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In this analysis, the theme of physical and psychological difficulties focuses on urinary changes and emotional responses to prostate cancer and its treatment. Climacturia was identified as a barrier to having sex Simon Rosser et al. The smell or leakage of urine was described in the study by Simon Rosser et al. One couple struggled with the loss of control that accompanied medication administration and climacturia Hartman et al.

The side effects remained a problem, leaving one participant in one study with a sense of regret concerning the treatment Thomas et al. Three participants in the same study identified an inner strength Thomas et al.

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Alternatively, Hoyt et al. Four participants in the study by Thomas et al. Some men commented that they had not been substantially changed by the experience Hoyt et al. One participant in one study failed to see any positive aspects in the whole experience, while another expressed regret and longed to return to a life before the diagnosis of PC Thomas et al. In another study, one patient questioned whether having a cancer-free status was worth the cost of sexual dysfunction Hartman et al. As a result of prostate cancer treatment, gay and bisexual men faced challenges to their intimate relationships.

The two subthemes are effect on couplings and sexual satisfaction. Couples encountered a reduced capacity for sexual activity Hartman et al. One participant in one study was unable to engage sexually with his partner, resulting in less intimacy in their relationship Thomas et al.

There was reported communication withdrawal between couples in one study Hartman et al. Some men avoided sex while others reported being rejected by partners Simon Rosser et al. The loss of intimacy, fear of rejection and perceived emotional gap made the long term prospects of some relationships in the study by Thomas et al. Hartman et al. One proposition was to move away from the phallic focus of gay sex and explore alternative ways of sexual intimacy Thomas et al.

Nonverbal expressions of affection, such as nonsexual touching, helped ease some of the potential detachment and isolation, while some participants were promulgated by Hartman et al. Focus on health, the normalcy of age-related sexual changes, and partner acknowledgment of a new normal helped couples in one study embrace their new level of functioning Hartman et al. Most of the partnered men who had surgery in this study got instrumental caregiving from their partners Capistrant et al.

The authors of another study reported that there was some value placed in operating outside their primary relationship to engage other sexual partners Lee et al. One man in the study by Hoyt et al. A predominant theme, particularly among single men, was reported by Capistrant et al.

Participants who were single often encountered difficulty pursuing new sexual partners or long-term relationships Lee et al. Another man also referred to himself as damaged goods, and described how overcoming intimacy challenges were different for single gay men than those in relationships Hoyt et al. In a third study, one man experienced depression, lamenting that he would never find another partner again Capistrant et al. In contrast, Lee et al. Men who had undergone radical prostatectomy in one study spoke of there being an overall decrease in sexual interest after treatment, and a reduced libido Hartman et al.

Some men in another study had gone without sexual contact for an extended time, and noted associations with increased sadness and a depressed mood Hoyt et al. All respondents in the study by Simon Rosser et al. Some reported this as a major emotional loss both to them, and for some, to their partners Simon Rosser et al. In terms of sex, Lee et al. Reduction in the ability to ejaculate was reported by Lee et al.

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The participants in the study by Hartman et al. 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.

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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.

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.

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  8. 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.

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    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.

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    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. 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.

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    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. 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.

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    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.

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