Cancer care professionals should pay more attention to the sexual aspects of cancer in men with a non-mainstream sexual orientation

Abstract

Cancer and its treatment are known to be associated with much collateral damage in the areas of sexuality and intimacy. Since nature doesn’t discriminate, cancer happens also to gay and bisexual men. In men who have sex with men (MSM) cancer treatment can cause serious sexual impairments that are unknown to the average heterosexual health care provider (HCP). Because insufficient appropriate knowledge impairs good cancer care, this article will address relevant aspects of sexual lifestyle, relationships and sexual behavior of MSM and the typical areas where cancer treatment tends to damage. After prostate cancer treatment there is no more ejaculate, a very important part in the average MSM sexual play. Radical prostatectomy causes climacturia (urine loss during orgasm) in a substantial amount of men. This is a real killjoy for oral sex, which is in MSM the most common way to have sex. Prostate cancer and anorectal cancer treatment damage the possibilities for prostate orgasm, an intense variety of orgasm, common in many MSM. Anorectal cancer treatment can impair the possibilities for various ways of anal sex, especially in the ‘bottom man’ (the receptive partner). Cancer treatments that impair erection tend to damage more in MSM, not only because erections are in their sexual encounters very relevant for sexual identity, but also because one needs for anal penetration a firmer erection than for vaginal penetration. This review will successively deal with the prevalence of MSM; with relevant aspects of MSM sexuality and MSM lifestyle; with different cancer prevalence in MSM; with consequences of cancer treatment that are typical for the sexuality of MSM; and finally with some aspects of optimal care in MSM with cancer. The aim of the information in this article is both to improve the communication with MSM, and to improve the oncological care for MSM and their partners. *Correspondence to: Woet L Gianotten, MD, Psychotherapist, Emeritus Senior Lecturer in Medical Sexology, Consultant in Oncosexology, University Medical Centre, Utrecht, The Netherlands, E-mail: woetgia@ziggo.nl