(HealthScoutNews) -- For Virginia and Keith Laken, treating Keith's prostate cancer was just the beginning.

"We had to redefine ourselves as to how our sexual relationship was going to be, and Keith had to redefine himself regarding his manliness," says Virginia, a communications consultant. "You need to understand that that's normal, that you're going to most likely need help with that."

The Minnesota couple had been married more than 25 years and were enjoying their new empty nest when Keith was diagnosed with prostate cancer at the age of 49.

Prostate cancer is second to skin cancer as the most common cancer in men, according to the American Cancer Society. An estimated 189,000 cases of prostate cancer will be diganosed in the United States in 2002, and more than 30,000 of them will be fatal.

Although there are a number of effective treatments for the disease, a large proportion (estimates range from 30 percent to 90 percent) of the men who undergo treatment will experience temporary or permanent impotence.

Worried that he would become one of these statistics, Keith first opted for no treatment at all. He later changed his mind and in 1995 underwent a radical prostatectomy to remove his prostate gland.

Then the real struggle began.

The very personal details of that struggle became the basis for a book, Making Love Again: Hope For Couples Facing Loss of Sexual Intimacy, which is the couple's candid and dramatic attempt to offer help and hope to other couples facing similar problems.

Like many men who have prostate surgery, Keith was unable to get an erection. The Lakens didn't have sex for three months after the surgery. Simply by chance, Keith's urologist told them that it was possible to have an orgasm without an erection. So the couple began experimenting with oral sex and found that it worked well -- for a while.

"Be careful what you wish for," says Keith, the president of Watlow Polymer Technologies in Minnesota. "Anything can get old."

The Lakens then tried penile injections to create an erection, which also worked for a while -- until the shots became a nagging reminder that Keith wasn't having erections on his own. They also tried Viagra, which, in this case, was not the cure-all it's touted to be.

Finally, Virginia and Keith made an appointment with a male sexual dysfunction specialist -- neither of them knew that such a person existed. That was the turning point.

The specialist assured them there was nothing wrong with Keith's libido, just his arousal system.

"It was like someone telling you you're doing pretty good," Keith says. "There's really nothing wrong with me. Basically, we just had to start working on making love differently."

Now, Keith says he approaches sex more like a woman.

"Instead of it being an automatic thing, I have to think about it from the standpoint of wanting to engage in sex," Keith says. "There will never be another moment where I say the moment caught me. That spontaneity part of it is gone, but it has raised us to a new level."

Most important, they both have redefined the role of intimacy in their relationship.

"Sexual intimacy is about comforting each other with our bodies. And that might mean we engage in intercourse. It might mean we just hug. It might mean we masturbate, but it is what we both decide we're going to do to physically please each other," Virginia says. "As time goes on, it's likely to change again."

Dr. James Talbott, director of the Center for Outcomes Research at Massachusetts General Hospital Cancer Center in Boston, read the Lakens' book in one sitting and says it "very much recapitulated the thinking that I see in patients."

He adds: "The first issue is, 'What do I do about the cancer?' And only later is what it will be like to live the rest of your life with these problems considered."

That struggle can be an even-more pressing issue with prostate cancer, where survival rates tend to be high.

"Far more people are diagnosed with the disease than are seriously harmed by it," Talbott says. "Over time, there's a gradual assessment that not only is the cancer not as big a threat as it initially sounded, but these sacrifices [such as surgery] that were willingly made loom bigger."

Among survivors and physicians both, impotence tends to be a taboo subject.

"It's interesting to me that at our clinic, every women who has breast cancer is referred for psychological counseling, and no patients with prostate cancer are automatically referred," Talbott says. "There really is nothing out there."

The Lakens are attempting to change that. They are currently on the lecture circuit speaking about their experiences to patients and medical professionals.

Keith sees renewed intimacy as a vital part of the healing process.

"The physical body may be put back together with a surgeon and sutures, but the connection to the mental expectations is part of the same process," he says. "It's better to look at it as a continuous process of recovery."

The Lakens advise couples confronting impotence to:

• communicate and candidly share information with each other.

• recognize the need to treat the mind as well as the body; seek help from support groups and mental health experts.

• accept that emotional states can swing from high to low unexpectedly, especially during the first year of recovery.

What to Do: For more information on prostate cancer, including impotence and finding a support group, visit the National Prostate Cancer Coalition. And impotence.org has a wealth of information on erectile dysfunction.

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