Prostate cancer is one of the most common cancers affecting men globally and is becoming an increasing public health concern. In South Africa, prostate cancer is the most common cancer among men across all population groups, with Black men carrying the highest burden of the disease. Studies have also shown that Black men are more likely to be diagnosed at advanced stages of prostate cancer, partly because of limited access to healthcare services, low awareness of screening programmes, and poor knowledge about the disease within some communities.

Advances in prostate cancer screening and treatment have improved survival rates, which allow many patients to live for many years after diagnosis. However, many men continue to experience long-term treatment side-effects that negatively affect their quality of life. Erectile dysfunction, together with bowel and urinary incontinence, is considered one of the most distressing side-effects of prostate cancer treatment.

A recent South African study explored the psychological impact of treatment-induced erectile dysfunction on masculinity among Black South African men undergoing prostate cancer treatment in Limpopo Province. Researchers specifically wanted to understand how prostate cancer treatment side-effects affected the participants’ sense of masculinity, identity, and emotional well-being.

To achieve the research objective, the study formed part of a larger project investigating the lived experiences of Black South African prostate cancer patients. Researchers used a hermeneutic phenomenological study design to better understand participants’ personal experiences.

Twenty Black South African men receiving prostate cancer treatment at Pietersburg Provincial Hospital in Limpopo Province were selected through purposive sampling. Participants were between 67 and 85 years old, with an average age of 76 years. All participants had been diagnosed with prostate cancer for at least five years and were receiving treatment, including surgery, hormone therapy, radiotherapy, or chemotherapy.

Researchers conducted in-depth semi-structured individual interviews in languages including English, Sepedi, Xitsonga, and Tshivenda. Interviews focused on participants’ experiences of living with prostate cancer and coping with treatment side-effects. The interviews were audio-recorded, transcribed, and analysed using Interpretative Phenomenological Analysis (IPA).

The findings showed that most participants experienced erectile dysfunction following prostate cancer treatment. Sixteen of the 20 participants reported erectile dysfunction, while 14 described experiencing a loss of masculinity linked to their condition. Most participants indicated that they did not experience erectile dysfunction before their prostate cancer diagnosis or treatment.

Many participants described erectile dysfunction as emotionally painful and damaging to their identity as men. Some expressed feelings of shame, helplessness, humiliation, and emotional distress. Participants often associated masculinity with sexual performance and the ability to maintain an erection. One participant stated, “You are no longer a real man when you can’t have it up,” while another said, “I am not a man anymore.”

Researchers found that treatment-induced erectile dysfunction negatively affected both the physical and psychological well-being of participants. Many participants linked their sense of masculinity to sexual virility and penetrative sexual intercourse. Erectile dysfunction therefore contributed to feelings of reduced self-worth, emotional suffering, and loss of dignity.

The study also found that several participants struggled to openly discuss their experiences because of embarrassment and stigma. Some participants reported feeling isolated and emotionally burdened by the condition.

Researchers recommended stronger collaboration between medical and psychological healthcare professionals in supporting prostate cancer patients. They also recommended that patients should receive counselling and psychoeducation about possible treatment side-effects before treatment decisions are made.