Saturday, December 01, 2007

An Unwanted Journey: Day 0735 - Afraid to Ask

The preparation was the same. The sedatives worked roughly the same way. The recovery was similar. The cookies and ginger ale were welcomed once more in the recovery room. The next day I felt great, as before.

There was something different this time, though. The surgeon asked questions about frequency of bowel movements, urinary function, and then the big one - how about sex? That was a surprise.

It makes you wonder why it should be a surprise. According to a fairly recent study in the Annals of Surgery entitled "Prevalence of Male and Female Sexual Dysfunction Is High Following Surgery for Rectal Cancer" (August, 2005), from research conducted and reported from Mount Sinai Hospital in Toronto, Ontario, high percentages (29% for women and 45% for men) indicated that curative rectal cancer surgery "made their sexual lives worse".

The conclusions of the study are that "sexual problems after surgery for rectal cancer are common, multifactorial, inadequately discussed, and untreated." Sexual functioning and quality of life (QOS) are very often negatively impacted by rectal cancer surgery and, it would seem, very few people are willing to talk about it. Even worse, when they do talk about it, very few validated instruments for measuring sexual functioning have been used by medical researchers and practitioners.

But my surgeon did something I didn't expect. He asked if I would like to get a referral to discuss the sexual functioning implications of surgery. My thoughts were simple and straight forward - why not?

But I've been wondering ever since. Exactly what kind of specialist will I be seeing? A psychologist? A sex therapist? A urologist? At this point, I really don't know what to expect. But my wife and I talked about it and wondered if maybe the outcome will simply be another prescription - this time for something like Cialis or Viagra. If so, then I'll be a little disappointed. After all, Viagra was simply a repackaging of a drug originally researched and marketed for hypertension. But when clinical trials were conducted by Pfizer, the researchers discovered the drug could induce marked penile erections.

We've seen the silly advertisements on television - the knowing looks between middle-aged men and women talking in gibberish sprinkled with the word "viagra" every couple of sentences. Dumb. Really, really dumb!

But, if you watch enough of these commercials (and I have to say that the Cialis ones seem a little more mature), you have to wonder what kind of magic these pills might do. The nickname of the "weekend pill" does, of course, conjure up all kinds of lurid images. But for men who are survivors of curative rectal cancer surgery, you have to wonder whether the focus on erectile dysfunction is appropriate.

I'm curious now. So we'll see what the surgeon has to say in our follow up visit. The most important aspect of the follow up is about the pathology results of the biopsies, not the nature of the referral about sexual function. But assuming, as I do, that there is no reason to be concerned about evidence of disease recurrence, then I find myself wondering just what kind of specialist and what kind of medication might be in the cards.

Who knows, maybe they'll want me to do a commercial.

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