Cybersex: The Dark Side of the Force. Edited by Al Cooper. Philadelphia, PA: Brunner-Routledge, 2000. v+149 pages, figures, tables, references, index. Paperback, ISBN 1-58391-305-X, $19.95.

Abstract

just knowing about lubricants or a position change is enough. But more often, in my experience, feelings have already been hurt, sexual contact has diminished, and it takes some subtlety and patient management to help a couple to attempt to reconnect sexually. I only point this out because I don't feel it was spelled out enough for the patients-who, I worry, may give up if I when their awkward attempts to better their situation fail. In stark contrast is Ralph and Barbara Alterowitz's The Lovin' Ain't Over: The Couple's Guide to Better Sex After Prostate Disease. From the title alone, we see that this book deals with couples facing prostate cancer only. It is one of many books now on bookstore shelves dedicated to one form of cancer or another, and important in that re"gard. Unfortunately, I found this book to be simplistic, presumptuous, self-righteous, and poorly organized, and noninclusive of the variety of couples or individuals facing this disease. Given that this book is about a couple who faced prostate disease and its sexual aftermath and who apparently conquered it, it is odd that we are never told this couple's story. So that while this book would seem to be far more personal and less clinical than Dr Schover's, it is only superficially so. Colloquialisms for body parts or sexual acts are never used, and definitions are omitted where less sophisticated readers might need them. For example, ejaculate is the only word used for cum. Endorphin highs are mentioned, but endorphin is never defined. There are no anatomy diagrams. "It is not necessary to have an erection for either partner to have an orgasm" (p. 14). This is important information, but it is embedded in a paragraph and not emphasized in a logical or prominent place where one might expect to find it. Moreover, it is poorly worded. Another instance of some really useful information being buried in the text is the recommendation to take nasal decongestants to reduce urine leaks after treatment. The caveat that men with enlarged prostates should not use nasal decongestants is noted, but could easily be missed since it doesn't follow immediately after the recommendation. Still worse is that a (relatively harmless) medical complication of prostate cancer treatment is explained in a way to frighten readers. On page 20, retrograde ejaculation is said to occur when "the ejaculate flows back into the body instead of flowing out of the penis"! It is more correct, and far less scary, to say that semen is ejaculated backward into the bladder and then expelled during urination. (Dr Schover covers this point far more sensitively, letting patients know that they can still father children using alternative reproductive methods.) Several times in the prostate book, the Alterowitz team exhorts couples to change their behavior: "If taking street drugs, stop immediately" (p. 13); and "Stay in shape or risk heart attack or stroke" (p. 57). If only merely telling people to quit their addictions, or exercise and lose weight, worked! This presumption that people can change if just told to carries through to changing entrenched sexual repertoires, trying new or different sexual activities, and being told not to worry about the almighty erection or orgasm. The Alterowitz's recommendations are, again, simplistic and have a "just do it" mindset. The Alterowitz seem to have used a model of the well-adjusted, open-minded, happily married couple as their guide in writing this book, I assume not unlike themselves. Unfortunately, that leaves out a large number of people. I'm sure there are people for whom this book will be helpful, but I would still recommend Dr Schover's more general book over this more specific one for all the reasons outlined above. Even Dr Schover' s chapter on penile implants is more thorough and more clearly explained, both verbally and visually. As I've said, neither book emphasizes how difficult it can be to make the changes suggested. Indeed, sex therapists and marital counselors are barely mentioned. I find that even the most open, caring couple has difficulty talking about-never mind actually making-the changes they need sexually, whether they've gone through a major upheaval like cancer, or even if they merely desire a change over time. Fortunately, and most important, Dr Schover's book makes more visible the extent of sexual issues facing cancer survivors, giving the survivors and their loved ones as well as professionals in related fields ample guidance about this sensitive and highly charged quality-of-life issue.