TMC PULSE

25 T M C » P U L S E | J U N E 2 0 1 8 to talk to your partner about what works and what doesn't work." She also encouraged couples to remain stead- fast early on. "Don't give up," she said. "There were times, we were like: 'Is this really it for us?' But we kept going with it and it worked out—and it's off the charts." Re-establishing confidence Although many survivors of gynecological or urological cancers face the challenge of physical intimacy with resignation and silence, there is hope. The consequences of altered sexual function after cancer treatment can be devastating to relationships and mental health, said Wang, who is a professor of urology at MD Anderson and also practices at Memorial Hermann- Texas Medical Center. "We have patients that lost their erectile function after prostate cancer or bladder cancer or rectal cancer treatment, then lost their partner as well because they could not engage in sexual activity. They also get depressed," he said. "Not only do we help the patient's ability to engage in sexual activity, but we re-establish their manhood and re-establish their confidence." Wang is a reconstructive surgery specialist who mostly performs penile and urethra recon- struction to restore function. He is part of an elite group of physicians worldwide who perform at least 100 penile implant surgeries annually. In May, he ended a two-year run as president of the Sexual Medicine Society of North America. A penile implant is a prosthesis surgically placed inside the penis to allow a man with erectile dysfunction to achieve an erection. The device is typically recommended when other treatments—such as pills, injections and vacuum pumps—are ineffective. There are two main types of implants: Inflatable, the most common, can be adjusted for firmness; semi-rigid implants always maintain some degree of firmness. According to Wang, a penile prosthesis pro- vides the most effective and reliable results for patients with erectile dysfunction, in comparison to injections or to medications, such as Viagra and Cialis. Recent research from the journal Andrology and other sources also reveals that the prosthesis provides more satisfaction for patients and partners. Wang emphasized that a large part of a patient's success with an implant is the partner's presence, involvement and support—which is demonstrated by the Fishers' use of "we" and "our" while discussing their experience. Wang believes the issue demands transpar- ency and engagement by patients, physicians and partners to achieve the most positive outcomes. "I will start a conversation with the patient about the therapy and we will talk about the pros and the cons regarding sexual function, ejaculation, relationship, incontinence and libido," he said. Otis Brawley, M.D., chief medical and scientific officer for the Atlanta-based American Cancer Society and an expert in prostate cancer health outcomes, also encourages patients to initiate conversations with their oncologists before cancer surgery and to invite their partners to those appointments. "Some of these issues that we end up talking about are things that would make Stormy Daniels blush," Brawley said. "Most men don't realize that if you get a radical prostatectomy, the penis is probably never going to get as hard as it used to. You need to be involved and discuss your options with that health care provider. Most men should get a second opinion." If a physician doesn't raise the issue early in the treatment process, patients should request access to a sexual medicine service or counseling, Brawley and Wang said. One resource for patient information was created by Leslie R. Schover, Ph.D., a Houston clinical psychologist. She founded Will2Love, a web-based information and self-help portal designed to address sex and infertility issues related to cancer treatment. Users can access information privately and receive personal telehealth services with a professional counselor. Will2Love was among the first startup compa- nies selected for the inaugural TMCx accelerator class in 2015. The concept sprang from Schover's career as a clinician and researcher. She is a former staff psychologist at the Cleveland Clinic Foundation and retired in 2016 as a professor of behavioral science from MD Anderson to work full time with her company. (continued) I'm 56. I'm not that old. My wife is a little younger than me, so we had a certain part of our lifestyle that was missing. So, we tried various methods to regain that. Pills. There's an injection. Neither gave the kind of fulfillment that, you know— it just didn't work. — ROBERT FISHER JR. Bladder cancer survivor Run Wang, M.D. Credit: Courtesy of McGovern Medical School at UTHealth Credit: Courtesy photo Leslie R. Schover, Ph.D.

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