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Guest Blog: Simon Faulkner from METRO Walnut on supporting men who have sex with men, and trans women, through prostate cancer


Guest Blog: Simon Faulkner from METRO Walnut on supporting men who have sex with men, and trans women, through prostate cancer


Simon Faulkner is a founding member and Coordinator of METRO Walnut, part of diversity charity METRO.

“A diagnosis of prostate cancer is bad enough for anyone. For gay or bisexual men, trans women (a person born a man but who identifies as a woman and may have had medical interventions to become physically female, but could retain some male functions), and those that love them, the cancer journey has a set of unique problems that these individuals don't yet feel many clinicians are comfortable addressing.

That is the same today, more or less, as it was four years ago when I helped set up the Walnut group - also known as LGBT-Walnut - a support group for those with a prostate cancer diagnosis who identify as gay, bisexual, or as a trans woman. They come to us to hear how others deal with the physical, intellectual and emotional effects of prostate cancer and treatment on their ability to express their sexuality as a gay man, or how to manage the focus on something so male when they identify as a woman. We talk freely about the lived impact on one's sense of self-image and sense of belonging, and the effect of prostate cancer on sexual relations and roles.

Our group helps where there is a lack of dialogue with clinicians about the effects of prostate cancer on gay and bisexual men, or trans women. We need more dialogue with those treating us. It would be interesting if a hospital invited our group in to talk things through and get a better understanding of our position as gay guys with prostate cancer – to join up clinical and non-clinical cancer support. If clinicians don't ask us the right questions because they don't take into account people's sexual status and preferences, those coming to groups like ours will only get half the answers they need from clinicians.

I speak from experience seeking out others with my experience. I’m a gay man with prostate cancer, diagnosed seven years ago and now on 'active surveillance'. It was a couple of years into my cancer journey that I joined a Yahoo.com group for gay and bisexual men who have prostate cancer, but most members were people from America, Australia and Canada – there were just a few British men. It was there that I noticed someone setting up a group in Manchester. I went to its first meeting in April 2013 and though there were only five or six of us there, the experience of talking with other people who had the same background was incredible for me; I wondered why didn't we have something like it in the south of England. Much later, after a bit of digging around online, I found out there had been a group like this in the late 1990s, but no longer, so I helped found Walnut.

Most of those attending our support group are men in their 50s and 60s, sometimes older. About 10-15 percent of our attendees are partners to someone with prostate cancer. We see people before, during and beyond their cancer treatment. It can be difficult to have a frank discussion between partners when they are fully aware of the effect prostate cancer and its treatment might have on their relationship. Some men in the group identify as gay but were married and have children. Many of them have come to a point in their lives where they are exploring more openly their sexuality; consequently, their relationship with their married partner has come to an end. So it's like being a teenager exploring your sexuality for the first time, but, prostate cancer being a disease of this age group, they have had the diagnosis at the same time. It can put limits on their sexual functioning at the worst time, which can be an emotional roller-coaster.

Some group members are in long-term gay relationships and some not. The physical problems they have or are facing from prostate cancer treatment are the same as for heterosexual men, erectile dysfunction, urinary incontinence, bowel issues – but because of the nature of sexual relationships between men and for trans women, these become a pressing issue for how that person sees themselves, their self-image and their masculinity, whether you can remain an active sexual partner or a passive one, depending on how your body is affected. This is very important in the gay community, which puts a lot of weight on performance and is very youth-oriented, which puts a lot of pressure on gay or bisexual men with prostate cancer to not talk about these things.

You try talking to a health professional about that. I cannot say that any of the guys in our groups have felt their health professionals fully understood what they meant when trying to raise these issues, that it was completely OK to raise it in the clinical environment, that the health professional was totally on board with the whole thing. It is usually the case that we get health professionals who offer gay and bisexual men or trans women heterosexual or heteronormative versions of treatment and outcomes. If a gay man asks in a traditional hospital support group setting, 'can I still have anal sex if I have had radiotherapy?' that is going to go down like a lead balloon.  Because they don't get the information relevant  to their situation and the right support from their clinicians, some older men decide that they shouldn’t expect to have sex lives any more, or to be able to start new relationships. They just accept poor outcomes.

Trans women also need support from cancer clinicians. Some trans women who go through full gender reassignment don't realise they still have a prostate. I don't know if trans women are made aware of the risk they have of developing prostate cancer even if they have not gone through a full gender reassignment, as many haven't. They may believe their risk is lower because they are taking hormone suppressants.

If we don’t talk about prostate cancer and its effects, and healthcare settings don't offer this support, it falls to organisations like ours to be inclusive of everyone in our community. The challenge for us is reaching them is not only that we are a very small charity; we are working against some challenging societal attitudes, a lack of clinical understanding of gay and bisexual men's lives, and a lack of education among men generally around prostate health and prostate cancer. So I'm happy that Cancer Care Map will reach everyone in the UK, and alert those we can help to the notion that such help exists.”

To find out more about METRO Walnut, click here.


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