Prostate cancer treatments uniquely affect sexual health in sexual minority men, particularly those engaging in receptive anal intercourse, and clinicians should inquire about sexual orientation, gender identity, and sexual behaviors when discussing treatments to align care with individual preferences.
Key Findings
Results
Sexual minority men (SMM) were significantly more likely to be sexually active with a partner in the prior 30 days compared to heterosexual men (HET) after prostate radiation therapy.
68% of SMM (n=21/31) were sexually active with a partner in the last 30 days compared to 39% of HET (n=57/145)
Difference was statistically significant (P=.005)
Of the sexually active SMM, 15 (71%) engaged in receptive anal intercourse (RAI)
This was a retrospective cohort study of patients seen between June 2022 and August 2023 who were at least 6 months post-radiation therapy
Results
The overall cohort reported worse orgasm ability, orgasm pleasure, and sexual satisfaction compared to US general population normative scores for sexually active adult men.
Worse orgasm ability with mean difference (MD) of 3.3 (P<.01)
Worse orgasm pleasure with MD of 7.2 (P<.001)
Worse sexual satisfaction with MD of 3.4 (P<.001)
Outcomes were measured using Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction, Sexual Health Inventory for Men, and American Urological Association questionnaires
Mean differences ≥3 were considered clinically meaningful
Results
SMM engaging in receptive anal intercourse reported worse orgasm ability, orgasm pleasure, and anal discomfort compared to normative scores.
Worse orgasm ability with MD of 3.5 compared to norms
Worse orgasm pleasure with MD of 6.3 (P<.05) compared to norms
Worse anal discomfort with MD of 9.0 compared to norms
15 SMM (71% of sexually active SMM) reported engaging in RAI
Results
Among SMM engaging in RAI, brachytherapy with or without external beam radiation therapy (EBRT) was associated with worse orgasm pleasure but less anal pain compared to EBRT alone.
Brachytherapy with/without EBRT was associated with worse orgasm pleasure (MD: 3.1) compared to EBRT alone
Brachytherapy with/without EBRT was associated with less anal pain (MD: 5.2) compared to EBRT alone
Overall, 9% of the cohort received brachytherapy, 46% received EBRT, and 45% received both modalities
Results
Among SMM engaging in RAI, the addition of androgen deprivation therapy (ADT) was associated with substantially worse orgasm ability, orgasm pleasure, anal pain, and sexual satisfaction.
Addition of ADT was associated with worse orgasm ability (MD: 14.1, P<.05)
Addition of ADT was associated with worse orgasm pleasure (MD: 10.7, P<.05)
Addition of ADT was associated with worse anal pain (MD: 6.8)
Addition of ADT was associated with worse sexual satisfaction (MD: 6.1)
14% of the overall cohort received ADT
Results
SMM were more likely to be single and had higher prostate-specific antigen (PSA) at diagnosis compared to heterosexual men.
SMM were more likely to be single: 72% vs 33% of HET (P<.001)
SMM had higher PSA at diagnosis than HET (P=.031)
These demographic and clinical differences were noted as relevant context for interpreting sexual health outcomes
Methods
The study population included patients with intact prostates who were sexually active with a partner in the prior 30 days, at least 6 months after radiation therapy and androgen deprivation therapy.
176 total participants were included in the sexually active cohort (57 HET, 21 SMM)
Eligible patients were seen between June 2022 and August 2023
Patients self-reported sexual orientation, gender identity, sexual behaviors, and health outcomes
P values <.05 were considered statistically significant; mean differences ≥3 were considered clinically meaningful
What This Means
This research studied how prostate radiation therapy affects sexual health in gay, bisexual, and other sexual minority men (SMM) compared to heterosexual men. The study found that all men who had received prostate radiation reported significantly worse sexual function—including reduced ability to orgasm, less pleasurable orgasms, and lower sexual satisfaction—compared to the general US male population. However, sexual minority men who engage in receptive anal intercourse (the 'receiving' partner in anal sex) experienced additional unique challenges, including notable anal discomfort and even worse orgasm-related outcomes than other patients.
The type of radiation treatment and use of hormone therapy (androgen deprivation therapy, or ADT) made a meaningful difference in outcomes for sexual minority men who have receptive anal sex. Brachytherapy (internal radiation) was linked to less anal pain than external beam radiation, but also to somewhat worse orgasm pleasure. Adding hormone therapy was associated with dramatically worse outcomes across multiple sexual health measures, including orgasm ability, orgasm pleasure, anal pain, and overall sexual satisfaction. Sexual minority men were also more likely to be single and had higher PSA levels at diagnosis, suggesting they may face different social and clinical circumstances than heterosexual patients.
This research suggests that healthcare providers should routinely ask patients about their sexual orientation, gender identity, and specific sexual behaviors—including whether they engage in receptive anal intercourse—when discussing prostate cancer treatment options. Because different treatments carry distinct risks for different sexual activities, this information could help doctors and patients make more personalized treatment decisions that better preserve the sexual health outcomes that matter most to each individual.
Dickstein D, Kapouranis T, Sigel K, Wheldon C, Nvepu E, Javier N, et al.. (2025). Sexual Health Outcomes in Sexual Minority and Heterosexual Men After Prostate Radiation Therapy.. International journal of radiation oncology, biology, physics. https://doi.org/10.1016/j.ijrobp.2025.01.023