There is a fallacy among certain gay man that if you are on the receiving end of anal sex, your chances of getting prostate cancer is lesser as some claim that you are getting your prostate massaged indirectly and that helps prevent getting prostate cancer. This is completely not true and has no scientific merit.
Prostate cancer isn’t more or less common in gay or bisexual men, or in men who have anal sex, and it’s treated in the same way as for all males. But if you’re gay, bisexual or a man who has sex with men, you might have some specific questions or concerns. We have included such information that may be relevant to you, and about the support available.
Symptoms of Prostate Cancer
Most men with early prostate cancer don’t have any signs or symptoms.
One reason for this is the way the cancer grows. You’ll usually only get early symptoms if the cancer grows near the tube you urinate through (the urethra) and presses against it, changing the way you urinate (wee). But because prostate cancer usually starts to grow in a different part (usually the outer part) of the prostate, early prostate cancer doesn’t often press on the urethra and cause symptoms.
If you do notice changes in the way you urinate, this is more likely to be a sign of a very common non-cancerous problem called an enlarged prostate, or another health problem. But it’s still a good idea to get it checked out. Possible changes include:
- difficulty starting to urinate or emptying your bladder
- a weak flow when you urinate
- a feeling that your bladder hasn’t emptied properly
- dribbling urine after you finish urinating
- needing to urinate more often than usual, especially at night
- a sudden need to urinate – you may sometimes leak urine before you get to the toilet.
If prostate cancer breaks out of the prostate (locally advanced prostate cancer) or spreads to other parts of the body (advanced prostate cancer), it can cause other symptoms, including:
- back pain, hip pain or pelvis pain
- problems getting or keeping an erection
- blood in the urine or semen
- unexplained weight loss.
These symptoms can all be caused by other health problems. But it’s still a good idea to tell your GP about any symptoms so they can find out what’s causing them and make sure you get the right treatment, if you need it.
Testing for prostate cancer
Tests for diagnosing prostate cancer are the same for everyone. But this page has information on things to be aware of if you have anal sex or have your prostate stimulated.
The PSA test
This is a blood test that measures the amount of a protein called prostate specific antigen (PSA) in your blood. A raised PSA level may suggest you have a problem with your prostate, but not necessarily cancer.
Lots of things can affect your PSA level, including being the receptive partner in anal sex (bottom) or having your prostate stimulated. Try to avoid this for a week before having a PSA test.
Digital rectal examination (DRE)
This is where your GP feels your prostate through the wall of your back passage (rectum). If your prostate is hard or lumpy, this could be a sign of prostate cancer.
If your GP thinks you may have a problem with your prostate, they will refer you to a hospital specialist for more tests, such as a magnetic resonance imaging (MRI) scan. This can show whether there is anything unusual in the prostate, or the area around it, that might be cancer.
This involves using thin needles to take small pieces of tissue from the prostate. Depending on the type of biopsy you have, the needle will either go through the wall of the back passage, or through the skin between your testicles and back passage (perineum). The tissue is then looked at under a microscope to check for cancer.
It’s normal to see some blood in your urine or bowel movements for about two weeks after having a biopsy. This will be different for everyone and may vary from a small amount to a much larger amount. You may also notice blood in your semen for a couple of months it might look red or dark brown. This can be a shock and some men find it distressing, but it’s normal and should get better by itself.
You can still masturbate and have sex if you’re the penetrative partner in anal sex (top), but you might prefer to use a condom until the bleeding stops. If it takes longer than a couple of months to clear up, or gets worse, you should see your doctor.
If you’re the receptive partner in anal sex (bottom), wait about two weeks until any side effects from your biopsy have settled before having anal sex. Talk to your doctor or nurse if you need any further advice.
Treatments for prostate cancer
There are several ways to treat or monitor prostate cancer. Some treatments aim to get rid of the cancer completely and others aim to control it.
Active surveillance is a way of monitoring slow-growing localised prostate cancer, rather than treating it straight away. The aim is to avoid or delay unnecessary treatment and its side effects.
Watchful waiting is a way of monitoring prostate cancer that isn't causing any symptoms or problems. The aim is to keep an eye on the cancer over the long term, and avoid treatment unless you get symptoms.
-Surgery: radical prostatectomy
-External beam radiotherapy
External beam radiotherapy uses high energy X-ray beams to treat prostate cancer. This page is for men who are thinking of having this treatment to treat their prostate cancer.
-Permanent seed brachytherapy
Permanent seed brachytherapy involves implanting tiny radioactive seeds into your prostate gland. This is also called low dose rate brachytherapy. Radiation from the seeds destroys cancer cells in the prostate. You may have this treatment on its own or together with external beam radiotherapy or hormone therapy.
-High dose-rate (HDR) brachytherapy
High dose-rate brachytherapy is also known as HDR brachytherapy, or temporary brachytherapy. It is a type of internal radiotherapy used to treat prostate cancer.
-High-intensity focused ultrasound (HIFU)
Cryotherapy is a treatment that uses extreme cold to freeze and destroy cancer cells. You might also hear it called cryosurgery or cryoablation.
If you have advanced prostate cancer, you may be interested in our information on abiraterone (Zytiga®), a new type of hormone therapy.
Enzalutamide, a new type of hormone therapy for men with advanced prostate cancer.
Clinical trials are types of medical research that test medicines, medical procedures or medical equipment. If you have prostate cancer, you might have the chance to take part in a clinical trial.
-Radiotherapy for advanced prostate cancer
-Bisphosphonates for advanced prostate cancer
Bisphosphonates are drugs that can be used to treat bone problems or prevent further bone damage in men with advanced prostate cancer. They do not treat the cancer itself, but can help to slow the breakdown of bone and may help to relieve bone pain.
-If your prostate cancer comes back
Recurrent prostate cancer is cancer that has come back after having treatments such as surgery (radical prostatectomy), external beam radiotherapy, permanent seed brachytherapy or temporary brachytherapy.
Side effects of prostate cancer treatment
All treatments have side effects, and some of these may be particularly relevant to you as a gay or bisexual man. Depending on the treatment you have, side effects can include:
- sexual side effects
- urinary problems
- bowel problems
You’ll have your own reasons for choosing one treatment over another, including how the possible side effects could affect your lifestyle. For example, if you’re usually the receptive partner in anal sex (bottom) and you’re thinking about having radiotherapy
, you might want to find out about how radiotherapy can affect the bowel and the back passage.
Speak to your doctor or nurse about your treatment options and the possible side effects. Consider telling them about your sexuality and lifestyle so they know how treatment and side effects could affect you. This might also help them to support you better.
Sexual side effects
Treatments for prostate cancer can cause sexual side effects. These include:
- how you feel about yourself sexually
- your desire to have sex (libido)
- your ability to get an erection (erectile function)
- not being able to ejaculate and having a dry orgasm
- not being able to orgasm
- urinating or leaking urine when you orgasm (climacturia)
- reduction in penis size
- your sexual satisfaction
- your ability to have children (fertility).
Not all gay and bisexual men have anal sex – but if you do, then the impact of side effects will depend on whether you’re being the ‘top’ or ‘bottom’ partner.
Your experience of sex
Dealing with cancer and side effects of treatment may change the way you have or think about sex. It may also affect how you feel about yourself. Many men find changes to their sex life difficult to deal with. We know from research that gay and bisexual men can find these changes particularly difficult to come to terms with.
When you're being the receptive partner in anal sex (bottom), a lot of the pleasure comes from the penis rubbing against the prostate. This is why the prostate is often referred to as the male g-spot. If you prefer to be the receptive partner during anal sex (bottom), your experience of sex will probably change after you’ve had treatment.
If you have radiotherapy
, your prostate may feel less sensitive afterwards. Or if you have surgery to remove your prostate (radical prostatectomy)
, the prostate will no longer be there to stimulate. You should think about these possible changes when deciding which treatment is best for you.
If you're the receptive partner in anal sex (bottom) and you’ve had permanent seed brachytherapy
to treat your prostate cancer, there is a risk that your partner might be exposed to some radiation during sex. Your doctor may suggest you avoid having anal sex in the first six months after having permanent seed brachytherapy. Ask your doctor or radiographer for more information about having anal sex after permanent seed brachytherapy. They might be able to give you specific advice about how long to wait before having sex, which is tailored to you and your treatment.
Even though your sex life may not be the same as it was before cancer, you don't have to give up on having pleasure, closeness or fun. It can help to be realistic but flexible in your approach to sex. It may not be possible to find a quick fix, but you may be able to explore new ways of giving and receiving pleasure.
It’s also important to look after yourself and your body. Try to focus on the things you like about yourself. Do activities or hobbies you are good at or try something new. Being physically active can lift your mood, keep your body in shape and may help your sex life.
If you have a new sexual partner or you’re starting to think about dating, you may worry about explaining sexual problems, such as difficulty getting erections, not being able to ejaculate semen or less desire for sex. Fear of rejection or being worried about what other people think about you is normal and everyone has their own worries, whether or not they’ve had cancer.
Talk about your worries with someone you feel comfortable with and ask for support if you need it. Some men find it helpful to attend a support group, where you can share your experiences and get support from others.
If you prefer being the penetrative partner during anal sex (top) you normally need a strong erection. You could try using a constriction ring around the base of your penis. Or some men use a vacuum pump to help with their erection problems. If you decide to try a vacuum pump, a health professional will usually show you how to use it properly. They will fit a constriction ring at the same time, to make sure the ring is the right size for you.
A vacuum pump and constriction ring can be used together with another treatment like tablets, to help keep your erection hard enough for anal sex. There are also other t
reatments for erection problems, such as injections, pellets and cream. There’s not always a quick fix. You often have to stick with them for a while or try different treatments to see what works best for you.
You could also think about other ways to pleasure yourself and your partner, such as oral sex and masturbation by using your mouth and hands. You don’t always need a strong erection for oral sex. Some men may also decide to change their roles during sex if they have erection problems. Talking to a sex therapist or registered counsellor may help you come to terms with these changes and think of ways you can have a fulfilling sex life.
Changes to ejaculation and orgasm
If you have surgery for prostate cancer (radical prostatectomy), you won’t be able to ejaculate semen, but you may still be able to have a dry orgasm. Some men also ejaculate less semen or stop ejaculating completely after radiotherapy. This can be difficult to come to terms with if you feel you need to ejaculate to enjoy sex, or for your partner to think that you’re enjoying sex. It can take some time to adjust to these changes.
Treatments for prostate cancer can cause urinary problems such as leaking urine. For many men this improves over time, but it can be a long-term problem. Urinary problems may affect how you feel about your body and about sex, and can make you worry about having oral sex and masturbating.
If you get any urinary problems, tell your doctor, nurse or radiographer. There are treatments to manage them, as well as things you can do to help yourself.
Bowel problems and anal sensitivity
If you prefer to be the receptive partner during anal sex (bottom), then bowel problems or sensitivity in the anus after radiotherapy may be an issue.
Your doctor, nurse or radiographer may suggest you avoid having anal sex while you are having radiotherapy
. If you have bowel problems or a sensitive anus after radiotherapy, you may want to wait until these have settled before trying anal sex again. Although problems in the back passage may settle down after a few months, there can be some permanent changes.
Here are a few ideas for when you feel ready to try anal sex again. You could try sitting on your partner and moving up and down on his penis so that you have more control of the penetration, and then moving positions if you want to. Try using a condom and extra lubrication. Or ask your partner to gently insert a small, well-lubricated dildo until anal sex becomes more comfortable.
Cleaning yourself before sex can also make you feel more comfortable. Some men prefer to just clean the outside area, rather than cleaning inside.
Remember that douching before or after sex doesn’t protect you from infections.
HIV and prostate cancer
HIV (human immunodeficiency virus) doesn’t only affect gay and bisexual men, but gay and bisexual men are more likely to be affected by HIV than heterosexual men. Current guidelines say that prostate cancer is not more common in men who have HIV.
Studies suggest that treatments for prostate cancer, such as surgery and radiotherapy, do work for men who have HIV. But if you have HIV and are diagnosed with prostate cancer, it’s important to discuss your treatment options with a health professional who specialises in HIV and cancer. It’s important to tell your doctor about all the medicines you take, including over-the-counter and herbal remedies.
If you need tablets to help with erection problems, you may be offered a smaller dose if you’re already taking medication for HIV (antiretroviral drugs). This is because HIV drugs can react with some other medicines, which can cause side effects that may be serious.
If you’ve had a biopsy or surgery for your prostate cancer, you may experience some bleeding afterwards. If you choose to have sex while you are bleeding, it’s important to use a condom. Some bleeding after treatment is normal and should get better by itself. But if it doesn’t get better, or it gets worse, you should talk to your doctor straight away.
Talking about your sexuality
Some men find that their doctor, nurse or radiographer assumes they are heterosexual. All hospitals should ask patients about their sexuality. This helps health professionals to give care and support that is right for each person. Information you give will be recorded confidentially and will stay private. But it’s your choice whether or not you decide to tell them.
You may feel anxious about how to raise the subject or how your doctor or nurse will react if you tell them you’re gay
or bisexual. Some men might worry that they will be judged or treated differently because of their sexuality, and we know that some men have had bad experiences in the past. If this has happened to you, you may find it more difficult to be open about your sexuality with your doctor or nurse.
But remember that as a gay or bisexual man you’re entitled to exactly the same standard of care and treatment as a heterosexual man. This means it’s illegal to discriminate against you because of your sexuality. Most health professionals will have had equality and diversity training, and they have a legal duty to provide fair and equal services to all people.
If you’re worried about telling your doctor or nurse about your sexuality, try planning exactly what you’ll say and when you’ll say it. You might find it helpful to take your partner or a friend with you for support. It might be easier to talk about it at the start of your appointment, so that you aren’t worrying about it during the appointment. You might also find it helpful to take this booklet with you to your appointments.
Many men find it helpful to bring a partner or friend with them to appointments for extra support. If you’re married to, or in a civil partnership with, someone of the same gender you have the same rights as a person who is married to someone of a different gender – including in healthcare. Your husband or civil partner has an equal right to be your nearest relative. This means they can be involved in decisions about your healthcare.
If you're not married or in a civil partnership, then you can nominate a partner or friend as your ‘next of kin’. Next of kin can be anybody in your social or family group. Some men choose a close friend who they trust. Health professionals must respect your wishes about who this is. If you give permission, your partner or friend can:
Getting more support
Look Into Gay Health News Support Section about getting access To various Support Groups and Resources
- go to your medical appointments
- be included in discussions about your diagnosis, treatment and care
- make sure your wishes are heard.