This is BayCare HealthChat, another podcast from BayCare Health System.

Caitlin Whyte: Welcome to BayCare HealthChat. I'm Caitlin Whyte. And today, we are talking about sexual and urologic health for men who have sex with men or MSMs. While personal and potentially embarrassing issues regarding sexuality and urinary function are routinely discussed in urology, some men may feel uncomfortable disclosing their sexual orientation due to fear of bias. And this has been associated with some bad health outcomes.

Joining us for this conversation today is Dr. Matthew Truesdale, a urologist at BayCare's Morton Plant Hospital. Now, Dr. Truesdale, although the physiology of lower urinary tract symptoms are the same for men regardless of sexual orientation or partners, certain factors increase the chance of a urinary tract infection. Tell us about that.

Matthew Truesdale, MD: So it's interesting there's factors that we've found that can actually increase the chance of someone experiencing lower urinary tract symptoms. And these factors include history of sexually transmitted infections or even psychological diagnoses, like depression or anxiety. And what we know is that gay men in the general population actually have a higher rate of these risk factors, including infections, sexually transmitted infections and depression. So the studies do show that they have an increased chance of experiencing symptoms in their urinary tract as well.

Caitlin Whyte: Now, multiple studies have shown increase rates of erectile dysfunction in men who have sex with men compared to those who don't. Tell us a bit more about these studies.

Matthew Truesdale, MD: Sure. So there's different things that can increase the cause of erectile dysfunction and this is in, you know, men in general population as well. And some of these are tobacco use, which can increase the risk of cardiovascular disease, even heart attacks and strokes, and has been shown to be linked to erectile dysfunction too.

In addition, recreational drug use has also been shown to increase cardiovascular disease as well, which can lead to erectile dysfunction. So gay men actually have increased rates of tobacco use and recreational drug use and, for that reason, can be more prone to erectile dysfunction.

Caitlin Whyte: When it comes to prostate cancer, there is a double chance of affecting a same-sex male couple. Why is that the case?

Matthew Truesdale, MD: So all men have a lifetime risk about 17% of being diagnosed with prostate cancer over the course of their lifetime. In the same-sex male couple, there's two men in that relationship. So that couple actually has a two times risk compared to heterosexual couple where there's only one man of experiencing prostate cancer.

And we know that prostate cancer diagnosis, treatment, the stresses associated with it doesn't just affect the patient, but it affects their partner, it affects their family. So same-sex couples have basically a two times increased chance of experiencing prostate cancer and going through treatment than a heterosexual couple.

Caitlin Whyte: Now on the topic of prostate cancer, what are some treatment options?

Matthew Truesdale, MD: So prostate cancer is a really diverse type of cancer. So first, you know, patients are diagnosed with what kind of cancer that they have. They're stratified based on their risk factors and in terms of their cancer. And then the goal is to treat or to cure the cancer before it spreads or leaves the prostate.

Now that process is extremely complex and it's basically the same for same-sex couples or opposite-sex couples, so gay men or straight men. But the difference is that gay men don't always talk to their physicians about the fact that they're gay. And so some of the factors that are at play for gay men with prostate cancer has to do with their anatomy. The fact that they have prostate, the fact that the prostate can be considered a sexual organ in same-sex couples, and the fact that heterosexual men or opposite-sex couple patients may not have the same needs after the surgery. And so when we talk about the types of treatments that we have for prostate cancer, it's really important to take those factors into consideration.

The treatments for prostate cancer, really the two main types of treatments are either radiation where the prostate is treated with radiation from outside of the body or through surgery where the prostate is removed. This procedure is usually done robotically and laparoscopically. It's a surgery that's done where the abdomen is blown up with gas and the surgery is done inside.

The technology of the robot is really interesting in that it basically gives the surgeon a magnified view of the surgery and also gives the surgeon increased dexterity in terms of the reconstruction aspects of the surgery itself. So it's a technology that decreases the side effects for the patient, increases the speed of recovery after the treatment as well, and can decrease some of the negative side effects that can occur from prostate cancer treatment.

Caitlin Whyte: And wrapping up here, for my last question, you mentioned it in your previous answer, there are some men who might not be comfortable disclosing to their doctor that they're sleeping with other men. As we wrap up here, how can we move forward and battle those stigmas and keep people feeling safe and comfortable with their doctors when it comes to these type of health issues?

Matthew Truesdale, MD: That's probably the most critical aspect of the disparities that we see for gay men and LGBT patients in general in the medical field. Medical schools, residency programs across the country are doing more to educate providers and practitioners on these important issues. But the long history of this sort of lack of discussing these issues and more importantly, the fact that LGBT patients are a minority, and so all of the studies that we have that kind of talk about how we do treatments, what's going on, gay men are underrepresented in a lot of those studies. And so even to this day, we don't truly understand all of the implications and aspects of treatment specifically in the LGBT population.

The most important thing that's good for all patients is to make sure that the physician that you find, you feel comfortable with them. And that means feeling comfortable telling them about who you are, telling them about your identity and telling about the fact that you're gay, lesbian, bisexual, or transgender. If you don't feel comfortable enough to talk to your doctor about those issues, then that doctor is not the doctor for you. And that's the biggest lesson I would say for all patients moving forward, because having an open and honest conversation means that you're going to get better treatment and that doctor is going to know you and your needs to tailor the treatment appropriately.

Caitlin Whyte: Well, thank you so much for joining us, Dr. Truesdale, and for working to end stigmas in healthcare. And that wraps up this episode of BayCare HealthChat. Head on over to our website at baycare.org for more information, and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other BayCare podcasts.

For more health tips and updates, follow us on your social channels. And if you found this podcast informative, please share it on your social media and be sure to check out all the other interesting podcasts in our library. I'm Caitlin Whyte. Stay well.