Patients’ sexual orientation and communication with healthcare providers


The ability and willingness of physicians to discuss issues related to sex, sexual function, and specific sexual activities with their patients (and their partners) before or after prostate cancer treatment is notoriously not seen to be high by most prostate cancer patients (although there are exceptions to that general rule).

However, the situation is almost certainly even worse for members of the gay and bisexual (G/B) communities because of an inherent assumption on the part of many urologists that their patients are all heterosexual — unless someone is willing to make it very clear, early on, that that is not the case.

We are therefore pleased to see recent publication of what are two new papers on the topic of sex and prostate cancer in the “mainstream” scientific press that deal very specifically with clinical support for sexual well-being among members of the G/B communities. (A quick PubMed search using the term “gay bisexual prostate cancer” found a total of just seven published papers on this topic dating back to 2008 and none earlier than that.)

Ussher et al. (a team of predominantly Australian researchers), writing in the Journal of Sexual Medicine, compared the experiences of a group of 124 G/B men to the experiences of an otherwise similar group of 225 heterosexual men with respect to things like their health-related quality of life (HRQoL) and sexual issues after diagnosis and treatment for prostate cancer.

Ussher et al. report the following:

  • The G/B patients were significantly younger, on average, at 64.25 years, than the heterosexual men (at 71.54 years).
  • The G/B men were less likely to be in an ongoing relationship, and more likely to have casual sexual partners.
  • When compared with age-matched population norms, participants in both groups reported
    • Significantly lower sexual functioning and HRQoL
    • Increased psychological distress
    • Disruptions to sexual communication between partners
    • Lower masculine self-esteem, sexual confidence, and sexual intimacy.
  • By comparison with the heterosexual men, the G/B men also reported
    • Significantly lower HRQoL (P = 0.046), masculine self-esteem (P < 0.001), and satisfaction with treatment (P = 0.013)
    • Higher psychological distress (P = 0.005), cancer-related distress (P < 0.001), and ejaculatory concerns (P < 0.001)
    • Higher sexual functioning (P < 0.001) and sexual confidence (P = 0.001).
  • Predictors of low HRQoL among G/B men were psychological distress, cancer-related distress, masculine self-esteem, and satisfaction with treatment.
  • Predictors of low HRQoL among the heterosexual men were psychological distress and sexual confidence.

Rose et al. (from the same Australian research group), writing in the European Journal of Cancer Care, report data from a survey among 125 G/B prostate cancer patients and 21 of their male partners and direct interviews with a sub-sample of the men surveyed (46 G/B men and seven male partners).

Perhaps unsurprisingly, the authors found the following:

  • G/B men identified multiple deficits in their communications with their health care professionals.
  • Information about medical support dominated sexual and psychological support.
  • The heterosexuality of G/B patients was often assumed by clinicians (as suggested above).
  • Disclosure of sexual orientation was commonly a problem for the patient.
  • G/B men perceived rejection or lack of interest and knowledge from a majority of clinicians about gay sexuality and the impact of prostate cancer on G/B men.

On the other hand, they also found that acknowledgement of sexual orientation and exploration of the impact of prostate cancer on G/B men could facilitate communication.

Rose et al. concluded that clinicians need to be able to (and probably helped to):

  • Address issues of hetero-centricism within prostate cancer care by addressing issues of sexual orientation with their patients and thereby facilitating disclosure of relevant information
  • Recognize and acknowledge that G/B patients with prostate cancer are likely to have specific sexual and relational needs
  • Increase their knowledge about and comfort with discussing gay sexuality and gay sexual practices

These conclusions are closely correlated with the conclusions drawn by Ussher et al.

 

2 Responses

  1. What about the urologists who want their patients circumcised before they treat them? I have been fighting for nearly 80 years to keep my foreskin. I have to assume the doctor’s religion is a factor.

  2. Huh? Go to a different urologist. I have never heard of such an idea before.

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