Lately@MSKCC, June 2005 - Studies have shown that male cancer patients can experience sexual problems at any point in the continuum of their care. Too often, the assessment and treatment of these problems are not routinely provided, usually due to time constraints, patient embarrassment, lack of physician training, or a combination of these factors. In recognition of this, Memorial Sloan-Kettering has created a Sexual Health Program to provide individualized, multidisciplinary care to men who are dealing with cancer-related sexual dysfunction.
Common Male Sexual Health Issues
For both current and former male patients with a variety of cancers, the most commonly experienced sexual health problems include erectile dysfunction, ejaculatory dysfunction (both premature and retarded), physical deformities (such as a condition known as Peyronie's disease, which can occur as a result of certain prostate cancer interventions), and both psychologically and hormonally based sexual desire issues. In addition, there may be anxiety that can accompany cancer diagnosis and fatigue that can accompany treatment.
"Any life stressor is harmful to your sex life," says Dr. John P. Mulhall, a urologist specializing in sexual and reproductive dysfunction and the Co-Director of the Sexual Medicine Program at Memorial Sloan-Kettering. "Using erectile function as an example, the most potent anti-erection drug is adrenaline. Adrenaline is released when you're tired, worried, stressed, or angry -- all emotions that cancer patients may experience during the various stages of their diagnosis and treatment."
Dealing with Men's "Y-linked Curses"
Compounding these issues is what Dr. Mulhall refers to as the "Y-linked curses" -- many men's predilection to deny that they have a problem or to try to solve the problem by themselves. He uses the example of patients with prostate cancer to illustrate this phenomenon. After surgical treatment for prostate cancer, Memorial Sloan-Kettering prostate specialists recommend that men enter an aggressive penile rehabilitation program, as early as four weeks after the procedure. The program includes the use of erection-producing drugs that will help protect erectile tissue, while waiting for any nerves that may have been affected by the surgery to regenerate. Unfortunately, many men are reluctant to participate in the program. "The typical male mindset is oftentimes a barrier to getting these men in for this critically important early treatment," Dr. Mulhall explains.
The Sexual Medicine Program - A Multidisciplinary Approach
Even with these obstacles, the overwhelming majority of men with cancer-related erection and other sexual dysfunction problems can be successfully treated. The Sexual Medicine Program at Memorial Sloan-Kettering treats male sexual dysfunction using a multidisciplinary approach, employing the skills of urologists, mental health professionals, social workers, and couples' therapists, who together provide everything from evaluation to diagnostic procedures and treatment.
Sexual dysfunction during and after cancer treatment can affect men of all ages. Reflecting this fact, the program has treated a broad spectrum of patients -- from a 19 year-old with brain cancer to a 90 year-old man 30 years after his prostate surgery. The program treats patients with all types of cancer, including prostate cancer, colorectal cancer, head and neck cancer, leukemia, lymphoma, soft tissue sarcoma, and male breast cancer.
One of the biggest challenges for men in this situation is the erosion of confidence. The restoration of that confidence is complex and can take up to six months of treatment, which, in the program, might include the use of drugs, counseling, or some combination of the two. In addition, Dr. Mulhall explains that partner interest, motivation, and support are extremely important when dealing with male sexual dysfunction. "It's not a man's problem," he says. "It's a couple's issue. And the program allows us to treat sexual problems on either side of the relationship."
"With this program, we're changing the landscape of cancer centers in the way in which they address the issues of sexual dysfunction," Dr. Mulhall notes with pride. "If you have a sexual problem, or if you even suspect you might have a sexual problem, our staff is here to help you."
For more information about the Memorial Sloan-Kettering Sexual Health Program for Men, call 212-639-8480.
