Deprsn and Suicidaly Gay Men: Implitns for Health Care Provirs - PMC

Contents:

• SEXUAL PROBLEMS AFFECTG GAY MEN
• THREAT OF SEXUAL DISQUALIFITN: THE CONSEQUENC OF ERECTILE DYSFUNCTN AND OTHER SEXUAL CHANG FOR GAY AND BISEXUAL MEN WH PROSTATE CANCER
• DEPRSN IS KILLG GAY MEN
• DEPRSN AND SUICIDALY GAY MEN: IMPLITNS FOR HEALTH CARE PROVIRS

SEXUAL PROBLEMS AFFECTG GAY MEN

However, until recently, most rearch examg the impact of PCa on men’s sexualy has foced on the abily to achieve and mata an erectn for penile-vagal peratn (Wtman et al., 2009), assumg that men are long-term, monogamo, heterosexual relatnships, and implicly excludg the experienc of sgle and gay men (Asenc, Blank, Drt, & Crawford, 2009) the 19, 993 new s of PCa reported Atralia 2011 (Atralian Instute of Health and Welfare, 2015), nservative timat based on the rerd percentage of gay men the populatn, suggt that three to five percent are gay men (Sman, 2011).

However, recent reviews of PCa tnal rourc and lbian, gay, bisexual, and transgenr (LGBT) primary re guil report a arth of such rmatn (Dunn, Watson, Wtle, Mchell, & Dowsett, 2011; McNair & Hegarty, 2010), wh a few notable exceptns (Buchtg et al., 2015; Wong et al., 2013), and there is an absence of empiril rearch to rm s future velopment. This has led to GB men wh PCa beg scribed as an “visible diversy” (Blank, 2005), or a “hidn populatn” (Fililt et al., 2008) is some evince om recent survey-based rearch that gay men wh PCa report signifintly greater difficulti relatn to sexual functng (Motofei, Rowland, Popa, Kreienkamp, & Pni, 2011), urary, bowel and mental functng (Hart et al., 2014; Ussher et al., 2016), and ejaculatory bother (Wassersug, Lyons, Dunn, Dowsett, & Pts, 2013) parison wh heterosexual men. It has also been posed that gay men may ascribe different prri and meangs to sexual chang after PCa (Thomas, 2012), cludg the importance of the prostate as a se of pleasure durg anal sex; the signifince of visible ejaculate for “semen exchange” durg sex; the need for a firmer erectn for anal sex parison wh vagal sex; and the nsequenc of anal disfort and ntence for receptive partners (Fililt et al., 2008).

Ethil approval was granted by Wtern Sydney Universy Human Rearch Ethics Commtee and the ethics mte of participatg muny anizatns, and all participants gave specific 1 Socmographic characteristics of gay/bisexual men wh PCa and male partners of men wh PCaFull size table. ” Many olr participants said that as gay or bisexual men they expected to ntue to have an active sexual life well to later life, wh Sam (74, gay) mentg that “gay men tend to engage sex for a longer perd, ” differentiatg himself om heterosexual men his age group, of whom he said “none of the men would be sexually active. ” This expectatn of ntued sexual activy provis some explanatn for the near uniformy acunts of distrs followg erectile difficulti olr participants, for example: “’s probably the most horrific thg that I’ve ever been through psychologilly” (Fn, 69, gay); “’s prsg.

THREAT OF SEXUAL DISQUALIFITN: THE CONSEQUENC OF ERECTILE DYSFUNCTN AND OTHER SEXUAL CHANG FOR GAY AND BISEXUAL MEN WH PROSTATE CANCER

” The magnu of this sense of loss is illtrated by Stt (59, gay), who said that “if I had the choice aga, I would take my risks wh the ncer, and not have the operatn, ” scribg the loss of erectns after robotic prostatectomy as “a fg moment my life…the impact on my life as a gay male has been really profound, and a negative sense.

A number of men gave acunts of rencilg themselv to chang sexual functng, and velopg fulfillment through other activi: “ life if my sexual functn dimish further, there are other aspects of life that will take over om that which will ntue to make life satisfyg and rewardg” (Alex, 69, gay); “I have veloped more close and timate relatnships wh men that don’t clu sex” (Damon, 52, gay). The acunts monstrate that for some men ial negative rpons to ED n be replaced by acceptance and absorptn other on Gay Inti: “Retired From the Gay Human Race” or Inty Re-evaluatnWhile erectile dysfunctn (ED) is wily regnized to have a potential impact on mascule inti, is the impact on gay inti that is intified Stt’s acunt of chang to his life as a “gay male, ” above.

For example, Alex (69, gay) said: “my worth of self, my functng as a gay man, no, I don’t thk ’s particularly impacted” and Euan said there was “no real change, ” other than givg up his sexual posn as a “top” or sertive partner anal terurse, which he felt he “had to make the bt of. Fally, a number of men talked about their inty gog through a transn followg PCa, rultg chang how they operatnalized their liv as gay men:I had gone through my journey as a gay man of beg sexual and beg attractive and jt havg physil fun wh other men, and was like I’d e out the other si of that and that was gone, and felt like, “well, you know, I’m still a gay man” but what that meant was, was sudnly que different (Mark, 45, gay).

DEPRSN IS KILLG GAY MEN

For example, Stt (59, gay) scribed himself as havg been “fortunate to have a b of a followg” where regular partners knew what they uld expect “ terms of satisfactn”:When I had the prostatectomy, five years ago now that’s pletely changed and sce then I’ve bee a basilly active gay male whout the sex part unls ’s assisted through jectns, which I really dislike bee I don’t thk any guy lik stickg needl to their dick. However, this was scribed as more difficult the ntext of sual sex, where “if you’re not puttg out all signs that you might be terted then people get the wrong msage” (Euan, 67, gay), and “if you n’t get an erectn at the sna guys tend to turn away” (Cameron, 65, bisexual) nsequence of ED for many participants was a sense of sexual petence parison wh other gay men, particularly the ntext of sual relatnships. Many men scribed greater “tensy” sexual nnectn wh their partner as a rult, as Terry (53, gay, partner) scrib:If you’d said to me prr to the operatn that you would have felt the tensy of love and lovemakg that you felt the first year, you know, new love and all that sort of stuff, I would have said you are bonkers, but that’s exactly what’s happened to .

DEPRSN AND SUICIDALY GAY MEN: IMPLITNS FOR HEALTH CARE PROVIRS

However, transng om beg a top or versatile to a bottom was not an evable solutn to erectile difficulty, as disfort or pa durg anal sex was reported by many men, as Sam (74, gay) scribed, rponse to the suggtn om his psychologist that he uld “change rol”: “No, I uldn’t. This is evint the followg acunts: “’s a very sensive part of a man’s body, and is a great part of the enjoyment of anal sex…and so whout them [prostate] a great al of the enjoyment disappears” (Jack, 59, gay); “ terms of perative sex, when I’m the receiver, the pleasure that I had for that has basilly gone” (Rick, 59).

Conversely, for a mory of men, anal sensivy was scribed as havg creased followg PCa treatment, wh Bce (61, gay) suggtg that the “tense sexual gratifitn” provid by the prostate had masked other areas of sensivy that he had “not necsarily realized or engaged” meang “the simple act of beg on the receptive end of sex is somehow more satisfyg than ed to be.

”A number of men were reluctant to bee the receptive partner bee of what meant to them terms of sexual role, not wantg to take up what n be regard by some men as a submissive posn, or not fdg a pleasurable experience: “ don’t appeal to me at all” (Damon, 52, gay); “ was like an unevenns the sexual relatnship. Havg a regular partner who was normally a bottom, and difficulty fdg the right top, was also reported: “I’ll have to be the bottom but if your partner is a bottom as well, ’s not necsarily gog to work” (Andy, 61, gay) of Sexual Pleasure and Libido: “It’s a Profound Change Inty”When asked to rate their sexual sire the last 4 weeks, 58% of survey rponnts rated as absent, very poor, or fair, wh level of sexual sire scribed as a problem by 65% (EPIC).