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One patient expressed that his pleasure while climaxing had deteriorated Hartman et al. Participants in another study reported that orgasms were a positive change; experienced as more intense Simon Rosser et al. Sex became less about the experience of pleasure, and more about the technical aspects of anticipating and managing side effects Hartman et al. Additionally, Hoyt et al. The final theme looks at the support mechanisms in place for gay and bisexual men, identifying both professional and personal subthemes.

Authors noted how health systems and service issues left many men without psychosocial support Lee et al. Participants described experiences of stigma, prejudice, and discrimination throughout PC diagnosis and treatment Hoyt et al. Not only were they apprehensive about disclosing their sexual orientation out of fear of the consequences Hoyt et al.

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Three participants in one study felt that a support group for gay and bisexual men might provide a safe haven for expressions Thomas et al. Some men who did not have access to a gay support group locally in the study by Capistrant et al. A majority of the participants in the study by Lee et al.

Some had to rely on self-education, often extrapolating findings based on the sexual obstacles of heterosexual men and applying them to their own sexual practices Lee et al. Men sought out social support groups to find information about possible treatments and side effects because they wanted to hear directly from first hand experiences and thus aid in their own decision-making process regarding treatment Capistrant et al. Thomas et al. In one study, a participant indicated a lack of caring and understanding from providers Hoyt et al.

One couple expressed frustration that they were provided with limited information regarding the course of recovery and the nature of the sexual disturbance Hartman et al. Urologists talking about and measuring erections in heterosexual terms was a problem raised by a participant in the study by Simon Rosser et al. Heteronormativity was felt by patients to be engrained in health care, and led to feelings of being marginalized, with one man noting in the study by Hoyt et al.

All gay and bisexual men in the study by Simon Rosser at al. Another wished that there were more therapists and nurses available to do the counseling and more doctors comfortable enough to talk about sex Simon Rosser et al. The sense of difference and isolation was compounded when it came to discussing sex and partnerships Lee et al. Gay men felt that they were not taken seriously as patients, and some specifically chose gay physicians, whom they felt made them more comfortable Hoyt et al. Authors of one study noted that warmth and sincerity were traits to be sought in choosing an urologist compared with dismissive attitudes which were deemed unhelpful Thomas et al.

The authors of another study cited that participants illustrated empathy, trust, and openness as creating positive experiences, and poor judgment, lack of communication, and a salesperson attitude among doctors as negative Hoyt et al. Some men received emotional succor from a support network, and spoke of having people who came to visit or spend time with them Capistrant et al.

Men who benefited from a support network often identified how individuals provided PC-related support Hoyt et al.

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In one study, one man spoke a lot about PC to his brother, from whom he received a substantial amount of support Hoyt et al. A theme of independence emerged mostly from the men who had undergone radiation therapy and other treatments Capistrant et al. In contrast, men who had radical prostatectomies reported needing and receiving more instrumental support immediately before and especially in the first days to weeks after returning home from surgery, such as cooking, running errands, transportation, and cleaning wounds Capistrant et al.

Most of the men in the study by Hoyt et al. The aim of this meta-synthesis was to elucidate the experiences of gay and bisexual men following prostate cancer treatment, an area that has previously received little attention. Six databases were searched, with the synthesized data aggregated under four themes and eight subthemes.

The review identified that gay and bisexual men have salient needs. There are unique phenomenological issues that gay and bisexual men will experience when in a sexual relationship with another man and although their experiences could differ from that of heterosexual men, the similarities pertaining to masculine and sexual difficulties were mutual. Gay men place a great deal of emphasis on the penis and its ability to function effectively. Although heterosexual men have made strides to recover their lost erections, their focus is on vaginal penetration Blank, , whereas anal penetration requires a greater degree of penile rigidity Cornell, ; Goldstone, , which Simon Rosser et al.

Equally, it has also been reported, according to Blank , that the importance of erectile function, and the way in which sexually related dysfunction may inhibit or disrupt intimate relationships, could be understood as being very different for gay and bisexual men. Some men believed that their inability to sustain an erection meant that they would become undesirable and that they would not be able to keep a partner.

Men who were the penetrators during sexual intercourse were psychologically affected more profusely by ED. At times, this could lead to depression and feelings of suicide Capistrant et al. Men who identified as the dominant partner were forced to try sexual aids, or reverse their roles from top to bottom. However, reversing their sexual role was not always an acceptable solution, with some men stating that they could only be top.

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Thus they turned to Viagra or other erectile stimulants to return to their preferred sexual role Lee et al. Again, the quantitative findings by Hart et al. There was more surmountable pressure for them to regain their erections, out of fear that they would eventually be rejected by their sexual partners or become undesirable by other men. For men who were receptive, the cost of PC treatment could lead to increased pain in the rectum and a loss of pleasure brought about by the erect penis rubbing against the prostate Simon Rosser et al. The inability to orgasm or ejaculate was greeted with grief and loss Simon Rosser et al.

Equally, the impact on sexual practices is thus twofold, and special consideration needs to be given to gay and bisexual men.

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Gay men are seen to break away from traditional masculine ideology mainly because of their affectional and sexual orientation Sanchez et al. The data indicate that the alterations to sexual function adversely impacted on their sense of masculine identity. Treatment resulted in one participant questioning his own self-worth as a man Thomas et al. This echoes the understandings of Sanchez et al. It can be argued that dominant masculine ideology has had an effect on the way gay and bisexual men view themselves. Masculine norms pressure some gay and bisexual men to have an ideal body Sanchez et al.

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As the collated data identify, there was concern about physical appearance following treatment Hoyt et al. In addition, ED and climacturia caused some to regret having treatment Hartman et al. Unlike heterosexual couplings, gay men in relationships were susceptible to opening their relationship, and allowing partners to seek sexual intimacy elsewhere. Gay men in some communities may have relationships that are dynamic, open, and not bound to one partner Kahn, This was a novel way of alleviating the stress of needing to perform sexually, especially due to an overall decrease in sexual interest and the loss of the ability to ejaculate Hartman et al.

Since sexual assertiveness and aggressiveness tend to be associated with masculinity, some men in the study by Sanchez et al. Generally, Lee et al. Men expressed frustration and difficulty when it came to seeking psychosocial support from health-care services Capistrant et al. Thus, clinical environments might be unaccustomed to supporting the sexual well-being of gay and bisexual men Rose et al. Blank , however, argues that gay and bisexual men are likely to be affected differently in all the major areas of impact that are recognized.

Some urologists appeared to cater to heterosexual men and their sexual and psychosocial issues, displaying a hetero-centric attitude to support Rose et al. As a consequence, gay and bisexual men were dissuaded from disclosing their sexual orientation, or discussing any sexual obstacles they may endure.

There was associated worry of experiencing subtle or overt homophobia Kelly et al.

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Quantitative research also reported lower satisfaction among gay and bisexual men with prostate cancer health-care treatment compared to other survivor groups Hart et al. Inequalities in service have led to mistrust towards the health-care system from other marginalized groups.

Black men in the UK have reported low levels of trust in the health-care system Keating, In the United States, institutionalized racism has led some Black men to feel like the system is set up against them, meaning they do not seek help for prostate cancer symptoms Forrester-Anderson, According to Kelly et al.

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Some gay men reported that their urologists did not want to discuss the sexual effects on their sex lives, even when brought up by the patient Lee et al. Urologists should be prepared to discuss the sexual practices of gay and bisexual men in terms of prostate cancer treatment. The detrimental psychological effects of failing to do this cannot be understated.

Gay men are made to feel invisible Rose et al. Experiences of heteronormative discourse and practices can be particularly harmful to the psychological well-being of gay and bisexual men, especially when cancer has affected their sexual function Kelly et al. In terms of sexual intercourse, erectile function suitable for oral and anal penetration is different from that of vaginal intercourse Blank, Yet erections were discussed in terms of vaginal penetration Simon Rosser et al.

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Mainstream support groups were often off-putting due to their hetero-centeredness. The atmosphere may not be conducive, or safe, for gay and bisexual men wanting to discuss their sex lives. It should also be noted that older gay men may have grown up at a time when homosexuality was illegal, and may have experienced discrimination, and so may be less forthcoming around heterosexual men. Social support aspects must be different for gay or bisexual men who are not fully open about their sexuality Blank, Additionally, the overwhelming emphasis on wives will be problematic for men who are partnered with other men Blank, The data establish that men who were dissatisfied with the lack of support, often turned to a personal support network of friends and family, but greatly desired to converse with other gay or bisexual men who had undergone similar treatment.

However, there was concern that care for gay and bisexual men with HIV has overshadowed care towards gay and bisexual men with prostate cancer Hoyt et al. Steps are being taken to address the gap in care. Blank emphasizes that it is essential that the clinical oncology community is sensitive to the particular needs of gay and bisexual men because of their sexual orientation, while Kelly et al. Evidence from this meta-synthesis postulates the importance of focusing on the salient needs of gay and bisexual men with prostate cancer.

Far too often this group has gone unnoticed, and gay and bisexual men are left to feel disenfranchised by the health-care system. In the current climate, there is a need for gay and bisexual men to be supported by health-care professionals. Moreover, urologists must avoid approaching the needs of gay and bisexual men in a hetero-centric way. Allowing gay and bisexual men to express their needs and concerns in an open and engaging manner may improve the experience for them. The results in this meta-synthesis demonstrated that some men had not been fully informed about the side effects of prostate cancer treatment.

Gay and bisexual men should be educated and given information at the initial meeting of the consequences of prostate cancer treatment, such as penile shrinkage. This would allow them to be fully prepared for the posttreatment side effects of prostate cancer. The results of prostate cancer treatment affect gay and bisexual men differently than heterosexual men, and the evidence confirms this.

However, it was discovered that gay and bisexual men can be influenced by the same hegemonic masculine ideology that heterosexual men can be subjected to. Subsequently, there is a need for more gay and bisexual support groups that would allow them to talk freely and to gain support from other men who are experiencing similar challenges to their lives.

If a safe environment is provided for gay and bisexual men, they are more likely to feel that their needs are considered and are being addressed. By understanding the issues, health-care professionals could improve the outcomes for gay and bisexual men with prostate cancer.