Transitory masculinities in the context of being sick with prostate cancer*

Objective: to interpret the meanings attributed by men with prostate cancer to the experience regarding their bodies and masculinities during illness. Method: ethnographic research with 17 men, guided by the narrative method and theoretical framework of medical anthropology and masculinities. The information was collected through recorded interviews, direct observation and field diary records, which were analyzed by inductive thematic analysis. Results: men undergo body and identity transformations when they get sick with prostate cancer, transiting through multiple masculinities, resigning their actions, and occupying subordinate positions in relation to other healthy bodies, which are marginalized in their social relationships and allied with regard to establishing their affective relationships. Conclusion: this evidence enhances and deepens the knowledge disclosed in the literature and contributes to the strengthening of nursing care actions when dealing with the sick.


Introduction
According to US statistics (1) , one in six men in the world will be diagnosed with prostate cancer (PC) during their lifetime. Regardless of population color and ethnicity, the disease still prevails as a silent threat to the Latin men's health as the third cause of death from noncommunicable -or chronic -diseases (1) . For the biennium 2018-2019, there are estimated 66,120 new cases per 100,000 Brazilian men, and the incidence is six times higher in developed countries, such as the United States, Canada, and England (2) .
The cure for PC is a phenomenon investigated from multiple scientific perspectives and each year new discoveries are evidenced. Parallel to this pursuit, the experience of surviving or living with the disease is still a field to be strengthened for the improvement of new techniques of care and implementation of public policies. Researchers (3) recognize that treatments for PC, except for vigilance, usually result in unpleasant side effects that end up leaving men vulnerable to aspects that involve their masculinity. These effects include sexual dysfunction, changes in body image and social stigma experienced by almost all those submitted to prostatectomy (3)(4) .
Faced with male vulnerability resulting from the treatments, men undergo transformations in their bodies and social identities during their lifetime. As much as the transition is a natural process for humankind, being ill intensifies this phenomenon and provides new experiences in the way they face the disease (5) . Thus, understanding the male transitions that occur due to PC is extremely relevant to strengthening treatments, education and research directed at this population.
The scientific literature has evidenced gaps regarding the knowledge of the subject. To illustrate this question, a qualitative meta-synthesis (6)  The filters used were human studies, with qualitative methodology, in English, Spanish, and Portuguese.
After finding and reading the titles, abstracts and results, the data were extracted and synthesized by two different researchers, who evidenced that among the 21 references selected, discussions about men's health issues related to sexuality, diet, prevention, diagnosis and treatment prevailed, but the transitions occurring in the body and masculinities during the disease were not included in this context.

Method
This is an ethnographic research guided by the narrative method and theoretical framework of medical anthropology (7) and masculinities (8) .
This approach is justified since it allows the researcher to use multiple techniques of data collection (triangulations), such as participant observation, interview, field diary records, and document analysis, thus composing a structured field, presupposing the organization and hierarchy of the elements of its content (9) . The method also enables the constant interaction between narrator and listener through the hermeneutic circle, proper to its rigor, as a constructive characteristic of the narrative (horizon fusion) that allows the researcher to reach information on culture that is not only rooted in verbal experiences, but rather in actions, with emphasis on the transformations of life (10)(11) .
For medical anthropology, the disease is not just a biological/body process, but the result of the influence of the cultural context and of the subjective experience indicating that the body is in trouble (7) .
For the anthropology of masculinities, the theory that observes the positions of power established in gender relations, health and disease are mediators of the practices by which men and women commit themselves to the masculine and feminine places in society and their effects on culture and corporal experience (8) . were selected to participate in the study for meeting the pre-established criteria.
In this study, the data were collected by the first After data collection, individual narrative syntheses were constructed followed by collective narrative syntheses to better understand the experiences reported.
The scripts were then submitted to inductive thematic analysis (12) with integration of similar and particular aspects of the narratives, presented as a thematic narrative synthesis, which is presented in italics as the primary interpretation, literally as they were produced, besides exemplifying the authors' analysis.
In the fieldwork, it was assumed that the man sick with PC had the experience to be known, that is, the primary understanding. Ethnographic work was focused on this man, and his experience was learned through interviews, observations, field diary records, and reflections, besides time spent with him. The data obtained were then transcribed and codified to become explanatory and this text was analyzed, there being reflection on its parts and on its whole in order to understand the meanings expressed in the script. In the process, the interviewees were consulted again to strengthen the investigation whenever new knowledge gaps emerged and there was need of further explanation to compose their experiences. When doubts were resolved (until that moment), the men's experience text was submitted to thematic analysis, which through induction, characteristic of its rigor, allowed fusing horizons (union of common sense with scientific knowledge) and constructing, in an explanatory way, the scripts of their experiences through stories narrated, which were presented to the interviewees for validation, thus getting the meanings, that is, a secondary understanding of the facts. However, even after all this process, during reflexivity, if the parts did not fit the whole and the whole did not fit the parts of the text, men were consulted again to clarify doubts and obtain new perspectives that helped learn more about their experiences and structure a comprehensible explanation of their narratives. This coming and going with the sick, with the analysis, with the narratives and with reflexivity was present during all stages of this research, and access was only possible because the hermeneutic circle was adopted as a guide for authors' actions.

Results
The group of participants consisted of 17 men    Anchored in sexual dysfunction, anorgasmia was also present as liminality in the narrators' experiences.
Semen was understood as a passport, an identity that every man has and needs to prove during the sexual act.
For the narrators, losing ejaculation was like losing a part of themselves, considered an embarrassing process that hurts their identities and hinders their marital and

Discussion
Researchers (13)(14) state that the body's disease process undermines the maintenance of hegemonic masculinity, as it presents dilemmas in identity, including subordination, passivity, recognition of emotions, and Faced with the globalizing process that permeates male culture, masculinities never occupy the same position within the patchwork; they are always allocating, modifying and adding new meanings through experiences (8) . In this perspective, it is interpreted that the meanings presented in the it was understood that this narrative has the identity transition as its central meaning.
Transition is an anthropological concept that occurs throughout the various phases of an experience and implies a change or logical reaction to an event (5) . It is a concept where the feeling of uncertainty and disturbance of identity is shared, as people transit in a space where they do not identified with one thing or another, or perhaps identify with both at the same time, since the identities do not more easily fit into categories and simply transit (15) . Process, perception and disruption are universal characteristics of the transition, which has the ultimate goal of achieving a well-being status (15)(16) .
The transition process is dynamic and multiple within an experience and can be classified into four types: situational, health/disease, organizational and developmental (15,17) . It is pointed out that this study was focused on the health/disease transition, as it is Transformation converges to a situation in life and transition is the experience related to this situation, that is, the transformation can occur outside a phenomenon and the transition can only occur by experiencing this phenomenon (18) . From this perspective, it is possible to say that not every transformation generates a transition, but certainly every transition, whether granted or not, generates a transformation.
As a science, nursing advances with the help of various philosophical approaches, because the profession assumes the perspective of the transitions resulting from the health and disease process, as well as from other life phenomena. Providing assistance to others who deal with changes in their body and well-being is under nurses' competence (15,17) . Therefore, it is pointed out that it is paramount to identify and characterize the transitions that men live in the course of their lives, so that later it will be possible to develop a plan of care individualized to real needs.
Whether from the health disease process, from the masculinity or even from the social process, the meaning of transition translated the experience of men in this study and accompanied them in times of identity crisis, where recognizing themselves and keeping on living became a constant process of resignification of reality.
From the perspective of common sense, resignation receives a conceptualization equivalent to accepting, allowing or agreeing with something. However, under the lens of anthropology, resignation is a sense of tension that individuals experience between fighting for something or simply giving up (19) . Faced with this situation, they become powerless, as they no longer have the necessary elements to influence their future and reach a possible or visible exit. Thus, being resigned is an acceptance process when experiencing an adverse situation even when it requires changes that are only possible at a great price or risk, and these changes are not necessarily desired by those who assume them (20).
In the context investigated, it was evidenced that male identities resigned to the experience of the disease, as they did not connect with the precepts of hegemonic masculinity, despite recognizing it as a pattern to be followed. By resigning, men felt oppressed by their own feelings and had difficulty managing their male identities.
Faced with a disease such as cancer, recognized for being stigmatized, mutilating, which generates uncertainties and responsible for triggering so many changes in the biological and social body, men stand "between a rock and a hard place," that is, they either However, because it is a research that evidenced local masculinities, it is noteworthy that it has limitations, since it summarizes the experiences of men inserted in a given culture, and masculinities influenced by a multiple culture. Other masculinities coexist at regional and global levels, which relate to those presented, which would broaden the understanding of the phenomenon studied.

Conclusion
The narratives allowed evidencing that PC provides the sick with liminalities in the experiences in dealing with sexual dysfunction, urinary incontinence, identity crisis, loss of hegemonic masculinity, among others.
Faced with these complications, the man who was strong and virile became a dependent and isolated man who logically reacts to the disease by transforming into a new man. From this perspective, it is concluded that man is able to go through multiple masculinities in the search for preserving his male status.