Editor’s note: This article originally appeared in the June 2021 edition of Outlife757 Magazine. We will continue to chronicle Craig’s journey on our web site as he navigates his post-cancer life.
Some things you might know about prostate cancer: according to the American Cancer Society, approximately one in eight men will be diagnosed with the second-most-common cancer in men (after skin cancer). It is the second-most-deadly cancer for men in the United States and about 60% of prostate cancer cases occur in men age 65 and older.
Some things you might not know: survival rates are high for this type of cancer. And, as a gay man you might be impacted quite differently from your heterosexual peers.
On January 20, at the age of 51, I was diagnosed with prostate cancer. I, like many faced with this diagnosis, took an immediate deep dive into internet resources to glean what I didn’t already know. It quickly confirmed what my doctor told me regarding basic treatment options like chemotherapy, radiation, and the removal of my prostate via a radical prostatectomy. The common side effects were sobering and included bladder incontinence and leakage, loss of or limited capacity to have fully rigid erections, shortening of the penis and the inability to ejaculate ever again.
I realized quickly that none of these articles or studies really considered the impact of prostate cancer on gay men.
Few resources account for the now ever-present emotional rollercoaster I was experiencing. They did not consider my battle with internalized homophobia, how I struggled with seeing myself as masculine and how so much of my gay identity and security had been defined by my sexual prowess. I found a few articles and scientific studies that focused on gay men with prostate cancer but they were extremely limited and only highlighted the need for more data and understanding.
One article acknowledged that anal sex requires a higher level of rigidity than vaginal intercourse but offered little insight beyond that fact. In fact, if anything, my internet search left me feeling more alone in dealing with my emotions.
My urology team has been spectacular, and I have been completely open about my sexuality. But the tools they provided such as printed materials and local survivor groups fail to acknowledge the struggles that gay men – let alone transgender or other LGBTQ+ people – may encounter.
The studies, limited as they are, demonstrate that gay men tend to experience a lower quality of life in terms of sexual function after their treatment than heterosexual men. I can speculate as to the reasons why this may be true.
Although not necessarily a universal truth, gay men tend to experience a highly sexualized existence. After routinely being told their desires are wrong, gay men may feel an opening of the sexual flood gates from when they began experimenting in gay sex or came out.
Being called a “sissy” “fag” or effeminate (which actually, is not an insult) can drive gay men to over-emphasize and over-prioritize their masculinity and or sexual abilities and a disease with the potential to profoundly impact sexual function can strike at the core of those concepts.
My diagnosis made me wonder if others experienced the same thoughts I was having. Would this surgery save my life but make me feel “less than” in a community that allowed me to finally feel whole? Would removal of my prostate mean the loss of my self-identification; my happy and secure place? Would I be rejected by the community that saved me from a life of trauma and rejection for being gay? Were the common side effects of this disease’s treatment potentially too high a cost for being cancer free?
Now that I am past surgery and in recovery mode, I find myself wanting to share this experience with our community. First, I strongly urge all men age 40 and older to be screened for prostate cancer. Establish a baseline for your prostate health so you can better understand any future changes. If, like me, you discover the cancer early enough while it is localized (contained within the prostate without spreading to other parts of the body) odds of survival and longevity increase significantly.
Second, gay men need to acknowledge that this disease has the potential to impact us mentally and emotionally more significantly.
We need to bring this topic into the light so our community has the tools we need and deserve. I know that not everyone may have the resources and support of a loving husband, amazing friends and personal introspective practices that allow them to see themselves as more than their sexual capacity—all factors that helped me more than I can express.
If you have already experienced this journey and care to share how your diagnosis and treatment impacted you as a gay man, I would love to hear from you. Share your story with others so we can normalize a healthier, non-sexualized self – image and better support gay men as they seek treatment for and recover from prostate cancer.
Craig Nicol lives in Norfolk with his husband. In his spare time he enjoys painting, cooking, gardening and promoting mindfulness. If you would like to share your story with Craig you can reach him at firstname.lastname@example.org.