, cramps, diarrhea and fecal incontinence (loss of bowel control). These effects change the man’s sexual experience especially if they are the receptive (“bottom”) partner. After treatment, talk with your doctor prior to resuming/engaging in sexual activities involving the rectum, to determine when it is safe to do so.
Body image
Prostate cancer treatments and side effects can have a major impact on a man’s body image. Some men perceive themselves as unattractive, may be anxious about their sexual performance, or be uncomfortable with the body changes that occur with some treatments. These feelings are valid and you are not along in feeling this way. Consider seeking advice from your healthcare team, joining a support group for men in similar situations and talking with your partner, family and friends about your feelings and what you’re going through.
HIV and prostate cancer
The incidence of HIV (human immunodeficiency virus) is higher among gay men. However, there is little research looking at men’s risk of developing prostate cancer if they are HIV positive. If you are HIV positive and are diagnosed with prostate cancer, talk to your healthcare team. They may adjust your treatment plan and can ensure that disease treatments do not negatively interact.
Communicating with healthcare providers
Some men may feel uncomfortable informing their healthcare provider(s) of their sexual orientation or preferences. Your healthcare team is there to help you along the prostate cancer journey. Informing your healthcare providers if you have sex with men may help you receive the information and advice you need or want, and help your healthcare team offer you the best care possible. If you don’t feel comfortable with your healthcare team don’t be afraid to get a second opinion regarding treatment or managing treatment side effects.
Explore our Expert Angle Webinars including:

Dr. Bernard LeeProstate Cancer Treatment Side Effects for Men-Who-Have-Sex-with-Men (MSM)

January 17, 2019

This webinar describes the side effects of prostate cancer treatment specifically for MSM. Dr. Lee reviews recent research on prostate cancer’s impact on the quality of life and sexuality of men within this community, including testimonials from patients. He also shares helpful information about the emergence of prostate cancer LGBTQ-focused support groups and future directions in healthcare and research to better serve the MSM population.


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