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Prostate Cancer and the Social Construction of

Masculine Sexual Identity

Article  in  International Journal of Men s Health · September 2008

DOI: 10.3149/jmh.0703.299

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 Prostate Cancer and the Social Construction
01 of Masculine Sexual Identity
02
03 MICHAEL IRVIN ARRINGTON
04 University of Kentucky
05
06
07 Perhaps no other disease illustrates the social construction of masculine identity
08 more vividly than prostate cancer, an illness whose common symptoms and treat-
09 ment effects (for example, erectile dysfunction and incontinence) leave men with
10 a diminished sense of agency over their bodies. This loss of agency reveals the
11 ways in which societal norms regarding appropriate masculine sexual behavior
and identity are cultural creations, not biological absolutes. Recalling prior stud-
12
ies of prostate cancer narratives and studies of prostate cancer support groups, this
13
article inquires not only into dominant constructions of sexuality, but also into the
14 possibilities of redefining sexuality and masculinity among prostate cancer sur-
15 vivors.
16
17
Keywords: men, prostate cancer, masculinity, social construction, gender, sexual-
18
ity
19
20
21
22 From January, 1997 to February, 2001, I observed monthly meetings of a Florida
23 chapter of Man-to-Man, a national support group for prostate cancer survivors. What
24 began as a research project on social support grew into a series of research projects
that investigated not only social support (Arrington, Grant, & Vanderford, 2005) but
25
also illness narratives that addressed the stigma and attendant identity changes elicited
26
by prostate cancer, the impact of the disease on relationships with partners and friends
27
(Arrington & Goodier, 2004; Arrington, 2005), the impact of the disease on men’s in-
28
teractions with health care providers (Goodier & Arrington, 2007), and the impact of
29
the illness on sexual identities (Arrington, 2000a, 2000b, 2003, 2004). These studies
30
employed a variety of theoretical perspectives (the narrative paradigm, grounded the-
31
ory) and research methods (narrative analysis, the constant comparison method). As I
32
reflected on the project and its various components, it became clear that many of my
33
findings dealt with ways in which prostate cancer survivors sometimes perpetuate and
34 rarely resist the dominant society’s definitions of masculine sexual identity.
35
36
37
Michael Irvin Arrington, Department of Communication, University of Kentucky.
38 Correspondence concerning this article should be addressed to Michael Irvin Arrington, Department of
39 Communication, University of Kentucky, 247 Grehan Building, Lexington, KY 40506. Electronic mail:
40 michaelarrington@uky.edu
41
International Journal of Men’s Health, Vol. 7, No. 3, Fall 2008, 298-305.
42 © 2008 by the Men’s Studies Press, LLC. http://www.mensstudies.com. All rights reserved.
43 jmh.0702.298/$12.00 DOI: 10.3149/jmh.0702.298

298
 PROSTATE CANCER

01 Prostate Cancer and Its Effects

02
03 Common symptoms and treatment effects of prostate cancer leave survivors with
04 a diminished sense of agency over their bodies. Survivors often face difficulty in con-
05 fronting the losses of control of their bodies, schedules, lifestyles, and relationships, and
06 of course, the looming possibility of death, that is, the larger loss of their very lives.
07 Medical treatments often lead to erectile dysfunction, which at best redefines and at
08 worst restricts the survivor’s sex life.
09 Post-surgical side effects include erectile dysfunction and incontinence (Bostwick,
10 MacLennan, & Larson, 1996). Other possible side effects include urethral stricture,
11 cardiovascular problems, blood clots in the legs, damage to the urethra, and rectal in-
12 jury. Side effects also occur with other treatment options. Men who opt for radiation
13 therapy risk intestinal problems, rectal irritation, and diarrhea, in addition to erectile
14 dysfunction and incontinence. Rectal ejaculation and rectal bleeding are also potential
15 side effects of radiation treatment (Carson & Akwari, 1980; Hanlon et al., 1997). Hor-
16 monal therapy reduces the amount of testosterone in the body but also leads to erectile
17 dysfunction, hot flushes, diarrhea, liver toxicity, gynecomastia and breast tenderness,
18 and decreased libido (Bostwick et al., 1996; Clark et al., 1997).
19 The painful physical changes caused by prostate cancer often pale in comparison
20 to the emotional hurt and psychological effects inflicted by the disease (Fitch, Gray,
21 Franssen, & Johnson, 2000). To put it mildly, prostate cancer scares people. Korda
22 (1997) wrote specifically about men’s fear of prostate cancer:
23
[T]he biggest fear of most men. It carries with it not only the fear or
24
dying, like all cancer, but fears that go to the very core of masculinity –
25
for the treatment of prostate cancer, whatever form it takes, almost in-
26
variably carries with it well-known risks of incontinence and impotence
27 that strike directly at any man’s self-image, pride, and enjoyment of life,
28 and which, by their very nature, tend to make men reticent on the sub-
29 ject. (pp. 3-4)
30
31 Fear is often accompanied by depression, which frequently follows a single up-
32 setting event such as a diagnosis of serious illness (Phillips, 1994). An unsatisfied need
33 for control, a feeling of helplessness, changes in lifestyle, and a lost sense of immor-
34 tality all contribute to depression among men with prostate cancer (Phillips, 1994).
35 These complications of the disease exert a cumulative force on men, often leaving them
36 feeling helpless or inadequate.
37
38 Prostate Cancer and Masculine Sexual Identity
39
40 The loss of agency caused by prostate cancer reveals the ways in which societal
41 norms regarding appropriate masculine sexual behavior and identity are cultural cre-
42 ations, not biological absolutes. Consequently, the men’s illness narratives and inter-
43 actions in support group meetings suggest that few men contest those norms and create

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 ARRINGTON

01 new identities for themselves in the wake of the disease. Most men choose or see no
02 other valid choice than to accept the social definition of masculinity and, consequently,
03 perceive themselves as less masculine than they were before the diagnosis. The re-
04 mainder of this article will illustrate the limits imposed by current cultural norms and
05 the potential for thinking beyond those limits.
06
07 Perpetuating the Dominant Definition
08
09 After observing group discussions in the Man-to-Man group, I found that many
10 group members spoke in a manner that confirmed a definition of sexual behavior that
11 required sexual acts to be spontaneous actions involving penile vaginal penetration and
12 that denounced anything else as phony at worst and incomplete at best. Among these
13 men, talk about sex and sexuality took the form of a drama in which the men charac-
14 terized prostate cancer as an evil agent that robbed them of their sexual identity. For in-
15 stance, several group members who opted for hormone therapy complained of being
16 “castrated” by their medications, in spite of their decision not to undergo the process
17 of having their testicles removed. Because of the dominant definition of masculine sex-
18 uality, these men often spoke of going to great lengths to maintain the ability to have
19 sex as it was defined for them.
20 Neil was a cancer patient for roughly four years. During that time, he had his ure-
21 thra restructured and experienced some incontinence after his surgery. He underwent
22 hormone therapy, after which his genitals shrunk to prepubescent levels. He experi-
23 enced nerve damage and received a prescription for a “vacuum device.” However, the
pump did not work for him. He then tried injections of medication, but to no avail. Neil
24
asked his physician about Viagra but was told that the medication would not work for
25
him at this point.
26
Neil began his story by discussing incontinence but spent most of his time dis-
27
cussing the numerous procedures he had undergone in an attempt to restore his sexual
28
potency. Support group members also conveyed the power of society’s dominant def-
29
inition of masculine sexual behavior when they described the reasoning behind their re-
30
spective choices of treatment methods.
31
In a one-on-one interview, for example, another group member, Mark, explained
32
his choice of treatment options and the impact of sex on his decision:
33
34 This is what [my physician] told me. So I opted on the radiation, be-
35 cause, it seemed like that would have less effect upon the sex life, than
36 an operation ... I had heard anyway that the chances that, of losing your
37 ability to have sex was much greater than just by radiation. So I went
38 through the radiation.
39
40 In this case, as in many others, the patient based his treatment decision solely on
41 the likelihood of maintaining his prior sex life, which allowed him to act in a manner
42 consistent with cultural norms of masculine sexuality.
43

300
 PROSTATE CANCER

01 Sex as Spontaneous
02
03 A popular notion among men was that sex was the spontaneous result of a simul-
04 taneous urge between partners. It followed that anything other than that was something
05 less than “real” sex. Consider, for instance, the moment when Bob told us about the
06 pump he bought four years ago but had not yet used.
07 In fact, he never even took it out of the box. He did not feel comfortable using the
08 apparatus because it made sex less than spontaneous. “It’s gotta be spontaneous,” he
09 stated firmly. At this point, he appeared defensive and uncomfortable with the conver-
10 sation, noting that it was easy for people without a given problem to talk about that
11 problem.
12 I sensed that the statement was directed at Brooks, the group facilitator, who did
13 not have prostate cancer. Brooks responded by asking a question that he said psychol-
14 ogists often asked: “What’s the alternative? Non-spontaneous sex is likely better than
15 none at all. Open the box and talk with your wife.” “Without the urge?” Bob asked. “If
16 I had the urge, I’d open the box.” “The urge is mental,” Al noted.
17 Bob argued that sex, by definition, must be a spontaneous event. Consequently, be-
18 cause of Bob’s inability to achieve an erection without the aid of the pump, he felt in-
19 capable of having sex at all. Brooks suggested, in contrast, that sex still could have
20 been enjoyable for Bob and that Bob still could engage in sexual activity even if doing
21 so required sacrificing a degree of spontaneity in exchange for the ability to achieve an
22 erection.
23 Brooks’s comment conveyed a watered-down version of Tiefer’s (1994) claim that
24 the notion of spontaneity in sex is nothing more than a myth. On several occasions,
25 Brooks and Bradley, two men who facilitated one of the discussion groups, attempted
26 to challenge the notion of sex as spontaneous. In a moment representative of many of
27 the later meetings, Brooks brought up the idea of “partial” or “limited” sex as the rule,
28 not the exception.
29 Contrary to the mediated messages we might have seen, couples are not constantly
30 “hot and heavy” for one another, he claimed. He asked Al whether he had talked with
31 his wife about sex. They had started to talk, Al answered, but the conversation never
32 got very far.
33 In this instance, Brooks challenged the notion of sex as a spontaneous action by
34 dismissing that image as an unrealistic media construction. In addition, he questioned
35 the notion by exhorting group members to confer with their partners about prostate
36 cancer’s effects on the couples’ sex lives. Brooks’s reference to alternative sexual acts
37 as “partial” was problematic, however, in that it suggested that those acts were some-
38 how incomplete.
39 In another meeting, Bradley attempted to question the spontaneity of sex. Without
40 mentioning specific studies or researchers, he claimed that research verified that men
41 get in the mood for sex, or “warm up,” more quickly than their female partners. On av-
42 erage, a woman takes fourteen minutes to warm up, while a man takes only two min-
43 utes, Brooks stated.

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 ARRINGTON

01 “Or if you’re Italian, about two seconds,” he added, lightening the mood with a
02 joke about his own cultural background. Bradley went on to note that while those meas-
03 ures change with age, they do not necessitate the termination of the men’s lives as sen-
04 sual, sexual beings. So while Brooks tended to dismiss the dominant definition of sex
05 as a spontaneous act, Bradley endeavored to redefine this aspect as an age-related con-
06 struct that simply changed slightly over time, but not with the effect of eliminating sex
07 altogether. Each group leader in his own way propounded a reconsideration of any
08 spontaneity involved in sexual activity.
09
10 Sex as Penetration
11
12 Brooks, likely recalling a prior group meeting that included a discussion of the pe-
13 nile pump, stated that the apparatus might lessen the spontaneous aspects of sex. John
14 interjected with a laugh, acknowledging that he could no longer have sex at all: “Maybe
15 I’ve had my quota already.” Brooks noted that there were other ways to share and show
16 love for one’s relationship partner.
17 When John claimed that he could no longer have sex, he might have meant that he
18 could not achieve or maintain an erection or that he could not achieve an orgasm. Re-
19 gardless, because the remark appeared during a discussion of the merits and limitations
20 of the penile pump, it was reasonable to assume that he actually was referring to erec-
21 tile dysfunction. Such a claim, then, assumed that an erection was a necessary element
22 of sexual intercourse and the implied definition of “real sex.” Along with an erection,
23 penetration was implied as a necessary component of sex and sexuality. Prostate can-
24 cer survivors who experienced erectile dysfunction as a side effect of treatments often
25 feel that their chances of maintaining a healthy sex life deteriorates along with their ca-
26 pacity for an erection.
27 The definition of sex as penetration emerged even more clearly in the amount of
28 effort Brooks and Bradley expended in defining acts as sexual and intimate. Rather
29 than being solely a physiological act, Brooks asserted, sex occurred primarily between
30 the ears. Brooks also noted that perceptions and definitions of sex were affected by
31 variables of ethnicity, socioeconomic status, and religion, including the repression of
32 sexuality often brought about by those influences. He introduced himself as a PhD in
33 psychology, not a physician. His background and interest in sex implied, as he occa-
34 sionally stated, that there was more to sex than “plumbing” and the physiology of the
35 human body.
36 On a different occasion, Brooks explained that although men with erectile dys-
37 function might not be able to achieve or maintain an erection, they are still quite capa-
38 ble of maintaining sexual relations with their partners through various means. “For
39 example, we see nothing wrong with mutual masturbation . . . in a marriage relation-
40 ship.” However, his failure to explain the identity of the aforementioned “we” was
41 problematic in that the statement might have contradicted the religious beliefs of some
42 group members. This possibility is especially noteworthy because the meetings were
43 held in a church.

302
 PROSTATE CANCER

01 In another meeting, Bradley advocated alternative means of sexual contact still

02 available to group members dealing with erectile dysfunction. Nathan entered the con-
03 versation, asking whether women were more apt to miss orgasms than men were. He
04 also asked about the merits of abstinence for older people. While he only might have
05 needed to hold hands with his wife to be satisfied in terms of intimacy, he explained,
06 she might also require clitoral stimulation. Bradley’s answer included a reference to
07 religious taboos against “fingering.”
08 Although Bradley made an effort to encourage group members to experiment with
09 other means of experiencing sexual intimacy, he also crossed into the more problem-
10 atic area of marginalizing the men’s new sexual options, as the next passage suggests.
11 “What about self-stimulation?” Nathan inquired. It was certainly not preferable to
12 “the real McCoy,” according to Bradley. “After all,” he continued, “we would rather
13 have a good piece of ass than masturbate.” He added that it was never too late to be cre-
14 ative in one’s sex life and made a vague (not too controversial, he hoped) reference to
15 oral sex, describing the sixty-nine position as including digital arousal but failing to
16 mention oral stimulation.
17 Though Bradley’s intentions might have been admirable, he perpetuated the notion
18 of sex sans penetration as somehow incomplete when he suggested that autoeroticism
19 was inferior to “the real McCoy.” The fact that neither Bradley nor the other members
20 ever discussed cunnilingus as a sexual option was also worth noting. I concluded that
21 either cunnilingus had not been part of the men’s prior sex lives or that it was a taboo
22 topic, not to be mentioned outside the marital dyad.
23
24 Contesting the Dominant Definition. Toward a Transcendent View of Sexual Identity
25
26 Most of the men who spoke with me defined masculine sexuality solely in terms
27 of the ability and willingness to perform penile vaginal intercourse, which they per-
28 ceived as the sexual act. The men’s comments inform us about what it means to be a
29 man whose sex life has changed because of prostate cancer and what it means to be an
30 older person whose sexual identity is altered by the disease. On a more universal level,
31 the narratives presented also have implications for the broader concept of sexual iden-
32 tity and the sometimes contradictory meanings which we assign to it.
33 One way to understand how sex is socially constructed is to compare it to race.
34 West (1993) wrote of three ways to talk about race. Americans, he claimed, tended ei-
35 ther to essentialize issues of race, making race the primary cause of interethnic differ-
36 ences, or ignore race, pretending that ethnic differences hold no significance in inter-
37 and intra-ethnic interaction. However, West added, far too few of us consider a third
38 way of dealing with race. We need to develop a way of talking about race that neither
39 essentializes nor ignores it, but transcends it. What we lack, he explained, is a way to
40 acknowledge race for what it is and for what it is not. Such an approach would ac-
41 knowledge that structures and behavior are inseparable, and that institutions and val-
42 ues go hand in hand. How people act and live are shaped (though in no way dictated
43 or determined) by the larger circumstances in which they find themselves. These cir-

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 ARRINGTON

01 cumstances can be changed and their limits attenuated by positive actions to elevate liv-
02 ing conditions (West, 1993, pp. 18-19).
03 A transcendent view of sexuality would require us to consider the role of culture
04 in our definitions and experiences of sexuality. Culture is “as much a structure as the
05 economy or politics; it is rooted in institutions such as families, schools, churches, syn-
06 agogues, mosques, and communication industries (television, radio, video, music).”
07 Like economics and politics, West continues, culture is “not only influenced by values
08 but also promote[s] particular . . . ideals of the good life and good society” (West, 1993,
09 p. 19).
10 The same can be said about our views of sex and sexuality. Most prostate cancer
11 survivors do not discuss sexuality in a way that acknowledges the broad potential of the
12 concept. Like race, sexuality is a social construction:
13
14 What we define as ‘sexuality’ is an historical construction, which brings
15 together a host of different biological and mental possibilities – gender
16 identity, bodily differences, reproductive capacities, needs, desires and
17 fantasies – which need not be linked together, and in other cultures have
18 not been. (Weeks, 1987, p. 15)
19
20 In the absence of a story that transcends sexuality, prostate cancer survivors seem
21 trapped between conflicting messages about the significance of sex and sexuality. Ei-
22 ther sex comprises the bulk of their identities, as evidenced by the fact that preserving
23 their sex life was a primary value in treatment decisions, or sex means little to them,
24 as downplayed in post-treatment accounts when there were no effective means of restor-
25 ing prior sexual potency. Hence, what we need are new ways and a new willingness to
26 talk about sex and identity, ways that reveal the fallacy of thinking about sex and gen-
27 der as dichotomies rather than conceiving each as a located along a broad-ranging con-
28 tinuum of meanings.
29
30
31 References
32
33 Arrington, M. I. (2000a). Sexuality, society, and senior citizens: An analysis of sex talk among
prostate cancer support group members. Sexuality and Culture, 4(4), 45-74.
34
Arrington, M. I. (2000b). Thinking inside the box: On identity, sexuality, prostate cancer, and so-
35 cial support. Journal of Aging and Identity, 5(3), 151-158.
36 Arrington, M. I. (2003). “I don’t want to be an artificial man”: Narrative reconstruction of sex-
37 uality among prostate cancer survivors. Sexuality and Culture, 7(2), 30-58.
38 Arrington, M. I. (2004a). The role of technology in prostate cancer survivors’ illness narratives.
39 In D. Cook & P. Whitten (Eds.), Understanding Health Communication Technologies: A Case
40 Book Approach (pp. 181-186). Jossey-Bass Publishers.
41 Arrington, M. I. (2004b). To heal or not to heal?: On prostate cancer, physician-patient commu-
42 nication, and sexuality. Journal of Loss and Trauma [formerly Journal of Personal and In-
43 terpersonal Loss], 9(2), 159-166.

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01 Arrington, M. I. (2005). “She’s right behind me all the way”: A narrative analysis of prostate
02 cancer and changes in marital relationships. Journal of Family Communication, 5(2), 141-162.
03 Arrington, M. I., & Goodier, B. C. (2004). Prostration before the law: Representations of illness,
interaction and intimacy in the NYPD Blue prostate cancer narrative. Popular Communica-
04
tion, 2(2), 67-84.
05 Arrington, M. I., Grant, C. H., & Vanderford, M. L. (2005). Man to man and side by side, they
06 cope with prostate cancer: Self-help and social support. Journal of Psychosocial Oncology,
07 23(4), 81-102.
08 Bostwick, D. G., MacLennan, G. T., & Larson, T. R. (1996). Prostate cancer: What every man
09 – and his family – needs to know. New York: Villard.
10 Carson, C. C., & Akwari, O. E. (1980). Rectal ejaculation and prostatic carcinoma. Urology, 16,
11 188-189.
Clark, J. A., Wray, N., Brody, B., Ashton, C., Giesler, B., & Watkins, H. (1997). Dimensions of
12
quality of life expressed by men treated for metastatic prostate cancer. Social Science & Med-
13 icine, 45, 1299-1309.
14 Fitch, M. I., Gray, R., Franssen, E., & Johnson, B. (2000). Men’s perspectives on the impact of
15 prostate cancer: Implications for oncology nurses. Oncology Nursing Forum, 27, 1255-1263.
16 Goodier, B. C., & Arrington, M. I. (2007). Physicians, patients, and medical dialogue in the
17 NYPD Blue prostate cancer story. Journal of Medical Humanities, 28(1), 45-58.
18 Hanlon, A. L., Schultheiss, T. E., Hunt, M.A., Movsas, B., Peter, R. S., & Hanks, G. E. (1997).
Chronic rectal bleeding after high-dose conformal treatment of prostate cancer warrants mod-
19
ification of existing morbidity scales. International Journal of Radiation, Oncology, Biology,
20 Physics, 38, 59-63.
21 Phillips, R. H. (1994). Coping with prostate cancer: A guide to living with prostate cancer for
22 you and your family. Garden City Park, NY: Avery.
23 Tiefer, L. (1994). The medicalization of impotence: Normalizing phallocentrism. Gender and
24 Society, 8, 363-377.
25 Weeks, J. (1987). Sexuality. London: Routledge.
26 West, C. (1993). Race matters. Boston: Beacon Press.
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43

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