Sexuality and intimacy are important aspects of an individual’s quality of life, and there is a growing body of evidence to show that prostate and testicular cancer can result in dramatic changes to sexual functioning, relationships, and sense of self, which can be among the most negative influences on the wellbeing of men with cancer. This mixed method study examined the nature and consequences of sexual changes after cancer, as well as sexual re-negotiation, in 98 Australian men with prostate or testicular cancer. Embodied changes included erectile difficulty, decreased desire, and difficulty with orgasm; such changes were associated with higher rates of depression and anxiety, and lower relationship satisfaction. The use of medical aids to minimise the impact of erectile difficulties was shaped by discursive constructions of ‘normal’ masculine sexuality which emphasised penetrative sex, for both heterosexual and gay men.

However, the majority of men reported accepting the changes to their sexuality post-cancer, normalising them as part of the natural ageing process. Re-negotiation of sex or intimacy was reported by 30% of participants, reflected in three themes identified in the qualitative analysis: Resisting the Coital Imperative: Re-defining ‘Sex’; Resisting the Coital Imperative: Embracing Intimacy; Adopting the Coital Imperative: Refiguring the Body through Techno-Medicine. The importance of relational context was reflected in the theme: The Inter-subjective Nature of Sexual Re-negotiation: Relationship Context and Communication. Whilst previous research has focused on embodied changes associated with sexuality after cancer, or their psychological consequences, the findings of this study suggest that hegemonic constructions of ‘sex’, in particular the coital imperative, where sex=penetration, are central to the experience and negotiation of sex and intimacy after cancer. Resistance of the coital imperative should be a fundamental aspect of information and support provided by health professionals who seek to reduce distress associated with sexual changes after cancer.