Duane Duncan

Diagnostic and outcome differences between heterosexual and nonheterosexual men treated for prostate cancer.

OBJECTIVE To determine if heterosexual and nonheterosexual men treated for prostate cancer differ in diagnostic and treatment outcomes and in various measures of physical health, sexual function, and well being, before and after the treatment. METHODS Four hundred sixty self-identified heterosexual and 96 self-identified nonheterosexual men completed an anonymous online survey. The men in the 2 groups were then compared using logistic regressions that controlled for differences among countries. RESULTS There were no significant differences in age at diagnosis for men in the 2 groups. However, Gleason scores at diagnosis were significantly lower for the nonheterosexual men (P = .02). There were no significant differences among men in the 2 groups in the proportion who receive different treatment modalities or in the incidence of urinary incontinence, who experience bone pain (as a marker of disease progression), who take antidepressants (as a proxy measure for mental health), or who experience erectile dysfunction after the treatment. However, nonheterosexual men rated the degree to which they were bothered by an inability to ejaculate significantly higher than did the heterosexual men (P = .04). CONCLUSION This is the first set of findings from a survey that compares heterosexual and nonheterosexual men treated for prostate cancer. Although the groups were generally similar, nonheterosexual men might experience more intensive screening for disease, as indicated by lower Gleason scores at diagnosis. Nonheterosexual men appear more distressed by loss of ejaculation after prostatectomy.

Out of the Closet and into the Gym: Gay Men and Body Image in Melbourne, Australia:

Psychological and health science research has identified a disparate experience of body image dissatisfaction among gay men (particularly in relation to heterosexual men), and have theorised that this reflects an emphasis placed on physical appearance in gay male settings. However, these studies largely fail to reflect upon the centrality of the body in securing a visible gay identity, or upon discourses of the nature, appearance and expression of gay identity in a historical and social context. Similarly, sociologically informed work has tended to emphasise gay mens paradoxical relationship—dependant upon and desirous of—heterosexual masculinity as the foundation for this emphasis. Drawing on a concept of “reflective embodiment,” interviews with four gay men are conducted to demonstrate how each negotiates an athletic, muscular body ideal with reference to understandings of masculinity, pride, and gay sexuality as a way of complicating these theorizations and injecting a discussion of subjectivity into this issue.

Flexibility in Men's Sexual Practices in Response to Iatrogenic Erectile Dysfunction after Prostate Cancer Treatment.

Introduction Prostate cancer (PCa) treatments are associated with a high incidence of erectile dysfunction (ED). Interventions to help men with iatrogenic ED have largely focused on penile tumescence adequate for vaginal penetration. Less research has been undertaken on sex practices other than penile/vaginal intercourse. Aim The aim of this study was to explore forms of sexual practice engaged in by men following treatment for PCa. We focused in particular on anal intercourse (AI) as practiced by both nonheterosexual (i.e., gay-identified men and other men who have sex with men) and heterosexual men. We sought to determine how common AI was subsequent to PCa treatment and how flexible AI practitioners were in their modes (e.g., from insertive to receptive) when faced with iatrogenic ED. Methods An international online survey was conducted in 2010–2011 of men treated for PCa, where participants (N = 558) were asked explicitly about their sexual practices before and after PCa treatment. Main Outcome Measures The outcome measures were the numbers and percentages of men who practiced AI before and after PCa treatment as well as the percentage who changed AI practice after PCa treatment. Results Five hundred twenty-six men (90 nonheterosexual men; 436 heterosexual men) answered questions on AI practices. A proportion of nonheterosexual (47%) and heterosexual men (7%) practiced AI following PCa treatment, and did so in all modes (insertive, receptive, and “versatile”). Many nonheterosexual men continued to be sexually active in the face of iatrogenic ED by shifting from the insertive to receptive modes. A few men, both heterosexual and nonheterosexual, adopted AI for the first time post-PCa treatment. Conclusions Flexibility in sexual practice is possible for some men, both nonheterosexual and heterosexual, in the face of iatrogenic ED. Advising PCa patients of the possibilities of sexual strategies that include AI may help them in reestablishing a sex life that is not erection dependent. Dowsett GW, Lyons A, Duncan D, and Wassersug RJ. Flexibility in mens sexual practices in response to iatrogenic erectile dysfunction after prostate cancer treatment. Sex Med 2014;2:115–120.

Embodying the gay self: Body image, reflexivity and embodied identity

Abstract The emphasis on a sexualised muscular body ideal in gay social and cultural settings has been described as facilitating body image dissatisfaction among gay men. Drawing on a concept of reflexive embodiment, this paper uses qualitative interviews to analyse gay men’s embodiment practices in relation to discourses and norms that can be found across and beyond any coherent notion of ‘gay subculture’. The findings reveal body image to be more complex than a limited focus on subculture or dissatisfaction can account for. In particular, gay men negotiate a gay pride discourse in which the muscular male body generates both social status and self-esteem, and deploy notions of everyday masculinity that imply rationality and control to resist gendered assumptions about gay men’s body image relationships.

The Meaning of ‘Regular Partner’ in HIV Research Among Gay and Bisexual Men: Implications of an Australian Cross-Sectional Survey

Estimates of the proportion of HIV infections coming from within regular sexual relationships among gay and bisexual men (GBM) vary widely. Research surveys use various partner type categories, but there is little understanding of how men classify their partners. We conducted an online cross-sectional survey of Australian GBM exploring sexual relationships, including 2057 men reporting on 2566 regular partnerships. Just over half of the partnerships were considered ‘relationships’, while the remainder were non-romantic ‘fuckbuddy’-style arrangements. In multivariable analysis, factors associated with considering the partnership a ‘relationship’ were: using a ‘romantic’ descriptor, partnership length, monogamous agreements, any condomless anal sex with each other, love, and commitment. The category of ‘regular partner’ can mask diverse partnership types, which have different meanings to GBM, associated behaviours, and HIV risks. Certain HIV prevention techniques may be more suited to particular types of partnerships. ‘Fuckbuddy’ arrangements need to be more explicitly acknowledged in HIV prevention.

The ‘Evidence’ of sex, the ‘Truth’ of gender: Shaping children's bodies

Abstract This paper is about the body, specifically a childs body, as a site where identity becomes contested. It is also about a surface or space where we lay claim—a site of vested interest. In April 2004, the Australian Family Court ruled that a 13-year-old child (Alex) had gender identity dysphoria and decided to allow reversible hormonal treatment. The Court ruling produced considerable legal, medical and public reflection over whether these decisions were in Alexs best interests, whether Alex was able to make such a decision at his age, and to assess Alexs competency. These debates also aimed to fix sex and gender through the deployment of a nature and nurture framework. The purpose of this paper, using the example of Alex, is to illustrate the various ways that these claims over a childs body, undermine the possibility for rethinking sex and gender.

There's No Teleology to It; It's Just about the Spirit of Play: Men, Intimacy, and "Late" Modernity

The certainties that characterized modern intimate life, and supported a hegemonic male sexuality defined by action and virility, are less present in contemporary mens intimate lives. In-depth interviews with ten heterosexual and gay men were conducted to explore how they organize their sexual and relational lives in contemporary Australia. Participants were committed to a “late” modern notion of intimacy characterized by reciprocity, and placed emphasis on committed relationships where opportunities to disclose vulnerability and relinquish the burden of responsibility for sexual activity were present. However, casual sex appeared to be ordered by more conventional discourses related to male sexuality. These men reveal the importance of particular definitions of sexual intimacy to a meaningful sense of self in late modernity.

Trust, Commitment, Love and Sex: HIV, Monogamy, and Gay Men

Research on gay mens relationships has neglected monogamy. Instead, it has tended to (a) emphasize HIV risk and relationship agreements between partners regarding sex and condom use with outside partners or (b) focus on nonmonogamous relationships as emblematic of relationship innovation. On the basis of qualitative interviews with 36 gay Australian men who favored a monogamous relationship as ideal, this article explores the meaning and practice of monogamy and its association with HIV risk. The authors present themes that include mens use of condoms in monogamous relationships, expectations of fidelity, and understandings of trust and security as the basis to meaningful and satisfying relationships.

‘I’d much rather have sexual intimacy as opposed to sex’: Young Australian gay men, sex, relationships and monogamy:

Few studies have explored how young gay men negotiate opportunities for rethinking sexual and relationship life associated with gay sexual cultures upon coming out. Drawing on qualitative interview data with Australian gay men aged 18–30, this article explores a tension these participants described between a desire for monogamy as the basis to a committed, enduring and mature relationship on one hand, and sexual opportunities associated with ‘the gay scene’ on the other. We analyse these mens negotiation of this tension in the context of wider political shifts in the social status of gay mens relationships, encapsulated in a debate between those who see ‘homonormativity’ and those who see transformation in the contemporary relationship practices of gay men.

Advancing Sexuality Studies: a short course on sexuality theory and research methodologies

Critical Sexuality Studies is an emerging field of academic enquiry linked to an international network of advocacy agencies, activists, and political issues. This paper reports on the development of an advanced short course in sexuality theory and research, drawing on Critical Sexuality Studies and aiming directly at academics in developing countries working in sexuality issues. Over a three-year period, a new curriculum was developed by an international team. The course was piloted in two continents, refined, revised, and released globally under a Creative Commons licence in 2010 on a dedicated website. This paper documents the project and its progress to date.