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ACKNOWLEDGMENTS
PROLOGUE. HOW TO USE THIS BOOK
CHAPTER 1. THE BASICS OF SEXUAL FUNCTION
I. Penile Anatomy
Blood Supply
Nerve Supply
II. How Erections Work
III. Reproductive Organs
IV. How Ejaculation Works
V. How Libido Works
VI. Sexual Difficulties are Common
CHAPTER 2. PROSTATE ENLARGEMENT AND SEXUAL DYSFUNCTION
I. Prostate Anatomy
II. Prostate Growth—Benign Prostatic Hyperplasia (BPH)
III. Treatment of BPH/LUTS
IV. Surgical Treatment of BPH/LUTS
V. How Does BPH/LUTS Affect Erectile Function?
CHAPTER 3. DECIDING ON A TREATMENT
I. Deciding on a Treatment
II. Impact of Prostate Cancer Diagnosis on Sexual Function
III. Complications of Treatment: Overview (Table 1)
IV. Factors to Consider when Deciding on Treatment
V. Information You Should Give Your Doctor
VI. Questions You Should Ask Your Doctor
CHAPTER 4. THE EFFECT OF RADICAL PROSTATECTOMY ON SEXUAL FUNCTION
I. What Does the Surgery Involve?
II. Nerve Sparing
III. What to Expect Before and After Your Operation
IV. Complications
V. Predictors of Erectile Function Recovery (Table 1)
VI. Erectile Function Results after Radical Prostatectomy (Table 2)
CHAPTER 5. PROSTATE RADIATION AND SEXUAL FUNCTION
I. How Does Radiation Work?
II. How Is Radiation Delivered?
III. Side Effects of Radiation
IV. Erectile Function Outcomes after Radiation (Tables 1 and 2)
CHAPTER 6. THE EFFECT OF HORMONE THERAPY ON SEXUAL FUNCTION
I. What Is Androgen Deprivation Therapy?
II. Side Effects of Hormone Therapy (Table 1)
III. The Effect of Hormone Therapy on Sexual Function
CHAPTER 7. PENILE REHABILITATION AND PRESERVATION
I. Introduction
II. What is Penile Rehabilitation?
III. Structure of the Penile Rehabilitation Program
IV. Other Strategies for Rehabilitation
CHAPTER 8. MISCELLANEOUS SEXUAL PROBLEMS IN THE PROSTATE CANCER PATIENT
I. Urine Leakage during Sex
II. Changes in Orgasm
III. Penile Length Changes
IV. Penile Curvature
V. Fertility Options
CHAPTER 9. PILLS
I. Viagra and the Like!
II. Differences and Similarities in the PDE5 Inhibitors
III. Safety of PDE5 Inhibitors
IV. Pills for Premature Ejaculation
V. Summary
CHAPTER 10. INTRAURETHRAL SUPPOSITORIES
I. How They Work
II. Advantages
III. Disadvantages
CHAPTER 11. PENILE INJECTIONS
I. Historical Perspective
II. How They Work
III. Injection Technique
IV. Medications
V. Side Effects
VI. Tricks of the Trade
CHAPTER 12. VACUUM DEVICES
I. How Do They Work?
II. Advantages
III. Disadvantages
CHAPTER 13. PENILE IMPLANTS
I. Historical Perspective
II. Who Are Candidates for Penile Implant Surgery?
III. Device Types
IV. Device Selection
V. Surgical Technique. Preparing for Surgery
Operation
Operative Technique
What to Expect after the Operation
VI. Complications
Implant Infection
Mechanical Breakdown
Auto-Inflation
Erosion
Device Migration
Reservoir Herniation
Penile Length Changes
VII. Summary
CHAPTER 14. FUTURE THERAPIES FOR SEXUAL PROBLEMS
I. Drugs for Nerve Protection
II. Drugs for Erectile Dysfunction
III. Gene and Growth Factor Therapy
IV. Stem Cell Therapy
V. Multimodal Therapy (Figure 1)
CHAPTER 15. TESTOSTERONE AND THE PROSTATE
I. Testosterone
II. Hypogonadism
III. Symptoms of Low Testosterone (Table 1)
IV. Evaluation of a Man with Low Testosterone
V. Risks and Benefits of Testosterone Supplementation
VI. Testosterone and Prostate Cancer
VII. How Testosterone Is Supplemented
VIII. Monitoring of the Patient Receiving Testosterone Supplementation
CHAPTER 16. GETTING BACK A SEX LIFE
I. What Is a Normal Sex Life?
II. The Effect of Aging on Sexual Function
III. Seeing a Doctor for Sexual Problems
IV. Re-establishing a Good Sex Life
SUGGESTED READING
Chapter 1: The Basics Of Sexual Function
Chapter 2: Prostate Enlargement and Sexual Dysfunction
Chapter 3: Deciding On a Treatment
Chapter 4: Radical Prostatectomy and Sexual Function
Chapter 5: Prostate Radiation Therapy and Sexual Function
Chapter 6: Hormone Therapy and Sexual Function
Chapter 7: Penile Rehabilitation and Preservation
Chapter 8: Miscellaneous Problems
Chapter 9: Pills
Chapter 10: Urethral Suppositories
Chapter 11: Penile Injections
Chapter 12: Vacuum Devices
Chapter 13: Penile Implants
Chapter 14: Future Therapies for Sexual Problems
Chapter 15: Testosterone and the Prostate
Chapter 16: Getting Back a Sex Life
RESOURCES
GLOSSARY
ABOUT THE AUTHOR
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.
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It is estimated that 50% of men over the age of 40 have erectile dysfunction. This is defined as the persistent inability to get and/or keep an erection sufficient for satisfactory sexual relations. The older a man gets, and the more medical problems he has (in particular, conditions such as high blood pressure, diabetes, high cholesterol, coronary artery disease and cigarette smoking exposure), the more likely he is to develop erectile dysfunction. Erectile dysfunction rates are estimated to be approximately 20% at 40 years of age and 70% at 75 years of age, with about 5% of 40–year-olds being completely unable to have sexual intercourse and 25% of 75–year-olds likewise. In contrast to what most people think, most men who have erectile dysfunction do not have a complete inability to have sexual intercourse. Indeed in the ED drug (Viagra, Levitra and Cialis) trials, something in the range of 25 to 30% of attempts before a man went on the trial drug resulted in the ability to have intercourse. However, the presence of erectile dysfunction is associated with a dramatic reduction in the man’s quality of life, which doesn’t just affect his function in the bedroom, but also affects his self-esteem and self-confidence and may carry over into his activities of daily living.
By far, the medical condition that is worst to have for erectile function is diabetes. Diabetes affects not just the blood vessels, but the erection nerves also, causing failure of the nerves to function properly and the health of the erectile tissue, which undergoes scarring. All of these issues cause problems with erection.
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