Prostate cancer treatments often have a negative impact on a man’s sexual function. However, to date, most of the research on prostate cancer and sexual dysfunction centers on erectile dysfunction, even though this cancer and its treatments may cause other sexual difficulties.

Receptive anal intercourse (RAI) is a common sexual behavior for many gay, bisexual, and other men who have sex with men, and prostate cancer treatments can change RAI function in several ways. First, the removal of the prostate can cause changes in sensation during RAI. Second, radiation therapy can cause chronic inflammation of the rectum, rectal fibrosis (a formation of fibrous tissues in the rectum), and bowel dysfunction. All of these changes can make RAI painful and/or cause anxiety.

To expand on the very limited information about the possible effects of prostate cancer treatments on RAI function, a recent study was designed with the following three aims:

1. To describe the clinical symptoms of painful RAI in men who have sex with men after prostate cancer treatment.
2. To estimate the prevalence of anodyspareunia, which is “recurrent or persistent pain experienced by the receptive partner during anal intercourse.”
3. To identify factors associated with painful RAI.

A total of 195 men who had had or had attempted RAI after prostate cancer treatment participated in this study. Of the 195 men, 82 (42.1%) experienced pain during RAI since completing prostate cancer treatment.

For about one third of the participants (33.4%), painful RAI got worse after their prostate cancer treatment. Furthermore, 15.4% of the 82 men who experienced painful RAI after prostate cancer treatment met the criteria for anodyspareunia.

Factors associated with anodyspareunia were lifelong history of painful RAI and bowel dysfunction following prostate cancer treatment. Those who reported pain with RAI were more likely to avoid it, which often led to lower self-esteem and sexual dissatisfaction.

These findings indicate that prostate cancer treatments may negatively affect RAI function, which can in turn lead to negative outcomes for men who have sex with men. This is important information for patients who include RAI in their frequent sexual activities so that they can prepare for any changes that may occur and take steps to possibly mitigate the side effects.

References:

• Wheldon, C.W., Bates, A.J., Polter, E.J., Rosser, B.S., Kapoor, A., Talley, K.M., Haggart, R., Kohli, N., Konety, B.R., Mitteldorf, D., Ross, M.W., West, W., & Wright, M. (2023). Unrecognized sexual dysfunction in gay and bisexual men after prostate cancer treatment: the antecedents and impact of anodyspareunia. The Journal of Sexual Medicine, 20(4), 515-524. https://doi.org/10.1093/jsxmed/qdad009