SAVING YOUR SEX LIFE
A GUIDE FOR MEN WITH PROSTATE CANCER
John P. Mulhall, M.D.,
Director, Sexual and Reproductive Medicine Program,
Division of Urology, Memorial Sloan-Kettering Cancer Center
C-I-ACT, Inc., POTOMAC, MARYLAND
© 2010 by John P. Mulhall
C-I-ACT Publishing
Direct all correspondence to:
C-I-ACT Publishing
P.O. Box 34188
Bethesda, MD 20827-1388
301-983-9702
Published in eBook format by eBookIt.com
ISBN-13: 978-1-4566-0339-7
Notice: The information in this book is true and complete to the best of the author’s and publisher’s knowledge. This book is intended only as an informative reference and should not replace, countermand, or conflict with the advice given to readers by their physicians. The authors and publisher disclaim all liability in connection with the specific personal use of any and all information provided in this book. References to real people, events, establishments, organizations, or locales are intended only to provide a sense of authenticity and are used fictitiously.
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage or retrieval systems, including digital systems, without written permission from the publisher, except by a reviewer who may quote brief passages from the book in a review.
Images by Tony J. Riley
Praise for Saving Your Sex Life
“Dr. Mulhall has written the authoritative guide to erectile dysfunction for the layperson. This book provides understanding and guidance for the man, couple and doctor. Especially valuable for patients are the in-depth discussions of every form of treatment, their use, benefits and cautions. An easy-to-read book about a complex subject.”
—Barbara and Ralph Alterowitz
Authors of The Lovin’ Ain’t Over and Intimacy with Impotence
For Cameron—my son—who has been a source of joy and inspiration for every day of his almost 7 years
For John—my grandfather—whose leadership, compassion and fairness touched all he met—a role model each day I strive to emulate
ACKNOWLEDGMENTS
No work of this nature can be accomplished alone. While this book has been written by me, many of its chapters have been reviewed by internationally recognized experts. For the past six years, I have had the distinct honor and privilege of practicing sexual and reproductive medicine at Memorial Sloan-Kettering Cancer Center in New York, a center that I believe offers the best cancer care anywhere in the world. I would like to thank the leadership at Memorial Sloan-Kettering Cancer Center for allowing me to develop a sexual and reproductive medicine program within the Division of Urology, where much of my focus has been the management of patients with sexual problems after prostate cancer treatment. In particular, I would like to acknowledge Dr. Peter Scardino, whose book Dr. Peter Scardino’s Prostate Book I have used as a reference for this book. I would also like to thank Dr. Scardino for his unerring support and vision in the development of a sexual and reproductive medicine program at MSKCC. I believe that this program over the course of the last six years has made a difference in many people’s lives.
I would like to thank Dr. James Eastham and Dr. Jonathan Coleman of the Division of Urology, for reviewing the chapter on radical prostatectomy. These two highly recognized surgeons have made sure that the information on surgery is both accurate and up-to-date. I would like to thank Dr. Michael Zelefsky and Dr. Marisa Kollmeier from the Department of Radiation Oncology for their review of the chapter on radiation therapy. While I see many patients who have had radiation therapy, I am not a radiation oncologist and they have ensured accuracy of the information presented.
I would like to thank Dr. Michael Morris, an expert in the management of advanced prostate cancer, for reading the chapter on hormone therapy. I owe a debt of gratitude to Chris Nelson PhD, a clinical psychologist, for his review of the chapter on sexual intimacy. I have had the distinct pleasure of working with Dr. Nelson in my daily clinical practice for the past 5 years. Joe Narus, nurse practitioner on the sexual & reproductive medicine team and the coordinator of the penile rehabilitation program, graciously and expertly reviewed the chapter on penile injection therapy.
I would like to thank Mrs. Vicky Frohnhoefer for her expert transcription of this manuscript, Rockelle Henderson from Hilton Publishing, and Clarence Haynes, whose insightful editing has helped me deliver critical and often complex medical information in a reader-friendly way.The illustrations drawn by Tony Riley BFA, a medical artist at Memorial Sloan-Kettering speak for themselves. Many thanks to him for the beautiful images.
Mention must be made of some of my mentors. My introduction to Urology occurred during my earliest years as a surgery resident in Ireland under Professor John Fitzpatrick at the Mater Hospital in Dublin. Indeed, it was Professor Fitzpatrick who encouraged me to seriously explore Urology as a career. I am forever grateful to him for his guidance. My career in the United States started under Dr. Myron Walczak, then Chief of Urology at the University of Connecticut Medical Center. While he has since passed away, I am eternally grateful to him for his foresight and guidance. My original interest in sexual medicine was inspired by Dr. Jim Graydon at Hartford Hospital, while my sexual medicine training was conducted under Dr. Irwin Goldstein and Dr. Robert Krane (RIP) and my infertility training under Dr. Robert Oates, all three of whom were at Boston University Medical Center. I would like to thank Dr. Robert Flanigan from Loyola University Medical Center for his mentorship during my early years as an academic urologist. It was he and his patients who sparked my interest in sexual health following the treatment of prostate cancer.
I would like to recognize the physicians and surgeons, famous and not-so-famous, who have contributed to the field of prostate cancer treatment over the course of the last 50 years. We must not forget those physicians whose shoulders we stand on, who have made great efforts and sacrifices before our time. I am also indebted to my sexual medicine colleagues alongside whom I have worked over the course of last decade. Your curiosity in and critique of my research has only made me a stronger surgeon-scientist.
I would like to pay particular tribute to two such scientists who have been a source of great inspiration to me, namely Dr. Irwin Goldstein and Dr. Tom Lue. These founding fathers of modern sexual medicine within urology have been a constant driving force for me in my efforts to conduct the best research and to deliver the best clinical care to patients.
I am indebted also to my clinical and support staff at Memorial Sloan-Kettering Cancer Center, especially all of the nurses/nurse practitioners with whom I have had the privilege to work. They have worked tirelessly to educate and support my patients. I would also like to thank the residents and fellows that have trained under me, for working with me to construct and refine the penile rehabilitation program.
Finally, I would like to pay tribute and offer my sincerest gratitude to the patients whom I cared for over the course of my 12 years in the practice of sexual and reproductive medicine. I have strived to offer nothing short of the best, most state-of-the-art medical care, and this has been driven by their honesty, by their needs, by their curiosity and inquisition. I believe that at Memorial Sloan-Kettering Cancer Center, the Sexual & Reproductive Medicine Program has made large contributions to the field of medicine over the course of last several years and this is in no small part due to these patients.