September 25, 2008

Dr. John Mulhall has devoted much of his working life to studying and treating the sexual difficulties associated with prostate cancer and its therapy. He is currently Director of the Sexual and Reproductive Medicine Program in the Division of Urology at the Memorial Sloan-Kettering Cancer Center of New York. Widely acknowledged as a world authority on sexual rehabilitation following treatment for prostate cancer, Mulhall is the author of over 150 papers in medical journals, numerous book chapters, and the medical text Sexual Function in the Prostate Cancer Patient. He reports that, in his practice at Memorial Sloan-Kettering, he sees more than 600 radical prostatectomy patients, approximately 150 radiation patients, and about 100 hormone therapy patients each year. They are all interested in pursuing improved sexual health following a prostate cancer diagnosis and treatment.

Yet, according to Mulhall, "The simple fact of the matter is that most physicians and patients do not talk about sexual health in a routine medical interview." Sometimes, he suggests, doctors treating men who have prostate cancer shy away from discussing in detail various of the possible side effects or complications of particular treatments. Their main initial focus is to save their patients' lives, of course. But an information gap is often the result. Consequently, Mulhall sees a need for solid, credible information, communicated in plain English, about the possible impact of prostate cancer on sexual function and on what options are available to treat sexual dysfunction and help men and their partners overcome the sexual problems associated with this disease and its treatment.

His book Saving Your Sex Life: A Guide for Men with Prostate Cancer fits the bill. It is "aimed at giving you state-of-the-art, up-to-date, comprehensive information on the impact of prostate cancer treatments on your sexual function and what options are available to you for the treatment of such sexual problems," writes Mulhall.

Chapters describe the basics of male sexual function, the connection between prostate enlargement and sexual dysfunction, the impact of a prostate cancer diagnosis on sexual function, and the possible effects of radical prostatectomy, prostate radiation, and hormone therapy on sexual function. Mulhall continues by examining various options available to avoid or treat sexual dysfunction, including penile rehabilitation and preservation, drugs such as Viagra, intra-urethral suppositories, penile injections, vacuum devices, penile implants, and other emerging therapies.

His book is comprehensive and has obviously been written to answer the many questions patients have asked him in the course of his practice. "Why am I experiencing urine leakage during sex?" "Can I still father children?" "My penis seems shorter now. Is that normal?" "What are the risks of testosterone supplementation?" Mulhall's direct, open, and intelligible answers are obviously the result of considerable experience and research, and they convey the doctor's concern for his patients as well as his very effective "bedside manner." Here is a sample:

It is surprising to me how many men come in to see me after radical prostatectomy who are not aware that they will not ejaculate again. While some physicians may not tell their patients about this, there are patients who are so stressed before surgery that they simply forget what was told to them. Remember that semen is produced by the seminal vesicles predominantly, yet also by the prostate, while the minority of semen is actually sperm from the vas deferens. The prostate and seminal vesicles are removed at the time of radical prostatectomy, and therefore, these men can never ejaculate again. They are, in fact, completely sterile. After radiation therapy, there is a chronic scarring of the prostate and ejaculation ducts, such that most men three to five years after radiation do not ejaculate semen at all. So, for a man who remains interested in future fertility, it is important that he banks sperm prior to the procedure. Banking sperm is a process by which a man masturbates into a cup and the semen is then examined and frozen (cryo-preserved) for future thawing and use down the road. (p. 121-122)

As you can see, the prose is easy to understand, and there is no dithering or avoidance of the facts. A man is left with concrete solutions: e.g., if you are interested in fathering children, bank sperm. Dr. Mulhall's book is an excellent resource for men with prostate cancer and their partners. It answers all those questions about sexual function after prostate cancer diagnosis and treatment that men and their loved ones may not have asked.

The book is available at fine bookstores everywhere. For more information, consult the publisher's website