Personalizing cancer treatment doesn’t only mean matching a drug to molecular markers on a tumour — it should also take into account a person’s sexual identity, interests and wishes.
. “One of the reasons for that is that they are more likely to do something about it — like to go and get counselling, try penile injections and suction devices, or use Viagra,” she explains.
Dowsett notes that the loss of the ability to ejaculate after a radical prostatectomy was absent from much of the public-health literature at the time he was diagnosed — he learnt of it only after he went for a second opinion. Similarly, Ussher says that many people are not told that their penis can shorten after a radical prostatectomy, or that this is sometimes temporary.
“A lot of physicians forget to check trans women’s prostate,” says Channa Amarasekera, a urologist and director of the Gay and Bisexual Men’s Urology Program at Northwestern Medicine in Chicago, Illinois. And even when they do, subsequent care cannot follow an identical path to that for cisgender men. For example, gender-affirming surgery that some transgender women undertake could be more difficult if they have already had radiotherapy for prostate cancer.
In many cases, the problem is a lack of education and training among clinicians. Amarasekera has found that many urologists have received less than five hours of instruction on how to treat people from sexual and gender minoritiesThere is, for example, a lack of guidance on how to discuss the various sexual roles that a gay or bisexual person can take on in anal intercourse, and the implications for treatment.
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