Sexual Activity

The idea that prostate cancer may be caused by specific forms of sexual activity has a puritanical appeal, especially for people who believe that sex was bestowed on humankind exclusively for procreation, not recreation. Conversely, the idea that prostate cancer is caused by sexual activity may also appeal to men inclined toward hedonism, cancer thus becoming for them a badge of a life well lived, a paean to Priapus.

The possibility that certain forms of sexual activity may lead to prostate cancer has been downplayed by many. One expert claimed that ''there is no good reason to believe that having an active sex life could stimulate the prostate to grow, or cause prostate cancer.''23 Another wrote that ''studies attempting to demonstrate a link between prostate cancer and various sexual issues have universally struck out.''24 These conclusions are surprising, given the number of studies that have reported associations between specific sexual activities and the development of prostate cancer.

One example is sexually transmitted diseases. Between 1971 and 2000, thirty-eight studies on STDs and prostate cancer were published. One summary of this research concluded that ''the data suggest an elevated relative risk of prostate cancer among men with a history of sexually transmitted infections.'' Another reasoned that ''the available epidemiological evidence does support a possible link between STDs and prostate cancer.'' Some of the studies reported having had sex with prostitutes as a risk factor. Others focused on the lifetime number of female sexual partners. For example, a study of 753 men with prostate cancer in Seattle reported that ''risk estimates increased directly with a lifetime number of female sexual partners''; men with fifteen or more partners lifetime had approximately twice the risk of developing prostate cancer as men with only one partner.25

Not all studies have, however, confirmed these results, and some contradict each other. Some report an early age of first intercourse to

I Wouldn't Change a Thing

It's not unnatural for the patient to think that it's sex that is killing him and to go back over his amatory history for clues. And of course this is splendid material for speculation, both lyrical and ironical. I'm tempted to single out particular women and particular practices that strike me now as more likely to be carcinogenic than others. Coitus interrup-tus, which was widely practiced before the Pill, seems a likely suspect, and oral sex comes to mind as putting greater strain on the prostate. But after saying this, I want to make clear that I certainly don't hold my cancer against these women-whatever I did, it was worth it. I have no complaints in that direction. I wouldn't change a thing, even if I had known what was coming.

—Anatole Broyard, Intoxicated by My Illness be a risk factor, similar to the findings for cervical cancer in women, but other studies do not corroborate this. Nor do researchers agree on what should be measured: frequency of intercourse? frequency of ejaculation? frequency of sex in specific age periods? number of partners? number of extramarital affairs? episodes of STDs in the man? STDs in the partners? exposure to prostitutes? use of condoms?

A possible problem is bias in data collection: Do men with prostate cancer exaggerate their sexual activity when asked about it retrospectively, after they have been diagnosed with cancer? A 2005 study of this question reported that men do not exaggerate the age of their first sexual activity or the lifetime number of their sexual partners.26 Another problem has been reliance on a single study of Catholic priests that reported their prostate cancer rate to be slightly higher than that of nonpriest controls.27 Under the assumption that priests are celibate, this study has been widely cited as having proven that sexual activity is not a cause of prostate cancer.

There are ways around these methodology problems. For example, in one study showing that having had syphilis or gonorrhea increased chances of getting prostate cancer, researchers also collected blood specimens from the subjects and confirmed their history of syphilis by measuring antibodies in the blood.

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