Sex and the Male Cancer Patient
Network - Summer 2011
By Mary Brolley
“I’m a guy. Guys don’t usually talk about this,” Bill Baun says.
Baun is referring to the sexual dysfunction and incontinence that often accompany treatment for prostate cancer.
Though it’s far from the only cancer (or cancer treatment) that causes incontinence and/or sexual side effects for men, treatment for prostate cancer is among the most closely associated with them.
These effects include erectile dysfunction and loss of desire.
Luckily, just as there are many effective treatments for prostate cancer, there are a number of options for men with erectile dysfunction.
They include pills, injections, suppositories, vacuum pump devices and, if all else fails, penile implant surgery.
Baun, a manager of Wellness Programs in the Department of Employee Health and Well-Being at MD Anderson, says he received expert care before, during and after his treatment. His surgeon was Richard Babaian, M.D., professor emeritus in the Department of Urology.
But Baun especially remembers Earl Davison, clinical nurse in the Genitourinary Care Center’s Urology Clinic.
‘We’ll fix this, one way or another’
Davison has worked with Run Wang, M.D., one of the clinic’s attending physicians, for 11 years.
In keeping with MD Anderson’s multidisciplinary care model, physicians across the institution refer patients at risk for (or experiencing) erectile dysfunction to Wang.
Wang and Davison see about 65 patients in the GU Clinic every week, and Wang performs about 100 penile implant surgeries every year in the care center, Davison says.
Davison is the point person for these patients — usually couples — and provides practical counseling and solutions to help men resume their sex lives.
“We provide hope for these guys. We tell them: We can fix this, one way or another.”
Because they are sensitive subjects, incontinence and erectile difficulties require a balance of frankness and tact.
“Talking to Earl was easy,” Baun says. “It’s his attitude — he’s matter of fact about it. He made me feel comfortable.”
The ‘double whammy’ of hormone therapy
For men like Baun with advanced prostate cancer, the addition of hormone or androgen therapies adds another problem: the therapies greatly diminish sexual desire.
A recent comment on MD Anderson’s Cancerwise blog, from a woman whose husband is being treated with androgen therapy, illustrates the issue.
“Not only am I dealing with the anxiety of his advanced disease,” she wrote, “but I no longer have any sexual life.”
In response, Leslie Schover, Ph.D., professor in the Department of Behavioral Science, acknowledged the “double whammy” men on androgen therapy experience.
“For many men, treatment for prostate cancer damages local nerves and blood vessels needed for good erections,” she says. “On top of this, androgen deprivation affects sexual desire as it’s perceived in the brain.”
Schover, a clinical psychologist with special expertise in treating sexual problems related to cancer, devotes her time to research on creating more effective treatment programs than currently exist.
MD Anderson physicians often refer patients for counseling to the departments of Psychiatry and Social Work or to sex therapists in the community.
Baun acknowledges that lack of desire was a side effect of his two years on the hormone therapy.
He and wife Mary Beth had to focus on each other and stay physically affectionate. They continued to talk about the issue, their feelings and the fact that they still loved each other, and had to show it in different ways.
Recently, after a hiatus from the hormone treatments, Baun’s prostate-specific antigen (PSA) levels went up enough for his physician to recommend he resume them.
This caused concern and renewed discussions between the couple, but they remain focused on their love and life together.
“I work at it; I bring her flowers,” Baun says. “We know we have to work at it together.”
For his part, Davison is grateful to be able to help so many male cancer survivors — and their partners — resume satisfying sex lives.
“Nobody, but nobody, does more to treat sexual dysfunction than MD Anderson,” he says.
“Patients never forget me,” he laughs. “I’ve been at the casino on my day off — you know, trying to be a tough guy, a cowboy.
“And a guy will recognize me, and bring over the group he’s with, and introduce me.
“It’s cool. Sometimes their wives hug me.”