Michelle: Becca, what makes this book different than other books about men’s pelvic conditions?
Becca: There are lots of books written for men about the pelvis; and they are fantastic and also very helpful to the guys that we treat. These books are typically written in a nonfiction format, but I am a reader of fiction. I resonate with people more than facts. I decided to write a book about the male pelvis from a fictional point of view. There are five characters within this story with different problems. I wanted to create personalities around their symptoms, to delve into the backstory of each person living with pelvic floor dysfunction and how it impacts their day-to-day lives. It is important to read nonfiction about how to address erectile dysfunction or pelvic pain, but another thing altogether to be inside a private treatment room with a man whose world is collapsing because of his pelvic pain or prostate cancer. I wanted to give the reader a glimpse into the mind of a man struggling with pelvic floor dysfunction in a very personal format.
Michelle: Can you tell us more about the actual conditions that these men have been diagnosed with?
Becca: I would be delighted to. One main diagnosis of men which is highlighted in this book is known as Chronic Pelvic Pain Syndrome. One of the reasons that I needed to write about this topic is because it is little known in the general population. Chronic Pelvic Pain Syndrome, or CPPS, is a cluster of symptoms which often include urinary burning and urgency, penile, testicular or rectal pain, constipation, pain with arousal and ejaculation and difficulty sitting due to these symptoms. In pelvic floor physical therapy, we treat men with this condition, though we are aware that there are many more men out there with such problems who don’t know where to turn.
One character in the story is named Tom; he is a successful sommelier (also known as a professional wine-taster, which sounds like a fun job if you ask me), with a wife and two daughters. Tom begins to have crippling constipation and he experiences pain in his pelvis after having sex with his wife. At first, Tom hides his pain and stops having sex with his partner, due to his great anxiety about the matter. But Tom has money and good medical insurance, so he is able to navigate through the medical quagmire to get the treatment he needs.
Kirk is another character who has Chronic Pelvic Pain Syndrome. But Kirk is only 24 and he is a drummer in a band. Kirk has searing urinary pain and pain having sex with the women he meets on tour with the band. Kirk attempts to treat his pelvic pain with drugs and alcohol (a very common finding for men with this diagnosis), but he has no medical insurance and is financially broke.
I wanted to show two vastly different outcomes for men with Chronic Pelvic Pain Syndrome with these two characters. They have exactly the same problem, but one has the means to get help for his condition, the other does not.
Michelle: What about prostate cancer? Can you tell us about how you created a character around this diagnosis?
Becca: Oliver is a biracial man raised in Alabama. His father is a white police officer and his mother is Jamaican. Oliver’s father teaches his son how to hunt wild turkey when he is merely ten years old. He then grows up and becomes a sharpshooter in the U.S. Army. Oliver is sent to Iraq and then Afghanistan and takes pride in his shooting abilities and time spent serving his country. When he comes home for Thanksgiving one year to visit his parents, he meets a woman named Talulah. They fall in love, Oliver returns home to the States and takes a job as a state trooper, the couple gets married and has a baby. Tada! Life is beautiful, right? Oliver is then diagnosed with prostate cancer as a 42-year old. In working with men with prostate cancer, there are some pretty consistent variables in how they respond emotionally, and these variables can be seen through Oliver’s journey. Oliver is my favorite character in this book. Maybe because prostate cancer is the second most commonly diagnosed cancer in the U.S. and I wanted men to feel that they could read the thoughts of a guy who is being told the worst news of his life; but who then gets treated for his cancer and still has a great life thereafter.
Michelle: Got it! Next, how about men with erectile dysfunction who don’t have prostate cancer or pain with sex? Does your book assign this very common issue to a character?
Becca: Yes. His name is Rick and he is a plumber in Pittsburgh, PA. Rick owns the plumbing company, in fact, and his son Francis will be the first man in his family to go to college. The main fly in the ointment in Rick’s life is his eroding marriage to his wife Nicole. Their partnership is devoid of intimacy and Rick notices newly-developed erectile dysfunction as his marital communication worsens. Rick goes to a female urologist for bioidentical hormone replacement. It is through his conversations with his urologist that we get to see underneath his tough exterior to the vulnerability of a man who has erectile dysfunction.
Michelle: I see that this female urologist is also a character in the story. Can you tell us how she enhances the book?
Becca: The character of Dr. Sheila Ashtiju is based on a very skilled physician who treats patients from our pelvic floor clinic to improve sexual function. Through Sheila’s eyes, we are able to see how she treats men with bioidentical hormones to address erectile dysfunction. We are also able to get an outsider’s viewpoint on how men react to their pelvic problems from a skilled physician, who also happens to be a female with sexual secrets that she feels she must hide.
Michelle: Who is the ideal audience for this book?
Becca: I’ll tell you a cool side-story that may answer this question. I had a choice between two cover designs for this book. One was distinctly masculine, the background was dark-blue and the vibe mysterious. The other cover was white, clean and crisp, and is the one I ultimately chose. Before choosing between the covers, I walked around a local restaurant and asked everyone there which cover they preferred, even though they had no concept as to what the book was about. 90% of men chose the blue, masculine cover and 80% of women chose the crisp, white cover.
I stayed up all night worrying, but was counseled by a very good friend who steered me in the right direction. “Women drive healthcare in this country,” she advised. “Men often won’t go to a doctor until a female partner pushes them to. Choose the book cover that will appeal to the greatest number of people, but also a cover that women will want to read. Because this book is for people of every gender and has something for everyone.” This book is for any person who has experienced erectile dysfunction, pelvic pain, prostate cancer and anyone close to those with these issues. I hope that answers your question about the ideal audience, Michelle.
Michelle: Any other pearls from the book that you’d be willing to ‘sneak out’ to the Connect PT community?
Becca: While I hope that the fictional characters are people with whom the reader can identify with in some way, I realized after writing that portion that a nonfiction/scientific explanation was necessary to illustrate why the characters got the treatments that they did. I have never written a book with nonfiction within it before, so it was a stretch to get through all those research studies. I remember doing it in my attic in July of 2019. I decided not to turn on the air-conditioning to really get to the grittiness of the matter.
After four weeks of sweating and gulping down coconut water in that attic, I had a bibliography. I wanted the readers to know that Chronic Pelvic Pain Syndrome is suspected to be present in 2-16% of the population. This is the NUMBER ONE diagnosis for men under 50 who come to a urologist’s office, yet very few people know this statistic. I also wanted to rationalize why the fictional character with prostate cancer was created as being biracial. Black men are 50% more likely to develop prostate cancer than white men. The nonfiction portion of the book is extremely important and reviews treatments for Chronic Pelvic Pain Syndrome, prostate cancer and erectile dysfunction. It is a nice compliment to the fiction.
And finally, I added a backstory on where the characters came from. It was in this portion of the book where I feel I was most able to honor men, to acknowledge their struggles in a world that does not allow for male weakness or vulnerability. This was the easiest part of the book to write; I waited until September as cooler winds blew and football season had arrived. I hope you can all get something out of this book.
For a sample of one of the many topics discussed in the book, check out Becca's latest video on Erectile Dysfunction & Physical Therapy Treatment.