Abigail Trafford (The Post)

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Virginia and Keith Laken chronicled their journey back to sexual health after prostate surgery in "Making Love Again: Hope for Couples Facing Loss of Sexual Intimacy." They recently addressed doctors and patients at the Johns Hopkins Center for Marital and Sexual Health on the importance of sexuality. "We decided to have sex dates. I realized I needed to take the lead and be more assertive, more imaginative," Virginia Laken told the audience.

Join Post Health columnist Abigail Trafford and guests Virginia and Keith Laken to discuss their book and their return to sexual intimacy.

In 1995, Keith was treated for prostate cancer and became impotent after the surgery. It took several years to recover their sexual intimacy. They are now going public with their private lives to help others overcome their sexual problems. They also want to educate doctors on the importance of sexual function in a person's recovery from illness.

The transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

Abigail Trafford: Welcome Keith and Virginia. You are on a medical mission. You want to change the way doctors treat sexual health--and you want people to know that they have a sexual identity all through their lives. Tell us how having prostate cancer changed your sex life?

Virginia and Keith Laken: Prostate Cancer changed our sex life by forcing us to look at what our life together was like without experiencing and enjoying sexual intimacy. A picture that was neither pretty nor healthy for our relations. It also then allowed us to take the opportunity---(athough there were many times we didn't look upon what we were going through as an opportunity)--- to step back and re-evaluate just how we really defined sex meant to us and then how we could reframe it for our current circumstances. Ultimately this turned out to be a very enriching experience for us.

Abigail Trafford: In your book "Making Love Again," you chronicle your long, lonely journey back to sexual health. Describe your sexual life today--and how you got there?

Virginia and Keith Laken: Our sex life today is in many ways better than it's ever been before. For a number of reasons. One because we value it more. We treasure what we have because we almost lost it. But specifically we have returned to having variety in our sexual intimacy. We are able to enjoy intercourse, but we no longer only focus on that or limit ourselves to that. We also are more experimental than we were previously. We understand the need for variety and enjoy being adventursome. And we also are more intentional about being sexual. By that we mean we make sure our intimacy happens on a regular basis. We have sex dates and plan and hint at what will happen. This helps with the expectation. And now we both approach sex from a mental intention rather than a physical "pull."

Abigail Trafford: One of your goals is to break the silence that has grown up around sex. No one wants to talk about it. How do you get people talking about it?

Virginia and Keith Laken: When we speak in front of groups we try to make a safe place for people. We do that by talking about our situation first. Being open and honest about what we went through. As we talk we see people nodding their heads and we understand that they are relating. By "us going first" we let people know we understand, we've been there, and we are not judgemental. We don't prescribe any course of treatment or behavior. We tell our story and invite others to share theirs - if they want. And usually people are anxious and relieved to be able to talk about what they are going through.

arlington va: where can i find you book?

Virginia and Keith Laken: Our book is available on line at Amazon or Barnes and Nobel and can be bought in most bookstores. If the store doesn't have it they can order it.

Washington, D.C.: THANK YOU for writing this article today. I am a 24-year-old woman, and have been undergoing treatment for manic depression for two years. Before I began taking anti-depressants, I had a very healthy and active sex life, in spite of the m-d. As soon as I began taking Paxil, my sex drive disappeared ENTIRELY. At first, my doctor assured me that the problem would go away -- but it didn't. I switched psychiatrists in an attempt to get better treatment, but my second doctor also seemed to think that the disappearance of libido was a side effect I would just have to learn to live with. I was also told that, now that my libido had disappeared, my sex drive was now more similar to those of "most women" and that I should just get over it. That comment was the straw that broke the camel's back.

Luckily, I learned to be my own advocate in healthcare, and I kept bringing this problem up with my doctor and asking that he find a medication that did not affect my libido. A few months ago, we did find an anti-depressant that was both effective in treating my manic depression and had almost no side effects (Wellbutrin -- and you wouldn't believe how many other medications we tried first). It was a major struggle, however, convincing my doctor that the absence of a sex drive was a BIG PROBLEM and it deserved just as much attention as the disease I was being treated for. Being sans libido made me feel like a neuter -- I no longer felt feminine or sexy, or even much like a woman at all. It's hard for me to imagine that my psych. couldn't immediately grasp why this would be a problem for me.

I always figured that part of the problem with my doctors not seeing the libido problem as an issue was because I am female, and women's sex problems always seem to have lower priority in the medical profession. After reading your article, though, I realized that the problem is a bit more gender-blind than I thought.

This topic deserves the full attention of the medical community. Loss of libido and sexual function is -not- just a small side effect that must be tolerated -- it is, as you said, a quality of life issue.

Thanks again.

Abigail Trafford: Well said! Bravo for you. Keith and Virginia: what advice can you give to people to help them fight for medical recognition of the importance of a healthy sex life? If your doctor dismisses your complaints, what do you do next?

Virginia and Keith Laken: If my doctor dismissed my complaints (and I hear about this happening frequently) I would immediately seek another doctor. There are excellent resources avaiable but it might take some digging. Here are some websites that might be of help:

Sexuality Information and Education Council of the United States: www.siecus.org (an excellent site listing publications and books dealing with sexual function for both men and women as they age.)


First To Know Bulletin: www.ivanhoe.com/firsttoknow (comprehensive site for treatment of ED from all causes)


American Foundation for Urologic Disease: www.aufd.org (site dealing with any type of urologic condition, including impotence)


A Primer on Prostate Cancer: www.phoenix5.org (an extensive site exploring not only prostate cancer, but treatments for impotence, along with first person stories of people dealing with the same)


To Locate Sexual Therapists in your area: www.sstarnet.org

Baltimore,MD: My husband will not discuss that it is hard to hold an erection. I have become very creative with my hands and creams to help him. I have not talked to him about the frustration I have experienced because it might hurt his ego. Why would he not want to discuss this problem. He does take the heart medication, Cozaar, and I have read that this is one of the side effects. I am getting the courage to discuss it. He does have a stressful job and I thought that was the cause of his ED. In my hands he is usually ok but not for intercouse like you dicussed in the article in newspaper today. any suggestions?

Virginia and Keith Laken: Many men don't want to talk about this condition, it is embarassing, threatening, and even frightening. But it must be recognized before any help can happen. One statistic that might help overcome some concern is that at least 80% of ED is the result of a physical condition and once the physical condition is attended to the ED can often be helped.

Many times we think this is just a natural part of aging, but that is myth. We can be sexual all of our life, and we owe it to ourselves and our partners to do all we can to keep this part of our life as healty as any other part of our being.

Abigail Trafford: Tell us a little about yourselves and your life before the cancer diagnosis. Keith where do you work? Virginia what is your job? And I know you have two children. How would you describe yourselves?

Virginia and Keith Laken: We are pretty "normal" mid-age people we think. Keith is a senior manager for Watlow Electric, the world's leading manufacturer of heaters, sensors, and controls for industrial markets. Virginia is a business consultant, specializing in conflict resolution and communications. We have two grown children and four grandsons. Prior to Keith's prostate cancer we were happily married, enjoyed sex often, and were looking forward to enjoying the empty nest.

Washington, D.C.: I'm a chronic Lyme disease sufferer, with ED since '96. Viagra,Yohimbine useless. Muse too painful. What about pumps and injections?

Virginia and Keith Laken: There have been several questions regarding what do we use? Keith uses a tri-mix injection. Many think this is too dreadful of a thought to even consider, but Keith says it is no more painful than a slight needle prick. He uses a small guage needle and injects at the base of the penis. When the needle is injected into the spongy-like tissue on the sides of the penis there is almost no pain other than a small sensation on the outer surface.

Regarding pumps we haven't tried these but I know many have had excellent results with them.

Rockville Maryland: I enjoyed the article this morning. I have similar problems. What can you suggest for overcoming sexual problems? Attend the Center at Hopkins.

Virginia and Keith Laken: The unit of Marital and Sexual Health at Johns Hopkins would be an excellent resource. The people we have met there are well trained, caring individuals who understand how to help people with this condition.

McLean, Va.: BHP has caused impotence either full or partial with weak erections. Will I be able to help myself with your book?

Virginia and Keith Laken: There are several aspects to the E.D. issue. Physical and emotional and we believe they are related. Regardless of the cause, the treatment and help usually needs to address both the physical and psychological conditions. In a sense we feel they are one in the same. To this degree, the book should be most useful. Let us know what you think after reading it.

Rockville, Md: I have ED and have for several years. I am 73. Any hope for me.

Abigail Trafford: The answer is Yes! Virginia and Keith, please elaborate!

Virginia and Keith Laken: Yes! The first indication is that you are interested or concerned. That is a great start. A good starting point is with a Urologist, which could lead to an Endocrinologist, and assistance from a Psychologist. Each has an important part of the puzzle. This is best accomplished with your partner by your side.

Rockville, Md.: My fear of sexual intimacy stems from several incidents of sexual violations when I was younger. As a result, I shy away from intimate contact. I have body shame and feel conflicted. I often have mixed instances of feeling very much "turned on," but get afraid of the contact that will result. I am in therapy, but it doesn't seem to be working. Any advice to help a partner deal with my issues?

Virginia and Keith Laken: This conditions requires the cooperation of both people in the relationship. And as Keith said before is a situation with complex issues, as your demonstrates. Please consider going for help to a specialist in the field of sexual function. They are a great resource. Don't be ashamed. You deserve to enjoy this aspect of your life.

Virginia: Is there a difference between young couples and older couples? Or younger/older women and younger/older men?

Abigail Trafford: My personal view: a sexual life is important to older and younger couples and older and younger men and women. It's a myth that age diminishes a person's sexual identity. Keith and Virginia--what do you think?

Virginia and Keith Laken: We couldn't agree more. We intend to enjoy sex as long as we're alive...in whatever way possible. As one ages the quantity and sensitivity will often be replaced by quality and sensuality. Taking the deeper sensitivities and nurish them. It's always surprising to the younger people how interested older people are in sex and we think it shouldn't be a surprise. We're human beings who crave touch and intimacy. Younger people who read the book are finding an aspect of sex and intimacy they hadn't thought of before.

Washington, DC: Being both a prostate cancer survivor and
single has been truly interesting. Viagra
has not worked for me and I have been
prescribed Caverject, but am yet to use it.
It seems that much of your success is based
on being a couple. Do you have any advice
for those of us who are not in long term
relationships in terms of how we might
position our condition? Also, I am told that
most patients undergoing nerve sparing
surgery will regain their ability to have
erections. Did you (Keith) have this type

Virginia and Keith Laken: You are in good company. Kinda double jeapardy. Just as when we were young teenagers and experimented with ourselves, (masterbation) and developed a better understanding of ourselves and our bodies, we have to do that again. In other words practice makes perfect even when solo.

My information is anectdotal, but in my travels and meetings, I have only met one person who claimed no ED after the surgery - nerve sparing or otherwise.

Washington, DC: My wife and I have a happy marriage, but we often go long periods without having sex. The cause seems to be less about any given condition (like prostate cancer) and more about a host of factors from stress - to poor self-image - to feeling pressure to perform - to fear of impotence - to inertia and complacency. Our problem is more general than any one issue. How can you overcome all the psychological and physical hurdles that get in the way of a healthy sex life?

Virginia and Keith Laken: Communicate communicate communicate. This sounds easy I know but it is crucial. Tell each other how you feel and listen without judgement.

Rockville, Md.: There are other "treatments" for impotence, besides Viagra. I am specifically referring to the vacuum pump method. I find this whole procedure depressing and degrading. And the climax is far from satisfactory. How do other men feel about this method?

Virginia and Keith Laken: Many agree.

Washington DC: My husband's impotence began about five years ago, and today is total. He insists it is "his" problem, not "mine". I keep saying it is "our" problem. He tried the injections a few times, tried Viagra a little longer, then gave up on both. Nothing I do seems to make any difference, and he seems to accept that this is the way it is. We are only only in our late fifties. I cannot accept the loss of our sex life as "normal" We are quite polarized about this, and angry, and I wonder if you can suggest how I might persuade him to seek help with me.

Virginia and Keith Laken: I know this sounds like an advertisement but please get our book. We wrote it so others could see that they are not alone in their feelings or reactions. And that there is hope.

Silver Spring, Md.: my husband has hypertension and has taken medication since he was 19 yrs old.he has had ed since he was in his early fortys is there any thing you know of that will help him? He has discussed this with his doctors and was told that they could do the implant but he is very scared of that.

Abigail Trafford: There are several options. Implants are one. There are also injections. The pump. Medications. You need to dicuss the options and be willing to experiment. That's what the Lakens did. Keith and Virginia, what do you recommend?

Virginia and Keith Laken: He needs to weigh all alternatives. Seek out a doctor who specializes in male sexual health. Look at Johns Hopkins and ask the folks at the Marital and Sexual Health unit for references.

Massachusetts: How can I change my negative feelings about sex? I'm a 25 year old heterosexual woman who grew up in a religious household. I've never had any abusive sexual experiences in my past, but I do feel ashamed about sex and neglected sexually. I have a hard time being emotionally intimate with people, never mind being sexually intimate. I want an intimate relationship with a man, but I still feel that I don't deserve it in some way. I haven't had sex in a year and I really miss it, but how can I develop an emotionally intimate relationship with a man and progress into a sexually intimate one rather than jumping into a sexual one right away? And how I let myself believe that I deserve a good sex life and that it's a natural, integral part of life? I want to believe it but I still feel guilty.

Abigail Trafford: Keith and Virginia met at a small Lutheran College. Many people grow up in a religious environment and guilt feelings about sex are common. At the same time, sex is a wonderful, vital part of life. Keith and Virginia have been married 34 years! They are grandparents! There is no place for shame in a healthy, satisfying health life. Keith and Virginia, how can people overcome their guilt feelings?

Virginia and Keith Laken: I can defintely relate to your feelings. I had similar all my life. I learned how to overcome them and I think most people can. We deserve to give and receive sexual pleasure, otherwise I don't think God would have given us the equipment.

Hernon Va: In 1999, at the age of 48 years old, I had a silimar problem and my wife of 25 years have experienced everything you have detailed in the article. I tried the pump, muse, Viatiam V (Viagra), trimix (10 hours ED and taken to emergency room). We are still struggling what would you recommend.

Virginia and Keith Laken: Persistence and a determination not to give up. Smaller does of tri-mix.

Washington, DC: What can you tell us about implants when VIAGRA and injections do not creat an erection?

Virginia and Keith Laken: We haven't used an implant, but check out the phoenix5 website I gave. Great information on them there.

"Out of the loop": Dear Abigail, Virginia and Keith--I'm a 34-year-old single female and have not had a sexual relationship in 12 years due to an abusive relationship in college that was/is hard to get over (I have sought therapy). While my "ex" was not, amazingly, sexually abusive, he was abusive in almost all other aspects of the relationship. I know that this is one of the reasons that I have remained single all these years. But, after much soul-seaerching, I have decided, albeit with trepidation, to get out into the dating world again. The reason I write to you is because I am terrified of being sexual again, though of course I woud love to enjoy the pleasure and intimacy that a sexual relationship can bring. I mainly fear my "performance" due to lack of experience, bad memories and years going without. I know that if I meet the right man I (hopefully) will be able to discuss this with him, but still, I am concerned about expectations, especially for a single woman. Do you have any advice for me, or can you recommend any books? I want to be prepared. Thanks!

Abigail Trafford: The Surgeon General's Report on Sex and Sexuality made a very good point: we are sexual beings with a sexual identity all of our lives from birth to death. Sexual intercourse is only a part of our sexual life--but a very important part. It's right that you want to have a sexual life and that is likely to include sexual intimacy with a partner. All of us are vulnerable and fear "performance." Once the silence is broken, it's amazing how open people become and how ready they are to listen and be tender their partner's needs and concerns. Keith and Virginia, what do you suggest. Are there books in addition to your that would help?

Virginia and Keith Laken: Seek out a sexual therapist. Someone who has experience and education in this field. Check out their credentials. Many people claim to be experts in this field but don't have the education to back it up. So look for the best qualified. You owe it to yourself. And don't wait until you find someone, start now.

Fairfax, Va.: Seeing a sex therapist to look at available options is all well and good . . . if you can pay for it. Do most insurance plans cover this, as well as medications or devices prescribed? Especially if we're talking about nonmarried couples (including homosexuals). Are there options for low-income folks or the health plan-challenged?

Abigail Trafford: You've highlighted a major problem. Health plans need to cover this the way they cover blood pressure and other vital elements of health. Until then, what can people do to get help?

Virginia and Keith Laken: Each insurance plan is of course different but don't hesitate to still check it out with an educational institution who might be willing to treat you without insurance. Sexual orientation makes no difference here, the pain is the same.

Washington, DC: What tecniques or medications are you using?

Virginia and Keith Laken: Tri-mix injections.

Falls Church VA: Comment: I disagree about the vacuum pump. My 6-year experience has been completely satisfactory (other than my wife's comment about the "mid-love-making pump-up"). I have a leaky vein that made it hard to hold an erection, followed by severe BPH and a TURP. The vacuum "therapy" has increased blood flow and produces super hard erections, when you are ready for them. I don't find it cumbersome or painful - try it! (now available in drug stores for about $135).

Virginia and Keith Laken: Thanks for the feedback.

arlington, va: You seem to have overcome "ED" without either surgery or medication. How did you accomplish this?

Virginia and Keith Laken: Keith uses the tri-mix. Tried Viagra didn't work.

Washington, DC: Like Mr. Laken, Viagra did not work for me
and I've been hesitant to utilize injections.
How did the latter work for yo

Virginia and Keith Laken: After trial and error they work great.

Gaithersburg, MD: I had doubl vascular bypass surgary in my lower belly/upper leg about three years ago. This was caused by smoking non-filtered sigarets for over 30 years. Since then my ability to have sex gas slowly diminished over time. Now it is so far I have trouble to get prolonged erections and sometimes can not get one at all. Also my desire to have sex has become less and less. I have tried viagra, but this does help. My urologist say that my bloodvessels in the penis are clogged to some point causing this. He he prescribed Muse now, but I haven't tried it yet. Needless to say all this has caused a terible strain on my marriage. I'm 54 and my wife is 48. What can we do to get a healthy sexlife back.
S.O.

Virginia and Keith Laken: You've begun the process by wanting to have a sexual relationship. We suggest looking at the medical and psychological issues involved. Don't ignore one or the other. Great resources at the end of the book.

DC Metro: I am a 33 y.o. woman who has completely lost interest in sex. As far as I'm concerned, I could very well go the rest of my life without it, and I'd be just fine. My husband, of course, feels strongly (and probably correctly) that sex is or should be a major part of our relationship. It has gotten so bad that he doesn't really even offer anymore, so we can go for months without having sex. It is humiliating to me, and I know it hurts him. But I don't know what to do. I have no desire, and when we do do it, I get no pleasure from it.

Please help. My OB/GYN hasn't been any help whatsoever.

Abigail Trafford: There is help. If you've lost interest in sex, or sex is painful, you need to get a good medical/psychological evaluation of what is causing the problem. If your gynecologist can't help you, ask for a referral to a gynocologist who can. Gynecologists can also refer you to sex therapy. One resource in this area is the Johns Hopkins Center for Marital and Sexual Health. It's also important to talk about it. Keith and Virginia, what is your advice?

Virginia and Keith Laken: Abigail you've said it all. And take your partner with you to the appointment.

Abigail Trafford: Alas our time is up. Thank you Virginia and Keith. We've created a safe place here online for people to discuss these issues. Thank you all for your comments and suggests. See you next week, same time, same place.

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