June 2004

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=120 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="03f8dfe1esnpes.jpg"> <div> <B>June 2004</B></div> <bR> <div> <A HREF="id3.htm" TARGET="_top" TITLE="Calendar"><U><B><U>Calendar</U></B></U></A><A HREF="id3.htm" TARGET="_top" TITLE="Calendar"><U><B> </B></U></A><B>  |   </B><A HREF="id60.htm" TARGET="_top" TITLE="Carers Group"><U><B><U>Carers Group</U></B></U></A><B>   |   </B><A HREF="id2.htm" TARGET="_top" TITLE="Group Guidelines"><U><B>Group Guidelines</B></U></A><B>   |  </B><A HREF="id61.htm" TARGET="_top" TITLE="Library"><U><B> </B></U></A><A HREF="id61.htm" TARGET="_top" TITLE="Library"><U><B><U>Library</U></B></U></A><B>   |   </B><A HREF="id4.htm" TARGET="_top" TITLE="Current Newsletters"><U><B><U>Current Newsletters</U></B></U></A><B>   |   </B><A HREF="id16.htm" TARGET="_top" TITLE="Archived Newsletters"><U><B><U>Archived Newsletters</U></B></U></A><B>   |   </B><B><U>Pamphlets</U></B><B>  |  </B><A HREF="index.htm" TARGET="_top" TITLE="Northern Beaches Prostate Cancer Support"><U><B><U>Hom</U></B></U></A><B><U>e</U></B></div> <div> </div> </td> </tr><tr> <td valign="top" height=360 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="03f8dfc3.jpg"> <div> <B><U>NEWSLETTER</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>No. 24. June, 2004</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Editor: John Conroy<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>1. REPORT OF THE MEETING HELD ON:</B> Tuesday, 4 May<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> a. Apologies were received from John Gately, Jack and Merryl Godfrey, Bill and Joan Lamont, Bill Liney, Jim Rogan, Jo-Ann Steeves and Phil and Wallis West.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> We welcomed new members Mike Harris, Eddie Lovely, and Ron and Kathleen Woodward.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> b. Our speaker for this Meeting was an old friend, Dr Michael Lowy. Dr Lowy first spoke to our Group in September, 2002 and has maintained a continued interest in our activities. At that time, Dr Lowy¹s work was with the Australian Centre for Sexual Health, Potts Point. He is now part of the Sydney Centre for Men's Health at Bondi Junction and has a continuing association with urologists at the St Vincent's Clinic. In his work, he deals with the old, the young, the gay and the straight.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Lowy's topic on this occasion was 'Sex and Intimacy after Treatment for Prostate Cancer'. Ideally, sexual rehabilitation should be part of the package before treatment begins, but there does seem to be an information overload at this time. He certainly tries to see all Prostate Cancer patients after treatment.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Male sexual function is seen to have four phases: libido/desire, which is the desire for sexual expression (and which tends to lessen with Prostate Cancer); arousal/erection, characterised by excitement and genital response; orgasm/ejaculation, - the release of tension; and resolution/recovery, - recovering the ability to repeat the process.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> An erection needs stimulus to occur. The brain sends a message (and in this sense the brain is the main sex organ) along nerves which go through to the penis which is, of course, the site of a Prostatectomy. An erection is all about blood flow: there is an increase in the blood supply to the spongy tissue in the shaft of the penis; this spongy tissue becomes saturated (engorged); and the erection is maintained by pressure on the veins taking the blood away from the penis, - they become crushed. When we wake with an erection in the morning, this is the last of several erections which occur naturally through the night. This is a kind of penile aerobics needed for oxygenation of the penile tissue.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Erectile Dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse. (The term impotence previously used to describe this state is now considered out of date.) This is a couple's problem, as both the man and the woman suffer as a result. Sexual dysfunction is common in partners of men with ED; it may be both a psychological and physical problem. Along with diabetes ED is seen as being among the diseases of the future.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> ED has many causes. Smoking has a major effect on ED; obesity is another cause of sexual problems. Like Prostate Cancer, ED is often age related, the two making their appearances at around the same time. Other medical conditions of older age, such as diabetes, may also contribute. In addition to increased erectile dysfunction, other normal changes with age are: more tactile stimulation is required, decrease in volume of ejaculate, lower libido, decrease in frequency and intensity of orgasm, and there is a longer refractory period. For a man is his 60s, this recovery period may take 24-48 hours. The old adage: 'use it or lose it' has some application in later years.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> There is another adage: 'the harder you try, the better it gets' - except for sex! This is the paradox of sex. Trying harder, like concern about size, creates a negative situation and can lead to performance anxiety. It is better to be more laid back, rather than eager to please.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> There tends to be a negative attitude towards sex among older people. While there is no reason why continued sexual activity should not be regarded as perfectly normal in older age, there are other aspects why it might decline: fluctuating desire, unavailability of a partner (due to death), medical illness, a too rigid sex script, - for example, lack of sexual repertoire, or focus on intercourse and penetration. As a little light relief, there is this catalogue of performance descriptors as indicators that we are getting old:<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Age:<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 20-30 tri-daily<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 30-40 tri-weekly<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 40-50 try weakly<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 50-60 try oysters<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 60-70 try anything<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 70 -> try to remember!<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Issues related to desire problems may include low sexual interest, inhibited sexual desire, or desire discrepancies. These may depend on such factors as hormonal status, physical well-being, emotional well-being, relational well-being, or how sexual experience has been in the past.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> There may be connexions between sexual behaviour and chronic illness. Disfigurement may lead to negative attitudes (e.g., the effect on body image after treatment for Prostate Cancer), medication or illness may have an effect on libido, as may depression and the nature of prior sexual activity and the nature of the relationship with a partner. Cancer has a significant impact on sexual function: 50% of women with Breast Cancer suffer an effect, 50% of women with other Gynaecological Cancers are affected, and 70% of men with Prostate Cancer. These effects work through hormone- or chemo-therapy and, in the case of surgery, through vascular or neurological effects. Dr Lowy referred us to: Understanding Sex and Cancer, a booklet published by the NSW Cancer Council.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The physiological impact of cancer on sexual function is the result of treatment, rather than the tumours themselves.There are various ways in which cancer therapy and body image can interact, but in the case of Prostate Cancer there can be a direct effect of incontinence or impotence.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> There can be a variety of ways in which Prostate Cancer can have an effect on sexual function. There can be a change in sexual self-image; eg., the fact that there may be a reduction in the size of the penis, something about which the patient may not have been informed beforehand. There can be grieving over the loss of genitals or the loss of a man's sense of masculinity. There are changes in the sex function itself.There may be post-treatment incontinence problems, though these are getting better. And there may be fear of disability or death.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> After a Radical Prostatectomy, there is no change in hormonal levels, and no change in the capacity for sexual pleasure with touch. Erection capacity is often impaired, though this is less with brachytherapy and radiation therapy. The sensation of an orgasm is slightly reduced, and there is no semen: there is a dry orgasm, like having a vasectomy. The surgeon can damage nerves and blood vessels during the operation, though nerve-sparing is now a common technique. 40-70% of men retain potency after surgery, depending on their age and their pre-operational sexual function, and may regain sexual function within a period up to three years.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> With Radiation Therapy, any damage to blood vessels is slow. Effects begin to show at about six months after treatment.There is also likely to be dry ejaculation.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Hormone Therapy is equivalent to chemical castration. It has psychological and physical effects, leading to a loss of desire and Erectile Dysfunction.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> There are other considerations concerning Cancer and sexual function. There is the psycho-social impact arising from having to choose an appropriate treatment. There may be changes in marital dynamics. And there are physiological effects, more related to treatment; changes in hormone levels and vascular and neurological change. The effect on a man's partner will be the emotional impact arising from the diagnosis.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> In resuming sex after treatment, it must be remembered that sex is a process which involves communication, intimacy, sensuality and sexuality. We need to ask ourselves how all of these operate within us. Psychological factors which may play a part in Erectile Dysfunction include depression, anxiety, prior abuse (physical, emotional or sexual), sexual orientation, conflict, ignorance and others such as low libido. Common sexual difficulties can arise out of: communication problems (a person not being easy to talk to, or who uses euphemisms, or whose communication tends to be mostly non-verbal), placing more importance on creating conditions for good sex, limited sexual repertoire, and factors such as anxiety, stress, depression, guilt, anger, grief. Important factors contributing to sexual dysfunction include childhood experiences (e.g., the attitude in the home to sex), the current situation and relationship issues.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Lowy listed a number of possible reasons for having sex: procreation, love and affection, giving and receiving pleasure and nurture, passion and sensuality (skin hunger), communication and intimacy, fun, release of sexual tension, helping to get to sleep, lust, 'try before you buy', proving your masculinity. Sexual enhancers are different for women and men. For women they tend to be pleasure-based (romance, communication, intimacy, affection, sensuality, quality time) while for men they tend to be performance-based (variety, novelty, spontaneity, nudity, eroticism, having a responsive partner, creating feelings of adequacy). For men, these become more of a problem after a prostatectomy.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> There are various solutions for post-treatment difficulties. One is to replace intercourse by outercourse. This can occur with either a rigid or semi-limp penis. As long as the man is aroused he can enjoy it. It requires stimulus and lubrication: manual, oral or with a vibrator. Frottage ( a French term meaning 'rubbing' against) can be a satisfactory means of gratification, either with or without a lubricant. 'Soft' intercourse may also be a possibility. Various treatments are available for erectile dysfunction, though Dr Lowy does not recommend the kinds of advertisements that can be found in some of the tabloid newspapers. He suggests that the best erections can be obtained with penile injection. It is the chemical injected rather than the needle which can cause pain. One more alarming side-effect can be priapism, - an erection that will not go away. This may be painful if it lasts for more than two hours and hospital treatment should be sought. Dr Lowy presented us with a video for our library on the appropriate method for administering penile injections.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Viagra does work if the nerves have been spared, but Dr Lowy does not recommend buying tablets over the Internet. Levitra is also good. It is important to realise that you must wait an hour for drugs to take effect - despite what the companies say. This compares with penile injection which is immediate. Both Viagra and Levitra are affected by alcohol; It stops the chemical getting through the stomach. Cialis is longer lasting (two to three days) than Viagra, but is not as effective. Side effects of these tablets can be facial flushing, headache, blocked nose, gastric reflux, blue vision (from Viagra) and back pain (from Cialis).<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The vacuum erection device is purely mechanical. It is en erection caused by venous blood rather than blood from the arteries. The penis is not as pink, but more cool and blue. It is not liked by some men because it is not subtle. The cost of the device can range between $300-500. A Chinese version is available in sex shops. The device is good if a man has a shortened penis after a prostatectomy.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Penile implants consist of silicon rods inserted into the penis, and activated by a pump placed in the scrotum. Implants are expensive and are not used as frequently as other alternatives.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Sexual rehabilitation should occur in hospitals at the time of treatment, but this will depend on staff attitudes, among other things. Ideally there should be a sex nurse and the provision of rehabilitation guidelines. There will be a possibility of discomfort with sex after treatment, and the need for improved arousal and the possible need to use a lubricant. The position for sex should be comfortable and acceptable. It will be necessary to talk to your partner about these issues. Good sex is more difficult in a bad relationship.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Finally, Dr Lowy referred us to two very useful websites:<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Impotence Australia at: <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.impotenceaustralia.com.au" TARGET="_top" TITLE="http://www.impotenceaustralia.com.au"><U><B><U>www.impotenceaustralia.com.au</U></B></U></A></FONT> Phone: 9280 0084<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> and </div> <bR> <div> Andrology Australia at: <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.andrologyaustralia.org" TARGET="_top" TITLE="http://www.andrologyaustralia.org"><U><B><U>www.andrologyaustralia.org</U></B></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Michael Lowy is available by e-mail at: <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="mailto:mlowy@bigpond.com.au" TARGET="_top" TITLE="mailto:mlowy@bigpond.com.au"><U><U>mlowy@bigpond.com.au</U></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> or by phone at:: 9387 6966<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>2. INFORMATION UPDATE</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> a.) As a result of Jim Rogan's canvassing we have received donations from several Northern Beaches businesses:<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Peter Barnett Constructions Peninsula Timbers P/L<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Commodore Plumbing P/L Maybrook Construction P/L<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> E.J.Shaw & Son JCB Plumbing.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Letters of appreciation have been sent to each of these firms. Thanks, Jim, for for your efforts, and thanks, too, to another member for a generous donation.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> b.) Andrology Australia has published Issue 10 (Autumn, 2004) of its Newsletter:The Healthy Male. A copy of this Newsletter is available through our Lending Library. The 'focus' in this issue is on Psychosocial Issues related to men's Health.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> If you haven't checked out the Andrology Australia website yet, go to: <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.andrologyaustralia.org" TARGET="_top" TITLE="http://www.andrologyaustralia.org"><U><B><U>www.andrologyaustralia.org</U></B></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> c.) The Prostate Cancer Foundation of Australia has also produced its Annual Report. (It's that time of year!)<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The Foundation's Aims and Objectives are:<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> '... to finance ongoing research into the cause, diagnosis and treatment of prostate cancer, to raise awareness of the disease, and to provide information and support to those affected by it'.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> A copy of this report is also available through our Lending Library.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> d.) During my absence overseas, the Group will be in the capable hands of a team consisting of: Geoff Emanuel, Ron Faulkner, John Reid, Jim Rogan, Jo-Ann Steeves and Phillip West. Many thanks to them in advance. Contact any one of them if you have need of any information.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> e.) Website. If you would like a preview of our website, go to: <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><B><U>http://members.optusnet.com.au/raylee/index.htm</U></B></FONT><B> </B>Let me know (phone or e-mail) if you have any suggestions or comments. The permanent site should be ready soon.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>3. REMINDER: DATES OF NEXT MEETINGS: </B>(6.30 pm on the first Tuesday of each month in the Palliative Care Cottage, Mona Vale Hospital) All friends, partners, carers, and family members are welcome. Refreshments will be served.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 1 June Dr Carolyn Mountford (Institute of Magnetic Resonance Research,Royal North Shore Hospital): Magnetic Resonance Technology and Prostate Cancer<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 6 July Professor Stewart Dunn (Department of Psychological Medicine, University of Sydney, Royal North Shore Hospital): Prostate Cancer and the Mind.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <bR> <div> <B>YOUR CONTACT NUMBERS</B></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" WIDTH="664" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 116 WIDTH="357"><div> <U>Program Co-ordinator</U> </div> <bR> <div> Dr Peter Moore </div> <div> Northern Beaches Palliative Care<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> 9997 3555 </div> </tD> <tD VALIGN=TOP WIDTH="296"><div> <U>Group Leader</U></div> <bR> <div> John Conroy<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> 9918 9358<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <A HREF="mailto:conroyjs@bigpond.com" TARGET="_top" TITLE="mailto:conroyjs@bigpond.com"><U><U>conroyjs@bigpond.com</U></U></A></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 89 ><NOBR><div> <U>NSW Cancer Council Cancer Support Helpline</U></div> <bR> <div> 13 11 20<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> <U>Prostate Cancer Foundation of Australia</U></div> <bR> <div> 1800 220 099</div> </NOBR></tD> </tR> </TABLE></div> <bR> </td> </tr></table></body>