Male coping with cancer-fertility issues: putting the ‘social’ into biopsychosocial approaches

Biopsychosocial approaches in infertility and cancer services and research pay limited attention to ‘social dimensions’. Additionally, existing cancer-related male infertility research is dominated by sperm banking studies even though fertility-related social concerns in the long term are reported to have an adverse effect on wellbeing. This paper considers whether social influences affected the fertility-related experiences of 28 men interviewed as part of a mixed-gender qualitative study of ‘South Asian’ and ‘White’ cancer survivors and their professional carers. Findings are reported under: managing stigma; sexuality and virility; ambiguity in fertile status; relationship to sperm; and meaning of fatherhood. Gender and other social influences were ambiguous, fluid and subtle – yet powerful. Combinations were neither standard nor static, indicating the dangers of practitioners stereotyping, and/or assuming homogeneity of, (in)fertile men and being unaware of their own socialized expectations. Social structures and attitudes towards valued male social roles as well as the men’s psychological capacity and bodily state appear to affect experience. Men may more readily be engaged if practitioners proactively attend to the impact of social concerns, including employment and financial matters, on their perceived capacity to be fathers as a route into raising issues of sexuality and fertility.Biopsychosocial approaches in infertility and cancer services and research pay limited attention to ‘social dimensions’. Existing cancer-related male infertility research is dominated by studies of sperm banking processes among younger males, even though longer-term fertility concerns are reported to also have an adverse effect on wellbeing. This paper analyses social influences on 28 men interviewed as part of a mixed gender qualitative study of fertility-related experiences of cancer survivors of ‘South Asian’ and ‘White’ origins and their professional carers. Men were affected not only by their psychological capacity and bodily state but also by social structures and attitudes towards valued male social roles, in particular those of virile man and fatherhood. The Findings are reported under five areas: managing stigma; sexuality and virility; ambiguity in fertile status; relationship to sperm; and meaning of fatherhood. Gender and other social forces were experienced as ambiguous, fluid and subtle – yet powerful. Combinations were neither standard nor static across respondents. This suggests it is unhelpful if practitioners make assumptions about the reactions and experiences of (in)fertile men, including in relation to gender, ethnicity, religion or social class. In addition, practitioners and researchers need to be alert to their own socialized expectations of others and of themselves. Men may more readily be engaged if practitioners proactively and routinely ask about traditional male concerns such as employment and finance – often heightened by cancer experiences and linked to valued social roles of fatherhood and being an economic provider – prior to, or alongside, raising issues of sexuality and fertility.