In this post I describe the results of a study presented at the 2026 meeting of the International Academy of Sex Research.

Prostate cancer is the most common cancer among U.S. males, and its treatments cause significant long-term sexual dysfunction. Yet sexual rehabilitation was designed almost exclusively around restoring erectile function for penile-vaginal intercourse — an approach that is incomplete or irrelevant for the approximately 31,000 gay and bisexual men (GBM) diagnosed annually. In this study, my colleagues and I asked a simple question: what are GBM actually using for sexual rehabilitation after prostate cancer, and what might drive those choices?

We drew on baseline data from 401 participants enrolled in Restore-2, a randomized controlled trial of an online sexual rehabilitation intervention designed specifically for GBM treated for prostate cancer. The short answer to our question: mostly a prescription. PDE-5 inhibitors were used by 62.4% of the sample, far exceeding every other modality. Anal dilators, a treatment modality directly relevant to receptive anal function, were used by just 24.0%. And 41.8% reported no current sexual role, the single most common response, consistent with systematic sexual withdrawal following treatment.

What I find most interesting is how clearly modality use tracked both sexual role and treatment type. Anal dilator use was almost exclusively among men identifying a receptive preferred role in sex (i.e., bottoms). That makes sense. Pelvic floor exercises and vacuum pump use were concentrated among surgery-treated men, with radiation-treated men strikingly underrepresented. This might reflect distinct side effect profile of prostatectomy and differential access to specialist care. Counseling was the only modality used at equal rates regardless of sexual withdrawal, but it was the still rarely utilized.

Taken together, these findings point to a rehabilitation system centered on erections, organized around surgical care, and largely silent on receptive anal function. For a population where 4 in 10 men have stopped having sex, we can do better.

Poster can be viewed here