John P. Mulhall, MD, director of the Male Sexual and Reproductive Medicine Program at Memorial Sloan-Kettering Cancer Center in New York City, has written a new book titled Saving Your Sex Life: A Guide for Men with Prostate Cancer (Hilton Publishing Company, Chicago, 2008).
In it, Dr. Mulhall discusses male sexual anatomy and sexual function; how prostate enlargement can cause sexual dysfunction; the effects of radical prostatectomy, radiation, and hormone therapy on sexual function; and strategies for recovering some or all of the patient’s pre-surgery sexual function. It is the first book written exclusively for men with prostate cancer about sexual function.
Who is your main audience?
Patients as well as urologists. There are plenty of physicians out there who are going to get prostate cancer. Everybody knows someone who’s got prostate cancer.
What was your primary objective?
I realize doctors are uncomfortable with sexual issues, so I’m trying to empower patients to feel comfortable asking their physicians about this. Prostate cancer is a slow-growing cancer. So it’s not as if men are diagnosed this week and need surgery the next.
Men are not going to get the best treatment if they don’t know what questions to ask, and they have time to do research and figure out what those questions should be. So there’s a chapter about deciding on which treatment to have. I try to tie the decision in with sexual function—one of the topics for questions you should ask your doctor.
For example, just because a doctor is a urologist doesn’t mean he’s an expert on radical prostatectomy—maybe he only does one a year. And we know that surgeon [procedure] volume is a predictor of success. So men need to ask how many he does.
Why was your book necessary? Do most urologists fail to discuss with prostate cancer patients the effects of treatment on their sex lives?
For physicians who manage prostate cancer patients, their first focus is oncologic—prostate-specific antigen measurements, etc. Their next concern is [restoring] continence. Sexual function isn’t near the top of the list. And they often don’t have the comfort level to talk to patients about it either.
There’s a famous slide I often use during talks—it shows a patient on a bed beside the doctor and both have “thought bubbles” that say, “I hope he brings up the topic of erection problems.” So it’s usually on people’s minds but rarely discussed.
In addition, we only get one or two hours of sex medicine information in medical school. There’s more time spent on tropical medicine.