Posts Tagged ‘impotence’

came to the desert for my ship to come in, no jacks or queens nor kings will make this losing hand win…i’m leaving las vegas

A bald patient of mine a few weeks ago told me, ” I don’t waste my testosterone on hair!” 


Do bald men face higher risk of prostate cancer?

Updated: May 22, 2012 3:01 PM EDT


© iStockphoto.com© iStockphoto.com

By Barbara Bronson Gray
HealthDay ReporterTUESDAY, May 22 (HealthDay News) — Got hair? If you don’t, you might have a higher risk of prostate cancer, a preliminary study suggests.Researchers are reporting that bald men who underwent biopsies of the prostate were more likely to have cancer than were those with more hair on their heads.

“Bald men should be aware that they may benefit from being screened earlier and perhaps, if necessary, from being biopsied sooner,” said study author Dr. Neil Fleshner, a professor of surgical urology at the University of Toronto. “In the study, the more bald people were, the more likely they were to have prostate cancer. We’re 95 percent sure this is real.”

However, not all doctors are ready to embrace the study’s conclusions.

The possible association between male pattern baldness and prostate cancer has been considered in previous studies.

Although the precise mechanism isn’t understood, researchers think male hormones known as androgens may play a role in both baldness and prostate cancer. Androgens, which include testosterone, can inhibit hair growth and trigger the development of prostate cells.

It’s thought that the androgen dihydrotestosterone (DHT) increases in bald men, causing the hair follicles to shrink gradually. As the follicles get smaller, the hair weakens and eventually stops growing. DHT also has been implicated in the development of prostate cancer.

The U.S. National Cancer Institute estimates there will be more than 240,000 new cases of prostate cancer this year. The prevalence of baldness increases with age, and it affects about 40 million men in the United States.

The research was scheduled for presentation at a news conference Tuesday at the American Urological Association annual meeting in Atlanta.

The study involved 214 patients aged 59 to 70 years old with elevated prostate-specific antigen test numbers (averaging 5.8). The men had all been referred for a prostate biopsy. Baldness was assessed on a four-point scale — just in the front, just a little on the top, moderate top and sides and severe top and sides — before the biopsy was taken.

The more severe a man’s balding pattern, the more strongly it was associated with a positive biopsy.

Men with a normal PSA were not included in the study, which found an association between baldness and prostate cancer risk, but did not prove a cause-and-effect relationship.

The researchers also sought to determine whether there is a relationship between the relative length of a man’s index and ring fingers and the diagnosis of prostate cancer, a question raised by previous studies. Some researchers have thought that the level of sex hormones in the womb could prenatally affect both finger length and predisposition to prostate cancer. No association was found in this study, however.

Dr. Nelson Stone, a clinical professor of urology and radiation oncology at Mount Sinai School of Medicine in New York City, questioned the potential value of the baldness study.

Stone said the researchers should have tested for hormone levels to see what association, if any, the amount of testosterone and DHT had on the diagnosis of prostate cancer.

“The incidence of baldness goes up with age, and we know that testosterone levels fall with age, and we still don’t know why,” he said.

Complicating the issue is also the question of whether the men with a positive biopsy had predominantly aggressive or nonaggressive forms of prostate cancer, Stone said.

Dr. Tobias Kohler, public liaison to the American Urological Association, said that, with or without hair on their heads, men can’t relax about prostate cancer.

“There is a link between baldness and prostate cancer, but it could be due to some other factor — perhaps something in the environment or something genetic, ” he said. “I would approach this study with caution.”

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

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you catch more flies with honey than you do with vinegar


Prostate removal surgery and sex: ‘Very few men… are the same as before’


Incontinence, impotence two possible side effects

By Denise Ryan, Vancouver Sun September 30, 2010 Comments (7)
Francine Hardaway and her husband, the late Dr. Gerry Kaplan.

Francine Hardaway and her husband, the late Dr. Gerry Kaplan.

Photograph by: Courtesy, Family

VANCOUVER – Francine Hardaway, an entrepreneur and tech guru, said love came upon her powerfully and unexpectedly.

“He was my boyfriend,” she says in a phone interview from Phoenix, Ariz. Her voice bursts with pride and pleasure when she says “boyfriend,” as if he was, and is, the very first.

She was divorced, and in her late 40s. Her hairdresser introduced her to Dr. Gerry Kaplan, a radiologist.

He was 57, also divorced. Kaplan was tall, intellectual and free-spirited.

They fell wildly in love. They had sex like teenagers.

There was just one thing. “He showed up on one of our dates and said ‘I just had a biopsy’.”

He downplayed it. He’d had rising PSAs, he explained. “He had gone to a urologist friend, who had not found anything and he let it go.”

A year later his prostate-specific antigen count had doubled.

Again, he waited.

The third time a biopsy detected prostate cancer.

For her, it was simple: Get the cancer out.

“I knew that people had surgery, and that surgery could work,” Hardaway said.

She couldn’t understand why he had delayed.

Then, it came out: “I could end up not able to get an erection.”

She pleaded with him. “Think of me. Think of your children. Your work.”

In reply, Kaplan blurted out, “Marry me.”

Hardaway was taken aback. “What does that have to do with it?”

Kaplan, utterly vulnerable, replied, “You’ll go away because I’ll be impotent. I’ll be all alone.”

Hardaway didn’t hesitate. They married, and Kaplan had surgery a week later.

Prostate cancer throws mortality and sexuality in the ring together: If you win your life, you could lose your erection.

“If a man is sexually active and it’s a big part of his life, it’s critically important. It’s a big part of what we talk about,” said Dr. Larry Goldenberg, founding director of the Prostate Centre at Vancouver General Hospital.

After a prostatectomy — the complete removal of the prostate gland — Goldenberg said, “There are very few men who are the same as before.”

The effects of surgery can range from mild loss of erection and pain on orgasm, to total loss of erection and incontinence.

“It’s almost impossible to predict,” Goldenberg said.

The good news, says Goldenberg, is that advances, such as earlier diagnosis and nerve-sparing surgery, have changed outcomes for men.

“With better treatments, we have higher chances of maintaining sexual function.”

He compares the nerve-sparing surgery to peeling the skin off an onion. “We peel the nerves off the prostate, it’s very delicate. Then we remove the prostate, reconnect the urinary bladder to the urethra.”

Nerve-sparing surgery cannot be done when cancer is detected close to the nerves.

The first priority, says Goldenberg, is to get all the cancer out. The second priority is to maintain urinary function.

The third priority is to maintain sexual function.

Often it is not until after surgery that sexual function moves front and centre.

Still no erection

Glen, 64, a Vancouver computer programmer, was diagnosed four years ago with an aggressive form of prostate cancer.

Nerve-sparing surgery was out of the question, and due to complications, part of the penile shaft was removed.

“You look down and go, holy smoke. It’s short. I was left with about a half-inch of male tool,” he says. “You feel like your manhood’s gone.”

Glen was angry. His wife tried to be encouraging, but that only made things worse. “She was talking to others, telling me erections come back. That was so hard to deal with.”

What got them through, he says, was acceptance.

“Once we accepted that the erections were not going to come back, we could move on.”

Snuggling and being close has really helped, he says.

“And we use a strap-on,” he says, somewhat mischievously. “We do it that way, which is pleasing to her.”

Jeff Jarvis, renowned American author and blogger, is fully out of the closet with his prostate cancer. He will take part in a live chat today at noon at vancouversun.com.

Diagnosed a year ago, he has blogged about the indignities big and small: having a “mondo stapler shoved up my ass” during the biopsy; picking up Viagra and pads to deal with incontinence; a helpful pharmacist who yelled out across the store, “Is he gonna need the diapers, too?”

Jarvis has fearlessly opened the door to the male kitchen and invited the public in.

A year after surgery, he still has not had an erection.

Going public with his experience, he hopes, will encourage other men to get tested and stay healthy.

This is his “small mitzvah,” for the luck he has had: He has been declared “cured.”

“It is very freeing to be oneself,” Jarvis said in a phone interview from New York.

“Erections are an odd thing, especially not having them. I still don’t.”

Jarvis considers himself lucky. “My grandfather died of this disease. I can rationally remind myself of this.”

He compares looking down at his unresponsive penis as a kind of out-of-body experience.

“Some people get some action back in a few months, but I’ve had nada. Absolutely no response. It’s a bit infantilizing. The thing hasn’t been like this in 50 years.”

The only “malfunction” he’d ever had before, says Jarvis was “once in a hot tub in Montreal.”

“Here’s the full humiliation,” he added. “I got the penis pump and even that doesn’t work for me.”

Jarvis, who is married with two children, is remarkably free of embarrassment.

For him, going public has been liberating, and forced him to engage with the very meaning of what it is to be a man.

“We men spend our lives being led around by our penises,” he said. “No longer.”

Francine Hardaway said that when her husband awoke from surgery, she knew he was going to feel sexually compromised.

“I got up into his bed and did some things that were gestures of solidarity for him,” she hesitates, her voice full of emotion.

“I got into his bed and started performing fellatio. He still had the catheter in. I wanted him to see, look, I am not afraid of this. This is not going to make a difference.”

Hardaway’s gesture may seem surprising, but there is a medical, not just an emotional, reason to stimulate the penis as soon as possible after surgery.

“I operated on a man yesterday,” Goldenberg said. “I started him on Viagra last night.”

Blood flow to the penis allows oxygen into the area, keeps tissues healthy, prevents atrophy and helps men recover sexual function.

“If you don’t use it, you lose it,” Goldenberg said.

Penile rehabilitation is part of the deal.

Help is available

Shannon Griffen, a sexual health clinician, said she encourages men to bring their partners to appointments where erection enhancement is discussed.

“Some of the men I see are of the mindset that ‘It’s my problem, my concern, I’ll take care of it,’” Griffen says.

“When a couple has gone through something like this they need to be more verbal, have more communication.”

Men experiencing failure with erections may withdraw from their partners; partners not wanting to pressure their husbands may also withdraw sexually.

“Couples that have been together 35 years and want to resume their sex lives now have to ask, ‘How do we do that?’ There’s shyness and discomfort,” Griffen said.

“You learn a whole lot about sex as a result of having prostate cancer,” said Alan, who was diagnosed at the age of 62.

After surgery, he experienced a year of erectile dysfunction, bladder spasms, physical pain and inner turmoil.

“We had been screwing each other regularly and enjoying it,” he says about his relationship with his wife.

“I found myself living under a dark cloud.”

Alan regrets not getting sexual counselling more quickly, but he said, “After a diagnosis, all your psychological bearings have changed. You’re vulnerable, your future is unknown, you have choices to make but not enough information to make them.”

Attending a support group and going online helped.

Alan had a poor response to Viagra, but has had great success with intracavernosal (penile) injections.

“It used to be, ‘Get the condom out of the drawer.’ It’s changed to, ‘I’m going to do the injection now.’ At 25 this would have been a real problem. At 65 you can get used to a lot of things.”

Although sex has changed, “orgasms feel different, but they are still orgasms,” Alan said.

“If you think about sex with your wife as being able to stick it in, then you’re in trouble,” he said. “If your manhood is more broad-based and sexuality is about mutual pleasure, you’ll do better.”

Hardaway’s husband did not recover erections. They found all sorts of ways around that. “I didn’t care, but he did. He decided to get a penile implant.”

She told him it was his decision. He got the implant, which left him semi-erect all of the time, and he was happy with it.

Sadly, the cancer metastasized, and five years later, he died. Had he been more proactive and less fearful, Hardaway believes “absolutely” that the outcome would have been different.

“Jeff Jarvis is a hero,” she said. “Men man up and don’t talk.”

Her husband, she said, had that “one Achilles heel.”

“But you don’t say this sucked, because I only had it for five years.”

The words pour out of her as she recalls the love she lost too soon. “You learn from each other, you leave each other alone, you have dinner, you sleep together, you comfort each other. Some people never get that. I nearly missed it.”





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the dog that trots about will find a bone

Dr. Jo-an Baldwin Peters (PhD) is conducting a survey on sexuality in regards to the prostate cancer survivor and the partner of a survivor. Judging by the search queries that my site gets, questions about sexuality after prostate cancer treatment, particularly prostatectomy, is an area of intense concern. There is very little written about it and I would think Dr. Peters’ work and the assimilation of the responses to the online survey will be ground breaking and helpful in the decision process. Below are some examples of the answers to the issue of ” penile size.” What you read in between the lines is that many patients are “surprised” to learn of the sexuality issues after treatment. This means that either the doctor or the patient did not do their job. I think patients over-value the ease of brachytherapy  and forget the potential for the side effects common of radiation, particularly its effect on sexual function. In a similar fashion, more and more patients are choosing the robotic prostatectomy and are enamoured with the “robot” and the faster “physical recovery” but fail to investigate the innate consequences of removing the prostate its attendant effect to the nerves responsible for erections. Dr. Peters’ survey will teach us all a lot but it will also serve as indispensible tool in the decision-making process. As a radiotherapist friend of  mine said to me one time about all the treatments, ” John , there ain’t no free ride.” It’s better to know that up front than to figure it out after ” The Decision.” The results of this survey and its availability to patients is going to help immensely.

Can penile length be preserved after radical prostatectomy?-Very nice discussion

Dr. Jo-an Baldwin Peters’ survey

Example responses

69 10/23/2009 20:04

After the first year (post-operative) I started to get erections and enhanced them using Viagra. The differences between sex prior to prostatectomy and post were a huge shock ! The surgery had reduced the size of my penis – erections were not si strong – orgasm was “strange” and sometiomes painful ( I could feel nerve pain ) and the lack of the ejaculatory sensation was disappointing. Most dramatic is my loss of libido – I think largely because I remain incontinent the whole issue of sex – desire and comfort – is diminished. We had a great sexual relationship – vigorous, creative, frequent and important to both – and I know that I have subliminated my sex drive due to three main issues: a) incontinence b) penile size and strength c) loss of orgasmic sensation ( meaning the sensation I experienced prior to surgery – )

90 11/19/2009 4:48

My partner and I were not terribly sexually active prior to my being diagnosed with prostate cancer. Having prostate cancer and being treated for it simply eliminated sexual activity from our lives. I am sad about that, but I don’t know what to do about it. My partner doesn’t want to discuss the matter, I have to take drugs (Lupron, etc.) that pretty well eliminate my sexual abilities, and the doctors I have dealt with have been utterly useless on the subject. It is like they simply don’t care about how the disease and treatments for it affect you mentally. If whatever they do keeps your PSA low, as far as they are concerned they’ve done their part, and how much damage has been done to you/your marriage in the process is of no consequence. On common theme in the support group I attended for a year or so after being diagnosed/first treated was the phenomenon of what we called “The Incredible Shrinking Penis”: –It didn’t matter what treatment people had had, whether surgery or radiation, everyone in the group was as certain as they could be that their penis was 30 to 50% smaller afterwards. I KNOW mine is. But universally doctors say it isn’t true/doesn’t happen/etc. They lie. It does

69 10/23/2009 20:04

After the first year (post-operative) I started to get erections and enhanced them using Viagra. The differences between sex prior to prostatectomy and post were a huge shock ! The surgery had reduced the size of my penis – erections were not si strong – orgasm was “strange” and sometiomes painful ( I could feel nerve pain ) and the lack of the ejaculatory sensation was disappointing. Most dramatic is my loss of libido – I think largely because I remain incontinent the whole issue of sex – desire and comfort – is diminished. We had a great sexual relationship – vigorous, creative, frequent and important to both – and I know that I have subliminated my sex drive due to three main issues: a) incontinence b) penile size and strength c) loss of orgasmic sensation ( meaning the sensation I experienced prior to surgery – )

49 10/21/2009 2:34

I have everal problems that are very frustrating to wife and I besides those captured in the questions above: 1- pyronies disease gave me a curvature that makes masturbation difficult and penetrative sex very very difficult. 2-I experienced severe shrinkage of penis (length and girth) after surgery that makes intercourse difficult. On t     he rare occasions when I am able to penetrate, it isn’t satisfying to my wife.

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youth is wasted on the young

From International Journal of Impotence Research

Motivations for Seeking Treatment for ED: The Woman’s Perspective

M P McCabe; H Conaglen; J Conaglen; E O’Connor

Posted: 03/29/2010; Int J Impot Res. 2010;22(2):152-158. © 2010 Nature Publishing Group

Abstract and Introduction


There is increasing evidence that partners have a major role in treatment-seeking behavior for men with ED. This study investigated the motivations of 100 females for seeking medical treatment for their partner’s ED. Semi-structured interviews focused on reasons for seeking treatment from the female’s perspective. The themes that emerged from the data centered on the importance of sex in the relationship, with closeness and intimacy frequently being seen as more important than sex. The second major theme related to hopes that females had in relation to the medication, particularly in relation to increasing their partner’s confidence and reducing his sexual frustration. Enhancement of the relationship as well as improving the female’s own feelings of self-doubt and sexual frustration were also mentioned. The results of this study show the multi-faceted nature of the motivations that females express in terms of seeking help for their partner’s ED.


There is a growing body of literature that shows the importance of the partner and the relationship in the treatment of ED in men.[1–7] Although a wide range of literature shows that PDE5 inhibitors (PDE5i) are very effective in restoring an erection in men with ED,[8] a large number of men do not continue with the use of these treatments for their ED.[9–11]

There are likely to be a wide range of factors that are associated with this discontinuation of PDE5i medication, or the failure to even use these medications despite their efficacy.[11,12] One particular factor that has been identified is the importance of the views of the partner.[13–15] As sexual intercourse is a shared activity, it is not surprising that the views of the partner are likely to impact both on initial use and continuation or otherwise of medical treatment for ED.

A substantial number of studies have now shown that ED is associated with both quality of life[16] and sexual dysfunction in the man’s partner.[17–20] It is not clear from these studies if the ED led to female sexual dysfunction (FSD), if FSD led to male ED, or if there were other factors (for example relationship problems) that led to both ED and FSD. However, there is evidence that treatment of male ED has a positive effect on FSD.[18,20–22] The use of a range of PDE5i medications has been shown to be associated with improvements in the female partner’s sexual function/satisfaction, as well as relationship functioning.

Cayan et al. [18] reported that all aspects of sexual functioning (except sexual desire) among 38 females whose partners experienced ED were lower than for 49 partners of men who did not experience ED. Further, after the treatment of ED, these females showed significant improvements in their sexual functioning. Chevret et al. [19] also showed that ED had a negative impact on the sexuality of female partners. Female partners (n=376) of men with ED evidenced lower levels of sexual satisfaction and sexual desire than female partners (n=345) of men who did not have ED. Even life satisfaction was lower among the females whose partners experienced ED. Similar findings were obtained by Heiman et al. [23] who found that postmenopausal females (n=85) whose partners were treated for ED (compared with 91 females whose partners received a placebo) showed improvements in their sexual function, sexual satisfaction, and treatment satisfaction. Finally, Fisher et al. [22] showed that the frequency of orgasm, sexual activity, and sexual satisfaction was lower among females whose male partners experienced ED. Females whose partners were using PDE5i medications showed a more favorable sexual experience than those females whose partners experienced ED, and were not using a PDE5i medication.

One would expect from the above studies that females whose partners experience ED would be keen to seek treatment for this condition. Consistent with this suggestion, Fisher et al. [24] found that there were high levels of agreement between men and their partners on their perceptions of ED and their communication about ED. In contrast, Mita et al. [25] found that among adult females recruited through the internet, almost half of them expressed a negative attitude toward the use of drugs for ED. However, it is important to note that it is not known if the partners of these females experienced ED, and all respondents were drawn from Japan. It is possible that the response to the use of PDE5i medication may be quite different once one’s partner is diagnosed with ED, and beyond that, prescribed and/or treated with PDE5i for the condition. Further, there may be different attitudes to the use of medication to treat ED (or even any treatment of ED) within Japanese society compared with US society.

Given the central role that females have in their partners’ treatment-seeking behavior,[26,7] it is important to obtain a better understanding of the reasons why females seek treatment. This study examined the motivation of females for seeking treatment with PDE5i therapy for their partner’s ED. The study used a qualitative approach to explore women’s motivations. The results from this study are expected to provide data that will be useful in a large-scale quantitative study.

Materials and Methods


The data for this study were drawn from a sample of 100 females from New Zealand, whose partners were experiencing ED, determined by an Erectile Function subscale score ≤20, from the International Index of Erectile Dysfunction.[27] Participants were obtained through convenience sampling through advertisements for volunteers placed in a local newspaper. Potential participants were informed that they would be taking part in a trial to determine their satisfaction with two different PDE5 inhibitors. Participants ranged from 30 to 75 years of age, with a mean age of 53 years (s.d.=8.89), and the majority were Caucasian (83%). Eighty-two percent of the females were married to their partners and had been in the present relationship from 3 months to 52 years, with a mean duration of 23 years (s.d.=14.95).


In depth, semi-structured interviews explored motivations for entering a treatment program for ED, such as the woman’s perspective on the importance of sex to the couple’s relationship, as well as questions about hopes for beginning the use of PDE5i medication, and any fears about their partners taking the medication. For example, females were asked, ‘How important is obtaining treatment for your partner’s ED, as far as you’re concerned, to you, and to your relationship?’


The study was approved by the regional ethics committee, and all participants provided informed consent to be involved in the study. The majority of females participated in face-to-face interviews, which were digitally recorded to enable repeated review during the analytical process. Interviews lasted ~20 min. Interviews were transcribed from the digital recordings, and then coded using NVivo software version 8.[28] Coding and analysis were carried out using principles from interpretative phenomenological analysis.[29] Using this approach, transcripts were examined one by one, so that extracts could be grouped into relevant themes as they emerged. As the iterative analysis continued, themes were constantly revised and extended until no further themes could be identified, and the resulting framework accounted for all relevant extracts found within the transcripts. A second coder, external to the initial analysis, coded 10% of the interviews to ensure consistency of emerging themes. From the analysis, a number of main themes were identified.


Three major themes emerged in female’s discussions of their motivation for their partner seeking ED medication. These included the importance of sex to the relationship, hopes for the medication, and worries about the medication. These themes are considered in more detail below.

Importance of Sex

Table 1 outlines the main themes in relation to the importance of sex in the relationship. A common response was that sex was not the most important aspect of the relationship. Closeness and intimacy were often discussed as being more important than sex:

Table 1. Frequencies for important of sex

Theme Frequency

Closeness and intimacy more important 31

Is part of a normal relationship 22

More important to partner than self 22

Increases intimacy and closeness 14

Part of aging 11

Nice benefit of a relationship 8

‘We do a lot of kissing and cuddling and stuff like that, I mean we are really close. We’ve been married for 35 years and we can still sit on the sofa and hold hands. Because we have such a good relationship, I think it’s what has enabled us to cope with this. I’ve been able to cope with it, and as long as I have my kisses and cuddles, I’m quite happy.’ (#83, aged 54 years, duration of relationship 35 years)

However, many females were also of the view that sex was part of a normal relationship:

‘It’s important, it’s part of who you are as a couple. It’s another way of expressing the love, the care, the enjoyment that you’ve got with that person.’ (#89, aged 54 years, duration of relationship 15 years)

Females were generally of the view that sex was more important to the male partner than the woman herself:

‘I would probably say it’s not wildly important to me—it’s very important to my partner so it’s important to me because it’s important to him. I enjoy sex when we have it and sometimes I want to really participate and sometimes I don’t—I’m not that bothered. I think at various times of the month—either side of my period—I’m usually quite wanting sex and then for the rest of the month I couldn’t give a toss but he certainly does.’ (#31, aged 51 years, duration of relationship 15 years)

A number of females indicated that they thought that sex increased their levels of intimacy and closeness with their partner:

‘I feel, I like the intimacy, to me it’s hand-in-hand with marriage, like, it makes me feel loved. I just really love the intimacy and the time, I mean, especially when you’re so busy all the time, to me, that’s our time out, together.’ (#03, aged 45 years, duration of relationship 19 years)

A number of females also noted that sex was not the most important aspect of their relationship because they believed that a decrease in sexual activity was a normal part of aging:

‘I just put it down to getting older. I mean, I don’t feel like sex as often as I used to and because we’re busy and we’re both getting older and I really just thought it was a part of aging and getting older. I mean, sex drive, my understanding of it anyway, is that it should wane as you get older or maybe it doesn’t, I don’t know. My experience is that it does for us or for me and perhaps for my partner too.’ (#32, aged 49 years, duration of relationship 30 years)

Finally, some females saw sex as being a nice benefit to their relationship:

‘I think, you know, I mean I’m not going to leave my partner because of it—because you know we’ve got a deeper situation than that. I mean that’s not why we’re together for the long term but I mean it is a nice benefit to have on tops of it isn’t it? So it is a nice plus.’ (#35, aged 51 years, duration of relationship 29 years)

Hopes for Medication

The main themes related to what the females hoped would occur as a result of using the PDE5i medication is summarized in Table 2. The themes from the female’s responses centered on how the medication would help the females themselves, their partner, and their relationship. There were a number of themes surrounding hopes for the medication that were focused on the impact of the woman herself. Examples of these three main themes of how the use of the PDE5i medication was expected to assist the females are outlined below.

Table 2. Frequencies of hopes for the medication

Theme Frequency Focus

Reduce cognitive preoccupation, increase confidence 29 Male

Reduction in partner’s sexual frustration 26 Male

Increased intimacy and closeness 23 Couple

Reduce own feelings of self-doubt 22 Female

Partner to feel more masculine 19 Male

Reduction in own sexual frustration 18 Female

To enhance the relationship 16 Couple

Reduce hesitation about becoming involved in sex 16 Female

Return to normal life 9 Couple

Determine how the medication works 8 Couple

Reduce Own Feelings of Self-doubt

‘It’s impacted I would say quite a lot, we are at the stage now where we are able to talk about it, and we’re much more open, … I sort of think, it’s me, I’m old, and you know, typical, he doesn’t fancy me any more, I’m unattractive to him, and I went through all those self-doubt things, and that was impacting very badly. We were starting to grow apart, and as I say, we decided to talk about it, and open up, and he said look, it’s got to keep reinforcing that it’s not me, it’s just a thing that’s happening, and we must work together.’ (#53, aged 52 years, duration of relationship 27 years)

Reduction in Own Sexual Frustration

‘It is very frustrating and I ended up saying ‘we have to do something, because I’m 33 years old and I can’t go on like this for the rest of my life’. And that was the trigger for him to say ‘I’ll go and do something’. He was quite nervous I guess, and I can understand that it must be difficult for a guy to suddenly go in to the doctor and say ‘I’m having problems’. Of course once the drug worked it was great and it seemed to restore some confidence, but the other thing we found was that when he could have an erection he would ejaculate very quickly, so it was all over within like 20 seconds. So again, that is very frustrating.’ (#75, aged 33 years, duration of relationship 12 years)

Reduce Hesitation about Becoming Involved in Sex

‘It was a two way thing I think, I know personally it was just that attitude, oh look, don’t even start. Because I’m not even going to try to be aroused, I got to the point where I wouldn’t allow myself to get aroused because I thought, oh damn, I don’t want to get like that, and then get so aroused, where you can’t complete the job, and I’d just be left frustrated.’ (#17, aged 49 years, duration of relationship 28 years)

There were also three main themes surrounding hopes for how the medication would help the male partner.

Partner to Feel More Masculine

‘I feel deeply for my husband because he feels a failure as a man; if there was some form of treatment that would give him his erection function back again I would be only too happy; as much as anything just for his peace of mind.’ (#27, aged 65 years, duration of relationship 47 years)

Reduce Cognitive Preoccupation, Increase Confidence

‘But of course, what happens is, being a male, even though there’s an underlying physical cause, psychologically it has a huge impact which probably compounds the whole situation even more. I think certainly from (partner)’s perspective, if by using some medication then it’s easier for him to become erect it’s certainly going to do his self-esteem and him a world of good, and hopefully he’ll be feeling less sexually frustrated, and that’s got to have positive spin-offs in the rest of our relationship.’ (#43, aged 46 years, duration of relationship 26 years)

Reduction in Partner Sexual Frustration

‘Just… he’s happier, I’m happier. He just gets so frustrated with the whole thing when it doesn’t work like he wants it to.’ (#29, aged 54 years, duration of relationship 27 years)

Finally, there were four themes that were focused more directly on the dyadic relationship and hopes for how the medication might help the couple.

Increase Intimacy and Closeness

‘Of course, the desire and the arousal depend so much on the situation, and a lot of different things come into it. And I can, in the past, I can remember being so aroused, and so full of wanting to get going, but when you kind of get into a relationship, and you’ve been together for quite a long time, things change. So I don’t feel a lot of desire now, but what I’m wanting is the closeness, and I’m wanting it for (partner), so that he can, you know, experience that again.’ (#14, aged 66 years, duration of relationship 18 years)

Return to Normal Life

‘Strangely we’re still getting on fine and we thought ‘well this is how it will be till the end of our days’, but it would be nice if it could be like it was.’ (#79, aged 66 years, duration of relationship 48 years)

Determine How the Medication Works

‘To find a product, obviously, because we’re going to have to use a product, we know that now. To find a product that’s going to suit both of us and for the side effects not to be too damaging.’ (#92, aged 49 years, duration of relationship 25 years)

Enhance the Relationship

‘I think that probably, if the sex in the relationship was right, everything else would balance out.’ (#90, aged 35 years, duration of relationship 6 years)


Table 3 summarizes the frequencies of the main worries that the females expressed in relation to their partner’s use of the PDE5i medication. There were five major themes that arose regarding these worries.

Table 3. Frequencies of worries for the medication

Theme Frequency

Side effects and health issues 29

The cost of medication 15

Not natural 10

Puts pressure on woman to perform 9

That it will take away the spontaneity 8

Side Effects and Health Issues

‘Oh only what you hear, you know, I’d hate him to drop dead of a heart attack or anything! But he’s been fairly extensively tested for his health and he’s a real physical health nut person so I don’t imagine he puts himself under any more stress than when he’s working out at the gym or walking up mountains or things like that.’ (#31, aged 51 years, duration of relationship 15 years)

Cost of Medication

‘I was going to say to you, we’re not that financial and it’s just horrendous, the cost, you know, one hundred dollars for four tablets, that’s, you know, there’s times that we just can’t get them, and we can go on for weeks or months and then I get really frustrated too, and I know (husband) does too. Because, you know, we’ve got a family, and we’ve got bills to pay, so it’s like, but then I think to myself, gosh, this is part of our life now, and you know, we need something for us as well, and I think sometimes that, I think it is important that we put money aside to try and get them, but it’s not always possible.’ (#03, aged 41 years, duration of relationship 19 years)

Not Natural

‘It doesn’t light my fire, but if it’s going to help (partner) then that’s fine with me. Because you know we had a little sample tablet and we had one and it was just, we couldn’t get over how it works. To me, I feel it’s a bit out of nature, but, one minute you can’t do it and the next minute suddenly wow! And you can do it about 1000 darn times, you know? And to me that’s just not a natural process. But if it’s going to give (partner) some satisfaction well that’s fine with me.’ (#19, aged 50 years, duration of relationship 31 years)

Puts Pressure on Woman to Perform

‘I think, if you have a pretty full-on day, really all you want is a cup of tea. ‘Oh, I’ve taken a pill’; well, it doesn’t always work that way I don’t think. Because, I think it’s going to be easier for him, having the pill, to be into it, than for me who doesn’t have a pill. I mean, he’s going to be able to perform, whereas a woman can’t always perform at that time.’ (#16, aged 55 years, duration of relationship 33 years)

That it will Take Away the Spontaneity

‘But I find with me, if he tells me he’s taken a tablet, then I don’t want it. You know, I don’t want sex. Because to me sex is something you do just out of the blue, you know? That’s where the excitement and all that comes into it. And when you think oh hell, I’ve got to do that.’ (#91, aged 48 years, duration of relationship 28 years)


This analysis of female’s motivation for treatment revealed that a large number of the themes related to their partner’s sexual and psychological functioning. Female partners wanted the partner to feel better about himself (more confident and masculine), and through addressing his needs, they expected that there would be a flow-on effect to their own sexual and interpersonal relationship. Many of the females indicated that sexual performance was more important to their partner than to them. In fact, they were of the view that closeness and intimacy was more important to them than sexual interactions. Interestingly, many females viewed sex as being part of a normal relationship, and a number of them experienced sexual frustration if they could not have sex with their partner. As suggested by Chevret-Méasson et al.,[30] females’ satisfaction with their sex lives were improved with the use of PDE5i medication and this is a central motive for females to seek treatment for their partner’s ED. Females expressed a number of concerns about using medication for their partner’s ED. These primarily focused on the cost of the medication, the side effects, pressure on them to perform as well as the lack of spontaneity that may result from the use of the medication.

These results are useful for identifying what motivates females seeking treatment for their male partner’s ED. Earlier research has shown that treatment of male ED has a positive impact on FSD, as well as on their levels of sexual satisfaction.[18,13,22,23] This study shows that the main motives for females seeking treatment for their partner’s ED primarily center on their partner’s needs rather than their own level of s.d. The other major motive was to improve the level of intimacy and communication in their relationship. These results would suggest that the females in the study were supportive of their partner seeking help for his ED, and were likely to have a role in his treatment-seeking behavior.

The themes emerging from the data also centered on the male’s sense of masculinity and confidence. Rosen et al. [31] found that treatment of ED using PDE5i medication led to an improvement in the quality of life of treated males, and that this relationship was mediated by mood and their relationship with their partner. Overall, these results show the broader impact of treatment on the lives of males with ED, and that female partners are aware of these change. Further, females seek treatment for their partner’s ED in an attempt to achieve positive changes in their partner’s lives, as well as broader aspects of their own life.

It is important to note that the couples in this study may not be representative of the general population, in that they were all motivated to be in the study, and hence, to seek treatment. Also many of them had been in their current relationship for a long period of time. Future studies need to further explore the role that female partners have in men with ED seeking treatment for this condition. Given that so many men do not continue with PDE5i medication despite its effectiveness in treating their ED, it is important to understand the role that their partner has in initiating and continuing this treatment regime. In this way, treating physicians will have the information to enlist the assistance of partners to ensure that men seek and continue treatment for ED. Such a process is likely to improve both male and female s.d., enhance their quality of life, and improve the level of intimacy and communication in their relationship.

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the mount yonah trip

Prostate cancer op ruins Andrew Lloyd Webber’s sex life

By ANIMarch 16th, 2010

LONDON – Music composer Andrew Lloyd Webber has revealed that his sex drive has been affected after prostate cancer treatment.

The 61-year-old ‘Love Never Dies’ composer, who has been married thrice, underwent a surgery to fight the disease.

“Sex drive does take a while to come back but, frankly, I’ve had five children so in my case it’s probably not a bad idea,” the Daily Express quoted him as telling Radio Times.

Webber worries if will ever get his sex drive back, but he insists that his wife Madeleine Gurdon and children are more important to him at present.

He added: “I don’t really know. The most important thing is my children have a father and my wife has a husband. In a way it’s Madeleine I’m more worried about than me.” (ANI)

Well it got my attention. “Ruin?”  Impotence is the inability to have an erection. Sex drive or libido is dependent on the male hormone testosterone.  After you have a prostatectomy (Webber had a prostatectomy) the nerves that are responsible for erections can be damaged causing varying degrees of erectile dysfunction.  Since the testicles produce testosterone and release it into the blood stream (not by way of the vas deferens) sex drive is not affected by having the prostate removed. As an aside fertility is based on sperm that is produced in the testicle and released in the semen at the time of ejaculation. Because the vas are  tied off at the time of a prostatectomy one is made infertile by the surgery. Because the prostate is removed and the external sphincter ( which is responsible for the feeling of climax) is not, there is no fluid at the time of ejaculation/climax. So if you are potent (having erections) after a prostatectomy your climax will be different for some but present, you will be infertile, your sex drive will be unchanged and there will be no fluid ( a dry climax). Some men however may have urine at the time of climax. (Not as bad as it sounds…did you know urine is sterile?)

So, I don’t know Mr. Webber, but I think what was meant to have been reported is that he is not having erections yet but that his sex drive is unchanged. It is too early to say that “prostate op ruins sex life.” Sex life is yet another term that encompasses all we have talked about and as you know can be bad even if you have erections. Does this clear things up for you? I have seen patients make decision based on a poor understanding of the caveats of the above. It is a bit confusing.

Don’t you just love the reporters sense of humor, Webber is identified as the 61 year-old ‘Love Never Dies’ composer. For his sake, I hope it doesn’t. As opposed to my jokes, that is funny. Well there you go again…love may never die as it is not directly related to sex life. Can there be a love life without a sex life? I am just asking, I think I know the answer.

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coast guard flag and chloe

my wife and i at the beach after prostate surgery

Something I give to all my patients who are leaning for the surgical removal of the prostate is a part of a chapter from Patrick Walsh’s book on prostate cancer. It has to do with post-prostatectomy incontinence. The beauty of the piece is that Dr. Walsh thoroughly vets the unpredictable nature of this issue. I have said to patients, “I have done hundreds of these, I do them the exact same way with every precaution regarding continence, but I cannot tell you you will be dry or if you are when that will happen.” The excerpt of this particular chapter makes this point and I feel that giving the couple the article enhances and reinforces this concept. Walsh quotes Osler, “The well wear a crown seen only by the sick.” I love that saying. I get it. You have to be sick once to truly feel it. I have been trying to now put myself in other’s shoes, particularly my patients, to try to feel what they are going through. In this sense, my experience with prostate cancer has helped me as a doctor. (I said helped me…I ain’t there yet.)

So after my surgery my wife gives me a little, “lift you up card” with two penguins holding hands walking on the beach. Essentially it said, “I know that you are now damaged goods but I don’t intend on leaving you anytime soon.” Or something like that. Anyway, we decide to go to the beach the week after my surgery to “recuperate in private.” The thinking was we could go down to Orange Beach, Alabama, a six hour drive, and do all the catheter stuff and transition to diapers down there in anonymity. The thought of someone coming to my home to visit and me having all the urinary paraphernalia draped about my body was a bit much for my ego, I’m sorry. (See “Diaper Diaries – The screenplay- my first diaper buying incident occurred at a Rite Aid on Perdido Beach Blvd.)

About a week after the surgery I take my catheter out, man that was nice, and switch to diapers. For some reason I had in my head that I’d have some control early on and that complete continence would come in a few weeks. That seemed to me the most common scenario in my patients or maybe that is how I perceived how they did (remember up until this point I was just a doctor not a doctor patient).  With the diapers and the bloody urine filling them up on an hourly basis, my wife and I agree that it would be good for me to take a walk on the beach. I put the diapers on under a bathing suit and away we go. The route we usually walk is to the left of our condominium and ends at a rock jetty just before Perdido Pass. It is a delightful walk, takes about 45 minutes round trip (one diaper’s worth I figured), and I enjoy having a defined stopping point before turning around. Its fun climbing up on the rocks and watching all the boats come back and forth through the pass. 

About half way there my diaper begins to sag. By the time we get to the jetty, they have bulged in a lopsided fashion with that glob absorbent stuff, which now was red, trying to find its way down one side of my bathing suit. I’ve developed an abraded area of skin from this and it is uncomfortable to walk. I had to walk like a cowboy or dare I say a penguin to keep the diaper from rubbing my inner thigh raw. I decided to ditch the diaper. It is the middle of May and it is cool and there are a fair number of beach walkers and folks lying around on the beach. In front of a hotel I saw a wooden enclosure that housed the lounges that are rented. I sneak up to the side of this, much to the chagrin of my wife who has walked ahead to distance herself from being associated with me. I kneel down as if I am looking for something, snatch the diaper out through one pant leg of the suit and in one motion, a maneuver that I will  come to prefect in the months to come, I have it out, compressed and  stuffed through the wooden slats of the container. (A nice little surprise for the attendant of the lounges. I am sorry, I was desperate.)  As I reach my wife, my bathing suit is now wet and has the pinkish tinge of blood in the front. It looked like I had been stabbed there.

I wasn’t embarrassed by all this. In a way it was an adventure. At times we were laughing. What I think helped me was that in my heart I felt that one day it would not be like this, that with time all the issues would resolve. That it would make for a good story to tell. I often time view things in real time as if I am telling a story about it later. (Can you imagine how you’d feel if there was no hope in this?  I am grateful for whatever spirit in me, it was not purposeful nor do I take any credit for it, which allowed me to feel that this was a temporary situation and remain optimistic.

It was too cold to jump in the water, although I did try to ease down into the water and let the waves “splash away any evidence of my predicament.” I resigned myself to just waddling back to the room wet, stained and raw. The adventure was not so neat now. I did not feel well. All the medicines I had taken for bladder spasms with the catheter, pain from the surgery were having their after-effect.  We were almost back to the room when something interesting happened.

It was if I were in a dream, or better yet superimposed into a movie and the sound effects were heightened and dramatic and so very real. The sound track of the movie was out of balance with the visual. The visual was there but the sounds were just spot on, loud, clear, natural, perfect and over emphasized. (My brother Bob says that the remastered Beatle C.D.’s that were just released have sounds in there like John walking a way from the mike, or someone coughing in the background. That kind of sound, something you hear beyond the obvious.)

I was surrounded by all the beach people and their children. Some are walking, some are throwing things, some are running, children are running and laughing. Imagine this, for yourself as if you are in my movie. Children running, the sounds of waves crashing and children are laughing. It was beautiful children laughing and waves in a soundtrack and in backdrop of all the beach people. The horizon of the ocean looms and completes the scene. But the sounds are what get you and feel.

And then out there on the beach the realization of it all came crashing down upon me, an intense sense of melancholy that I feel right now as I write. I was not well, my pathology report was unknown to me, I am leaking urine and probably would have some degree of impotence. Unseen, unknown to all of those around me, those “well people” the young children without a care in the world and a world where every thing works in their body without even thinking about it or trying to make it that way. “Youth is wasted on the young,” indeed I thought.  Why did this happen to me? I wanted it to be easy. Have I taken my previous life for granted? I have let my wife and family down. It was so easy then. The well do have a crown they don’t even know they have and they take for granted.

I can see their crown as plain as day.

When we got home, I found the penguin card, tore the edge of the envelope off and fashioned into the shape of a diaper and pasted it back on the card. Clever huh?

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Nature Reviews Cancer, advance online publication, Published online 11 February 2010 | doi:10.1038/nrc2795


Opinion: Breast and prostate cancer: more similar than different

Gail P. Risbridger1, Ian D. Davis2, Stephen N. Birrell3 & Wayne D. Tilley3 


Breast cancer and prostate cancer are the two most common invasive cancers in women and men, respectively. Although these cancers arise in organs that are different in terms of anatomy and physiological function both organs require gonadal steroids for their development, and tumours that arise from them are typically hormone-dependent and have remarkable underlying biological similarities. Many of the recent advances in understanding the pathophysiology of breast and prostate cancers have paved the way for new treatment strategies. In this Opinion article we discuss some key issues common to breast and prostate cancer and how new insights into these cancers could improve patient outcomes.

My thoughts-

In addition to the points made in a medical perspective in the story above, I see similarities as well in the emotional consequences of both diseases. It is well known that the journey of the women with breast cancer is tough. Just the mention of it conjures thoughts and visions of the disfiguring surgery, potential for chemotherapy and the subsequent loss of hair. I think everybody has a feel of the magnitude of the emotional rollercoaster that the woman and family of the woman must endure.

For the male and prostate cancer, all the treatments can adversely affect how you urinate and your sexual function. Both issues strike right at the heart of the man’s ego, pride, and “malehood.” But here’s the thing, you can’t see the prostate, you can’t see the erection problem, you can’t see the diapers and worse yet most men will not discuss those issues with his loved ones. For most, they carry the weight of the aftermath of the treatment not only silently but… invisibly. I asked a female coworker why there was not more national attention and fundraisers for men like there is for women. “Men won’t walk”, she said.  All the reader has to do is join a prostate cancer support group discussion board and you’ll see the extent of the issues out there. My hat is off to the prostate cancer male. I think they go through a lot. I am noting that there are more “women for prostate cancer” type organizations being formed. It may be that this is what it will take to the get the prostate “the rodney dangerfield of organs” on the same plane as the breast.

What you can’t see won’t hurt you-or as it pertains to the prostate-can it?

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