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Mr F. is a hard-working electrician who often worked late. He said, ‘I wouldn’t like her to have a coil, she’d find it too embarrassing.’ He is a man who keeps an awkward distance from medical events when he is wanted. When his wife has migraine, or grandmother’s blood specimen needs taking to the laboratory, he is always too far away to help. Later he told me about his wife’s delivery. She needed stitches and he hoped to get out of the delivery room, but somehow he ended up holding the baby. The midwife and his wife said what a pair they made in the low chair across the room, but all he was thinking of was the doctor’s hand inside his wife, particularly as at the same time she was smiling. ‘No, no-one is going to give her a coil, thank you.’

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Her immediate anger at the hospital staff was quickly reflected in the speed with which she jumped at the subject of childlessness, almost as if she was saying, ‘Someone should have warned me that I would not be able to change his mind about babies, even after 10 years of marriage.’

Because she was unable to share her ambivalent feelings about motherhood with her husband, her fears of both having and being without a baby were sublimated into a physical pain associated with intercourse, so that their ‘mutual penetration’ became intolerable and inaccessible.

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A 13-year-old girl came to the clinic with her mother. Mother did all the talking, saying that her daughter was in a relationship with a 22-year-old man who had two young children. Mother thought her daughter should go on the Pill as she foresaw intercourse occurring. The doctor felt pity, anger and anxiety as she noticed that the girl was small and thin, her face pinched and hard-looking, trying to look older than her age. The doctor managed to see the girl alone and said, ‘I wonder what you expect from this visit?’ The girl replied, ‘I expect I’ll get stuck on the Pill’. This made it easier for the doctor to say what was uppermost in her mind, that the girl had choice. Slowly, as the consultation continued and with the doctor trying to respect the girl’s feelings and treat her as a responsible person in her own right, the girl changed, her face softened and she allowed herself to look her age. She said that she did not wish to decide anything that day, and certainly did not want to take any pills.

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To doctors, methods of birth control fall into five main categories: barrier, hormonal, intrauterine devices, sterilization and termination of pregnancy. To patients there are two main divisions: those you can get on with yourself, and those for which you have to involve others, usually doctors or nurses, and therefore lose some privacy and control. The extent to which this external interference is tolerated depends on many factors, some obvious to medical minds, like the absolute desire not to get pregnant now, and others less clear – a fear of using something perceived as unnatural or artificial, for example. Every method has a different meaning for each individual patient.

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Drugs currently being developed and used to treat BPH attack the problem in two ways: One strategy is targeted at shrinking the prostate by interfering with the hormones that cause certain prostate cells to enlarge and accumulate. The other is aimed at keeping the prostate muscle tissue from tightening around the urethra.

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Recurrent Urinary Tract Infections, associated with residual urine. Sometimes, when urine lingers too long in the body—if the bladder is not completely drained for months—it becomes infected. And if the fundamental problem, urinary obstruction, is not solved, it’s difficult to get the infection cleared up.

Bladder Stones, also associated with residual urine. These form when crystals of uric acid or calcium precipitate into the urine. It is possible just to treat the stones—uric acid stones can be dissolved medically, by drugs that make the urine more alkaline; and many techniques are available to crush calcium-containing stones. But these measures do nothing to relieve obstruction. And the fact that a man has developed a bladder stone in the first place usually means he’s got a significant problem with urinary obstruction, which needs to be treated.

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However, there are many advantages to participating in a study. Medical studies are strictly controlled, with well-defined rules (participants can stop being in the study whenever they want) and review boards that include doctors, nurses, lawyers, scientists, clergy members, and laypeople. Often, people who take part in medical studies are followed more closely, and thus receive better medical care, than the general public—and usually at little or no cost. (Sometimes, if a medication proves helpful, participants are even given a free supply as a reward for their help!)

Participating in a study often means access to new drugs that aren’t yet available to others; you may get first crack at a new breakthrough. And many people who volunteer for a medical study say that they feel that they are doing something important—that their contribution will advance medical science, and that it ultimately will help other people.

“If they’re motivated and feel well, patients should always explore this option,” says a Johns Hopkins oncologist. “They shouldn’t give up. For many patients, being in a study gives them a new outlook and new hope.”

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In prostate cancer, the rate of cell division, or birth of new cells, is relatively low. Cancer begins amassing—cells begin building up and spreading to invade new tissue—because something happens to throw off the normal process of cell death. So if scientists can’t stop new cells from being born, maybe they can help other cells to die at a faster rate. This treatment idea is being explored aggressively

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There are two tiny bundles of nerves, one on either side of the prostate, that are essential for erection. Sometimes, depending on the extent to which the cancer has spread, one or both of these bundles must be removed. Men can still be potent even if one — but not both—of these bundles is removed. In men over so, sexual potency is better in men who have both of these bundles preserved than in men who lose one bundle during surgery.

The men most likely to remain potent are younger, with disease confined to the prostate. These are also the men who are most likely to benefit from surgery.

Both the retropubic and perineal approaches are discussed in this chapter, as are all the possible complications and aftereffects you can expect, and ways to help you deal with them.

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