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Some of the anxiety about the method may reflect the general awareness of the safety of modern contraceptive pills and the threat of pelvic infection, even although that is a small risk in multipara who are in a stable relationship. Many people are well informed and may wish to discuss the risks of specific infections such as chlamydia. Despite reassurance one can hear a certain ‘I told you so’ attitude from men towards the coil if complications arise. This can be interpreted as being an expression of healthy caution about a contraceptive method that asks for such a degree of trust in the doctor from the woman and her partner.

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Mrs N. married on the understanding that neither of them wanted a baby. She was referred by a gynaecologist to a specialist in psychosexual medicine because she was still complaining of dyspareunia following a laparoscopy and urethral dilatation, performed in an attempt to find the cause for her pain. Nothing abnormal had been found. She had been complaining of dyspareunia for 18 months and there had been no intercourse for a year.

She was a smart business woman wearing a suit, who came briskly into the room and sat down. She very quickly began to tell the doctor how angry she was with the people in the hospial. She had felt weak after the operation, so much so that she had to be off work for a whole week. No one had warned her that it would be like this, with so much abdominal pain and feeling so unwell and her original problem had certainly not been resolved.

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Complications with the stents are few and, in most cases, seem to resolve themselves over time. Most men experience irritative symptoms—some incontinence, a sense of urgency to urinate, and a need to urinate frequently— and some discomfort in the perineum for days to weeks after the operation. Anticholinergic drugs may be prescribed to help slow a too-frequent need to urinate. A few men in one study reported painful ejaculation the first time they had sex after the operation, but this went away with later sexual activity.

Sometimes the stents don’t work out—if the irritative symptoms persist, or if the epithelial cells fail to cover the tubes adequately, causing them to become clogged. In these and other studies, when this happened the stents were removed intact, without harming the urethra or the bladder’s external urinary sphincter. Stents can also be repositioned, and sometimes just a slight adjustment in their placement can resolve such symptoms as incontinence and urinary retention.

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A “Backed-Up” Bladder, Impaired Kidney Function, or Overflow Incontinence. Sometimes, when the bladder is too full for an extended period and is not emptying completely, the mounting pressure can cause the urine to back up in the kidneys—which can lead to severe damage if left untreated. The first step here is simply to drain the bladder, by means of a catheter threaded into the urethra through the penis. For most men, function of the upper urinary tract (kidneys and ureters) improves right away. Some men may be given oral replacement of fluids and key minerals to flush the body of impurities and prevent dehydration once the pressure is relieved. The fate of the lower urinary tract (recovery of function in the bladder, prostate, and urethra) is less certain, and depends on how much—and for how long—strain has been placed on the bladder.

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No appetite? Able to eat just a little at a time? The thought of vitamins makes you gag? Then do what pregnant women with bad morning sickness do: Eat less, more often. Have small, nutritious snacks throughout the day. Make every calorie count. Empty calories in sugared iced tea or soda won’t do your body as much good as the calories in juice, for instance; the same goes for the empty calories in a doughnut versus the calories in a muffin or slice of banana bread. Finally, if you just can’t force yourself to eat as much food as your body needs, you may want to try a calorie-packed liquid nutrition supplement like Ensure or Sustacal. Most hospitals have nutritionists available to help you solve dietary problems like these. That’s what these people are there for—use them!

In severe cases of weight loss, doctors can insert a gastrostomy tube, which bypasses the upper digestive tract and allows patients to get much-needed nutrition in liquid form. This tube “really takes the burden from the patient’s shoulders,” says one Johns Hopkins gastroenterologist. This tube provides a painless route for food to get to your stomach. It’s comfortable and discreet— hidden by clothes—and it can be removed when your appetite comes back and you don’t need it anymore.

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For years, scientists have been working to understand why hormonal treatment eventually fails—why some cancer cells seem to kick in and grow with such vengeance. “There’s probably no area of cancer therapy where we’ve got as many good options as we do for treating the hormonally responsive element of prostate cancer,” says a Johns Hopkins cancer researcher. “In sharp contrast, we have almost nothing that has proved very useful in managing the hormonally independent portion of the cancer.”

When a man starts hormone therapy, the early results are successful and highly encouraging: The tumor shrinks, PSA levels drop in the blood, and the patient feels better. But in the prostate, only the hormone-dependent cancer cells have been affected. The rest, the cancer cells that have nothing to do with hormones, go on about their merry, proliferative business, oblivious to the hormonal war being fought just cells away.

Scientists believe that these androgen-independent cells probably inhabit the prostate for years; they don’t just suddenly appear one day after the cancer is diagnosed. And so to do battle with them, many scientists feel, in the future hormone therapy must be combined with something else—chemotherapy, drugs targeted specifically at these androgen-independent cells. Today, however, effective treatment along these lines is not yet possible in men, and is only under experimental study.

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With the reduction in side effects, and with better screening techniques to identify men with localized prostate cancer, radical prostatectomies are now performed more often than ever before, lie-cause of this, there’s a wealth of information about long-term results, and the news is good: At ten wars after surgery, 70 percent of patients have undetectable levels of PSA; only 4 percent develop local recurrence of cancer, and only – percent have distant metastases. Overall 92 percent of men have complete urinary control, and only 2 percent of men have long-term, troublesome problems ‘wearing more than one pad a day). Total urinary incontinence is rare (and, as in impotence, there are several ways to improve this).

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