Web Exclusive: An Excerpt from "Conquer Prostate Cancer"

Even before I first saw urologist Dr. Jonathan Jones, to begin my early-stage, localized prostate cancer treatment, I suffered from occasional impotence and a lowered libido. This was due to medical conditions such as prostatitis, an enlarged benign prostate (BPH), and diabetes. My libido had also been diminished because my wife, Yvonne, herself had to contend with severe, ongoing pain and I didn’t want to impose on her with sexual advances. She suffered from severe spinal stenosis, fibromyalgia and chronic fatigue.

Consequently, after reviewing my options for prostate cancer treatment, I nervously asked the doctor if he knew of a sex therapist. What my wife and I needed to know is how we could function more effectively in bed, despite our current maladies, even before finalizing which procedure was most suitable to eradicate the prostate cancer.

Dr. Jones indicated that a sex therapist's guidance was a long shot. He voiced his doubts that it would make any difference for us. Instead he stressed that, apart from the prostate cancer, my impotence might be caused by any or all of the medical factors I’ve described. He referred especially to my neuropathy, secondary to diabetes, with accompanying depression, and he added that my medications themselves might have diminished my sex drive.

After further thought - maybe it was that pleading look on my face - Dr. Jones referred us to a noted sexologist at St. Petersburg Hospital, Dr. Rhonda Levine. She was an experienced clinician, whose views on sex education and practices have appeared in local St. Petersburg newspapers and television. "She might be of help," opined the urologist. "After all," he added, "While a man has an orgasm in his pelvic area, sex starts in the mind.”

Dr. Rhonda Levine, the sex therapist, met with us three times. Each session lasted two hours and cost three hundred dollars, but my wife and I gratefully shelled out this fee at our own expense. We had no choice in the matter since our health plans did not cover issues like intimate relations. What health insurance company anywhere would deign to pay for wholesome conversations that might lead to less stressful and more fulfilling sex?

When we met Dr. Levine, the first thing that struck me was that she met the stereotypical image of what a female sex therapist should be. She was a tall, sultry blonde, wearing a low-cut silk blouse matched by a colorful long skirt. She greeted us at the door in a professional yet lighthearted manner calculated to put us at ease.

Dr. Levine was not just a sex therapist but a registered psychotherapist. For that reason, I told her at the outset that we were not coming to her in order to rehash our life histories. We had done enough of that during many prior years of individual and couple’s therapy.

In past sessions we had covered the impact of our respective parents’ divorces, being uprooted from our homes, adjusting to the untimely deaths of our fathers and other close relatives. Other sessions had dealt with anxieties that come with being a professional social worker and teacher like my wife, or a teacher, rabbi and community leader, like me. We acknowledged there had been various sources of stress in our lives. However, our sole purpose now was limited to one goal: we wanted short term therapy to discuss our intimate relationship and, more specifically, my sexual functioning and low libido.

On that note, the therapist asked us to describe the problems we experienced in the past twelve months. Softly I mentioned my difficulties in getting and sustaining erections, both before and since I was diagnosed with prostate cancer. Then I explained that even when I got hard and became intimate with my wife, she could achieve an orgasm whereas I could not. I added that for the past couple of months I had been unable to produce any semen at all. In plain English, as much as I loved my wife, I just could not come to a climax.

As a rabbi it wasn't that easy to be so explicit with another woman, even in my wife's presence. However, given the therapist’s professional standing, I didn't get all stressed out over my admission. I myself had heard such confessions (and matters far more outrageous) when counseling congregants in past years, so I figured this sex therapist too had probably heard it all.

Dr. Levine’s response was objective and somewhat predictable. She indicated that whether they had cancer or not, one out of three men experienced ED (Erectile Dysfunction) at several points in their lives. She added that even with ED and some form of localized cancer treatment, men could have orgasms, first in their minds and then in their pelvic areas. Why? Because an orgasm really begins in the mind! It was almost as if she and my urologist, Dr. Jones, had discussed our personal issues earlier and were taking their cues from the same script.

During our sessions Dr. Levine asked question after question about personal "stuff" between my wife and me. She asked how we touched, how we kissed, how we aroused each other, and how often we did so. She even asked if we kissed while we made love. She also asked if our sexual relations had been good previously, before and since I learned about having an enlarged, benign but intrusive prostate and then cancer, and whether our love-making left us both very satisfied.

We responded that we had always enjoyed pleasurable relations and were mutually satisfied, except during those inevitable moments of day-to-day tensions. We concurred as well that ever since I retired as a rabbi half a year earlier, we had less intercourse but enjoyed greater intimacy, be it kissing, hugging, or just holding hands. In part, we explained, infrequent sex was the result of our highly stressful transition in moving to Florida after a couple of decades in the Boston area. We informed her that our level of intimacy also became more limited due to issues we had discussed earlier with Dr. Jones: my oversized prostate, my prostatitis, neuropathy and diabetes, along with various medications that lowered my libido. Nor did it help that my wife experienced increasing pain due to ongoing fibromyalgia and spinal stenosis.

My wife confessed that during our infrequent moments of sexual intimacy she felt guilty, since I helped her achieve an orgasm but she could not reciprocate. In fact, she stated that at times she felt so guilty she did not want to engage in sexual relations with me at all. Putting a positive spin on this, the sex therapist gushed, "How wonderful that a woman your age (then sixty-one) has always been so sexy!”

I agreed! I commented that I got great pleasure in "pleasuring" my responsive wife, to borrow a phrase from the famous sex therapist, Dr. Ruth Westheimer. I first heard Dr. Ruth use this phrase at a lecture in my Boston area synagogue a few years ago. But her view actually has a basis in highly regarded religious texts included in the Jewish marriage contract. At any rate I’ve long seen this as one of my more enjoyable conjugal duties. I would hope that many husbands agree, regardless of their faith background.

In the course of our thirty-six years together, Yvonne told me more than once how important it was not just to hop in bed together at the end of the day. She often felt the sting of my preoccupation with my rabbinic occupation, and more recently my preoccupation with writing this book! Accordingly she did her best to insist that we ought to greet each other during the day with a few words, a smile, a kiss and a hug and go to bed the same way.

While she had often told me this when we were alone, saying all this in front of the therapist made it clear to me not just intellectually but viscerally. Such actions are of great importance as a prelude to greater intimacy. To reinforce this, Dr. Levine affirmed that being affectionate from day to day, in every way, whether clothed or not, was the best kind of foreplay. It led to the kind of physical intimacy both of us craved.

In the course of our thirty-six years together, Yvonne told me more than once how important it was not just to hop in bed together at the end of the day.

After both the first and second sex therapy sessions, Dr. Levine came up with some “homework.” She directed my wife and me to start “dating” the way we had thirty-four years earlier, before we were married. Her specific directions were that in the week between the first and second session we were to decide in advance when to be emotionally and physically intimate, but with absolutely no attempt to have intercourse. Apparently she figured that couples like us, married for two or three decades or more, tend to put off the special moments that made them a twosome in the first place.

After leaving Dr. Levine’s office, my wife and I commented to each other how her assignment to put our intimate relations “on the clock” seemed contrived. While our first "date" was physically and emotionally satisfying, it was difficult to schedule having a second round of physical intimacy until the night before our next meeting with her. We felt like high school students who have to cram in order to finish a homework paper the night before it’s due. As a result our second date was not all that pleasurable.

At our second session with Dr. Levine, one of the subjects that came up was jointly watching videos and movies with explicit or implied sexual content. A few years earlier, while surfing on some TV channels, my wife and I happened to watch a fifteen minute HBO re-run of a series called "Real Sex.” Picture this: an attractive African-American poet reads her passionate poem celebrating the vagina, reminiscent of “The Vagina Chronicles.” Simultaneously another woman, as shapely as she is naked, slowly enters a bath at stage-center. As we told the therapist, minutes after this scene ended, we turned off the television to have real sex ourselves! Dr. Levine asked if watching more sexy films might "turn us on" and help heighten our sexual intimacy.

Our response was both yes and no. We remembered a humorous cinematic spoof on contemporary sexual mores many years ago, featuring some twenty-something young lovelies. That kind of film had also prompted us to become quite amorous. On the other hand, in our earliest years together, we watched one of the first X-rated films to be shown in a standard movie theater. The controversial porn movie, called "Deep Throat,” was hardly a political thriller, although its title was later applied by the Washington Post to an anonymous “whistle-blower” who divulged the White House’s notorious illegal activities during the Nixon era.

“Deep Throat” attracted a sellout crowd, including us, shortly after we got married in September 1972. After watching the film’s opening scene, depicting oral sex between total strangers, we both got thoroughly disgusted, stood up and promptly left the theater. Mind you, it was not the idea of oral sex that turned us off; rather, it was the pornographic depiction of a woman being impersonally exploited by a manipulative man she had just met, that prompted us to exit the movie house even faster than we had entered. This movie, which reportedly grossed more income than any film prior to its release, succeeded only in “grossing us out”!

Switching subjects, the sex therapist asked if I had ever used Viagra before becoming intimate with my wife. I answered that I never had. She suggested I make an appointment with a well-known local urologist, Dr. Winston Barzell, with whom she was acquainted. In referring me to Dr. Barzell she not only thought I might ask him to prescribe Viagra, but that I would do well to see him in order to get a second opinion about my prostate cancer options. As I will explain in the next chapter, that referral would lead to a physical and life-altering decision.

After meeting with our sex therapist, it became clear to me that despite my previous qualms, I was going to become a bonafide part of the E.D. generation after all. A week later I saw Dr. Barzell and his associate, Dr. Robert Carey, who eventually would write two segments of this book. I obtained the prescription and purchased a few Viagra pills at a local pharmacy. When I got home, I asked my wife if I should take one Viagra that evening. Her answer was “Yes!” At ten dollars a pill, we didn’t want to waste the opportunity for intimacy. That night we pleasured each other for half an hour in a way that I had never experienced before.

When we saw the sex therapist at a third session two weeks later, she asked, "So, how was it?" Knowing my wife has severe reservations about discussing such intimate details, I responded briefly but accurately. I simply declared that, "We just had the best sex we have ever had in nearly three and a half decades of being married." Without missing a beat, the sex therapist said, “Then I guess our sessions are over!”

And indeed they were! As a result, what started out as a stressful, psychologically painful subject ended up as a pain-free experience, to say the least. Our three sessions had enormous consequences for me and my wife, in terms of a new understanding of sexual interaction in the framework of marriage.

During the first phase of prostate cancer treatment the urologist, Dr. Jones, directed his nurse to inject me with a hormone called Lupron, to lower my testosterone. He did this to reduce my oversized prostate while also reducing the prospect of letting my localized cancer advance any further. The net result was that this suppressed my libido more than ever.

Whether prostate cancer patients use hormones or not, what can they do to arouse their passions and keep their libido intact? This is a pertinent question for many men, both before and after mid-life. This is particularly relevant when prostate cancer patients face procedures like surgery, which can result in intermittent or permanent impotence or erectile dysfunction. Many men equate the loss of their sexual responsiveness with the loss of their “manhood.” To offset such concerns it is worth reviewing some literature that can help.

Dr. Ruth's

Sex After 50: Revving Up Your Romance, Passion & Excitement!

Even if a man experiences erectile dysfunction he need not lose his capacity for sexual play. This is emphasized by Dr. Ruth Westheimer in a brief list of sex play suggestions, found in her book called For instance if a man cannot sustain an erection, he or his partner can still perform a strip tease, caress each other with silk garments, engage in mutual masturbation, or play a board game calculated to arouse their sexual passions.

Even if a man experiences erectile dysfunction he need not lose his capacity for sexual play.

Some alternatives that can elicit sexual arousal are offered by nationally known sex educator, Dr. Laura Berman. Dr. Berman is a an extremely qualified individual, who earned a Master’s degree in Clinical Social Work from New York University, as did my wife. In addition Laura Berman holds a Doctorate in Health Education and Therapy from the same university, with a specialty in human sexuality.

Dr. Laura Berman’s Passion Files

Dr. Berman writes a regular on-line newsletter, , which makes for constructive reading (www.drlauraberman.com). Her material is not geared specifically to people with cancer; in fact it’s intended for healthy women. Still it has many applications for men or women with cancer. For instance one of her articles is called “Get in Touch With Your Senses.” In that article she advocates the importance of touch both during sex and at other times for mutual pleasure and personal rejuvenation. She also advocates the use of word games to spice up a relationship. One example is reading a popular novel out loud with a companion and substituting words that will create sexual attraction between lovers.

In addition, Dr. Berman has a legitimate online sex-toy store, which some will find useful in heightening their relationships. All this is in the context of her work as a sex educator and therapist and as the founder of the Berman Center in Chicago, Illinois, which focuses on women’s sexual health.

I point this out only by way of reviewing a few of Dr. Berman’s contributions, not because I endorse everything she says or offers. However, I applaud her efforts to bring couples together in a healthy, loving manner, without shame or embarrassment. My only cautionary note for couples who seek deeper satisfaction in their relationship, is that they first reach some agreement as to what is appropriate or not for both of them, before going to the next level.

Intimacy With Impotence: The Couple's Guide to Better Sex After Prostate Disease

Other perspectives specifically for prostate cancer patients have been presented by Ralph and Barbara Alterowitz in their book called . After experiencing prostate cancer as a couple, they wrote this book advocating that the joy of sex is not dependent on having an erection. The book includes case examples and medically approved approaches for enhancing sexual intimacy.

Making Love Again: Hope for Couples Facing Loss of Sexual Intimacy.

Virginia and Keith Laken offered a highly personal account following his prostate cancer treatment. Their thoughts are recorded in a book called According to their book, the Lakens were both stressed about Keith’s experiences with his prostate cancer treatment, - the surgical removal of his prostate (radical prostatectomy).

He and his wife felt he was cured of prostate cancer but remained frustrated by his erectile dysfunction. For a while they resolved their E.D. dilemma by engaging in oral sex when they made love. This led to Keith’s first post-op orgasm and became a turning point in restoring his confidence that he was still “a man.”

Their nightly oral forays literally relieved his high degree of stress and his fear that he would forever lose his manhood. Oral sex became an acceptable alternative for expressing their mutual love, accompanied by endearing caresses. In time though, this became too routine and stultifying.

With the help of penile injections, Keith was able to have erections again. After further psychological counseling the Lakens realized there is a difference between loss of libido and the inability to be sexually aroused. He recognized that his desire for his wife was muted, but intact, despite his inability to be sexually aroused due to the considerable physical trauma caused by his prostate cancer surgery.

In addition the Lakens broadened their definition of intimacy to include physical closeness of any kind, accompanied by the intention of pleasuring each other through various forms of lovemaking, without indulging in bizarre behavior. They also learned to forego sexual spontaneity by replacing it with greater sexual intensity. These new insights, accompanied by their physically and emotionally intimate activities, were essential in helping bind this loving couple further in matrimony.

The Lakens wrote their account in the same spirit as I have written this book. Like me they hoped their experiences would be a source of guidance for those who have walked in their shoes. The way they chose to counter the effects of prostate cancer treatments may be inspiring to some, although embarrassing to others. For that matter, some of the thoughts I’ve conveyed in this book may produce similar responses. Still, I trust you’ll remember that for the most part rabbis and their spouses have the same desires as anybody else!

Lest I be misunderstood, all the literature I’ve reviewed while preparing to write this book aims to help couples maintain or strengthen their strong connections, physically, emotionally and spiritually.

Whether stated or not, the objective of thoughtful, informed professionals and cancer survivors like myself, is to promote ever-increasing sexual intimacy in the framework of marriage. I might add, however reluctantly, that such discussion may also apply to those who are not officially married but enjoy a committed relationship.

It can be argued that the drive for physical intimacy is also healthy for unmarried couples, when both individuals respect each other and wish to express their mutual affection. I refer to two adults who strongly wish to get to know each other at every level for the long-term. Others would probably not hesitate to add that this applies even for those who choose to get acquainted for a limited duration.

As I elaborate in my book, the goal of sex is not necessarily procreative, but recreative. Human sexuality can provide physical bonding that recreates (that is, “re-creates”) a couple’s physical ties to enhance their sense of oneness. This simultaneously helps them achieve a large measure of personal and mutual fulfillment. This is what my rabbinic colleague, Irwin Kula, has called “sacred sex.”

It is a view shared by several Christian pastors, including Rev. Paul Worth of the Relevant Church in nearby Tampa, Florida, only an hour from my home in Sarasota. In 2008, he issued a 30-day challenge (posted at www.30daysexchallenge.com) to his married congregants and other married couples, to have sexual relations daily, for the sake of growing closer as couples. This outlook, while sparking national attention in the United States, is a far cry from the debasing, promiscuous sexuality played out in all too many real life situations and depicted in films like “Deep Throat.”

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In summary, while sex really begins in the mind, it must be expressed physically in order to foster intimacy. To think otherwise is to imperil your physical and emotional health, causing needless emotional pain and stress. Acting on your innate sexuality during your earlier or later adult years is the best way to go. That the case, as long as you retain and build on your sense of dignity and mutual enjoyment.

Rabbi Ed Weinsberg, EdD, DD, is a prostate cancer survivor, gerontologist, patient health educator, speaker and the author of

For tips on coping with prostate cancer, its treatment and side effects, visit

CONQUER PROSTATE CANCER: How Medicine, Faith, Love and Sex Can Renew Your Life.

www.ConquerProstateCancer.com

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