It is always an honor when the AUA asks me to write an article. When William P. Didusch Center for Urologic History of the AUA asks you to write an article on the Canadian contribution to the field of sexual medicine, it is not only an honor but also very stressful and worrisome. It is stressful because you always worry about forgetting someone in the process. As a disclaimer, this article will be mainly based on my memory and concentrate mainly on urologists that I know for certain are Canadians who have contributed to sexual medicine in Canada and the United States. I would need to write a book on Canadian contributions if I wanted to be thorough, but I am limited to an article. I am certain that I will forget some individuals, and I apologize in advance as it was not done intentionally. Dr. Hossein Sadeghi-Nejad has been very helpful for this article. He has given me his excellent presentation of the Canadian contributions that he made at the last SMSNA meeting in Arizona in October 2021. I will talk about the sexual field in Canada and the impact of Canadians working in the United States who have influenced the field.
When we want to appreciate changes in the field, guidelines are an interesting polaroid picture of who was involved in a specific time in history.
The first guideline on erectile dysfunction (ED) organized by the Canadian Urological Association (CUA) was published in 2015. The authors were Anthony J. Bella, Jay C. Lee, François Bénard, Gerald B. Brock, and myself.
In 2018, the CUA published a guideline on Peyronie’s disease and congenital penile curvature. The authors were Anthony J. Bella, Jay C. Lee, Ethan D. Grober, Serge Carrier, Francois Bénard, and Gerald B. Brock.
In 2021, under the guidance of Ethan D. Grober, a urologist from the University of Toronto, the CUA published a guideline on testosterone deficiency in men with the following co-authors: Yonah Krakowsky, Mohit Khera, Daniel T. Holmes, Jay C. Lee, John E. Grantmyre, Premal Patel, Richard A. Bebb, Ryan Fitzpatrick, Jeffrey D. Campbell, Serge Carrier, and Abraham Morgentaler. Of course, not all are Canadian or urologists, but they are still contributing to the field of sexual medicine in Canada. Dr. Grober and Krakowsky work together in Toronto in sexual medicine and gender-reassignment surgery.
The second CUA ED guideline was published in 2021. The authors were Trustin Domes, Borna Tadayon Najafabadi, Matthew Roberts, Jeffrey Campbell, Ryan Flannigan, Phil Bach, Premal Patel, Gavin Langille, Yonah Krakowsky, and Philippe D. Violette. These authors are the new generation of Canadians involved in the field of sexual medicine.
Canadians have also been involved in the publication of the AUA guideline on sexual health. Jeremy Heaton was in the 2005 AUA update on the management of erectile dysfunction. Hossein Sadeghi-Nejad has been on the panel of the 2015 Peyronie’s Guideline and the 2018 ED AUA guideline. Gerry Brock and Faysal Yafi have been on the panel of the 2021 AUA/SMSNA guidelines on acute ischemic priapism. Jeremy Heaton was in the 2004 guideline committee on premature ejaculation, and I had the honor of being part of the 2021 AUA/SMSNA guideline on Disorders of Ejaculation.
As shown by these guidelines from the CUA, AUA, and SMSNA, many Canadians have been involved in the field.
SMSNA was founded in 1993 under the guidance of Dr. Ira Sharlip under the name of the Society for the Study of Impotence (SSI). The first meeting of the Society was held at the AUA, San Francisco in 1994. The Society was renamed the Sexual Medicine Society of North America in 2001. Dr. Alvaro Morales was the first Canadian to become the chair of the Society in 1997. At that time, the term of the president was one year.
Since then, other Canadians have been presidents of the Society. Irwin Goldstein, renowned internationally, was the president in 1999. He was one of the founders of the International Society for the Study of Women’s Sexual Health (ISSWSH). He became the first Canadian to be the president of ISSWSH in 2016. became president in 2004. He was the first Canadian to become president of the International Society for Sexual Medicine (ISSM). His work has had a significant influence on the field. Wayne has trained many Canadians over the years.
Dr. Faysal Yafi, a rising star in the field of Sexual Medicine in the U.S., is one of them. I had the privilege of accepting Dr. Yafi into our residency program as the Urology Residency program director at McGill University. He is the chief of the Division of Men's Health and Reconstructive Urology, Director of Men's Health and Newport Urology, and co-Director of the Fellowship in Male Reconstructive and Prosthetic Urology at the University of California, Irvine.
Hossein Sadeghi-Nejad was the president of the SMSNA from 2018 to 2020. He also served on the American Board of Urology Examination Committee and is currently an examiner for the oral boards. Hossein did his medical training at McGill University. His family immigrated to Canada from Iran. Before settling in Montreal, his father worked in Abitibi at the Hotel Dieu d’Amos hospital in Quebec as a general surgeon.
In 1998, the Canadian Male Sexual Health Council (CMSHC) was founded as an affiliate of the CUA. The CMSHC had the mission to raise awareness of sexual issues between partners, heighten recognition of male sexual dysfunction as a significant health problem in Canada, and promote male sexual health and excellence in care through professional and public education and research relevant to sexual function and disorders. The CMSHC has been very involved in developing continuous medical education for family doctors and specialists in the field of sexual medicine in Canada. Alvaro Morales, a past president of the SSI (SMSNA), was one of the founders of the Council.
Dr. Alvaro Morales is a urology legend in Canada. He is well known globally for his pioneering work using Bacillus Calmette–Guérin. He was the head of Urology at Queen University, in Ontario, from 1982 to 1997. Under his leadership, his department has been very prolific in the field of Sexual Medicine. He has collaborated with Jeremy Heaton and Michael Adams, a renowned primary researcher. They have published work to help us better understand the physiology of the erection as well as the pathophysiology and management of erectile dysfunction and hypogonadism. Johanna Hannan, another Canadian, well known for her work on smooth muscle physiology and abstract chair at our 22nd SMSNA fall meeting in Arizona last October, did her PhD with Dr. Adams.
Over the years, many great Canadians have led the CMSHC organization. Dr. Gerry Brock was the chair twice. Dr. Brock is a renowned urologist nationally and internationally. Gerry Brock is, in my opinion, one of the most prolific Canadian urologists in the field of Sexual Medicine. I met Gerry in 1995 while we were fellows together in Tom Lue’s lab in San Francisco. He started his career at McGill University in Montreal, Quebec, then moved in 1998 to Western University in London, Ontario. I moved then from the University of Montreal to McGill University to take his previous position. He is the current president-elect of the ISSM. He has been chair of the 4th ICSM-Madrid and the CUA and secretary of the ISSM and SMSNA. Dr. Brock trained Anthony Bella, who went to work at Ottawa University after his fellowship. Dr. Bella, also well known, has been the lead author of the 2015 CUA ED guideline and 2018 PD CUA guideline. Jeffrey Campbell has taken the position of Dr. Brock at Western.
Dr. Auld Brewer from Dalhousie University, a past president of the Northeastern Section of the AUA (NSAUA), was the next CMSHC chair. He was very involved in CME. I was then the chair of the CMSHC, followed by Jerzy Gajewski. Dr. Gajewski has also been the president of the NSAUA and the CUA. He is the recipient of the CUA Life Achievement Award. From the University of Calgary, Dr. Jay Lee is well known nationally and internationally in sexual medicine and was the following president. Stacey Elliott then took the leadership role. She became the first non-urologist to occupy this position. She is a sexual medicine physician from the University of British Columbia. She is well known in the field, especially for her implication with a patient who has a neurological disability. Richard Casey followed Dr. Elliott as chair of the CMSHC. From Ontario, Richard established the first Canadian Journal of Sexual & Reproductive Medicine in 2001, for which he was the editor in chief until his publication was stopped. Over the years, many other urologists and non-urologists have been involved in the CMSHC and CME nationally.
The 1st International Consultation on erectile dysfunction organized by the International Consultation on Urological Diseases was held in Paris in July 1999. Many Canadians participated in this major event and contributed to the edition of the 1st book on the international consultation on ED, such as in alphabetic order: Gerry Brock, Serge Carrier, Irwin Goldstein, Jeremy Heaton, and Alvaro Morales. Since then, many more Canadians have been involved with the consultations. Dr. Gerry Brock was the actual chair of the 4th consultation in Madrid in 2015.
There are two other internationally known Canadian urologists that I would like to mention. The first one is Dr. Sender Herschorn, from the University of Toronto. He is also a legend in Urology in Canada. Although he is well known for his incontinence and functional urology work, he has been involved in many major events and study trials related to erectile dysfunction. He is a Past-President of the Canadian Urological Association. The second one is Abraham Morgentaler from Harvard Medical School. Dr. Morgentaler is an international authority on men’s health and a pioneer in the treatment of testosterone deficiency in men.
Although I had initially intended to focus on urologists, the significant contributions of many non-urologist Canadians who have had an impact in the field of sexual medicine cannot be overlooked. I will mention a few of them only.
At McGill University, I had the chance to collaborate with psychologists that impacted my patients and me. Irv Binik, a renowned psychologist in the field and well known for his work on genital pain, has been a great collaborator. I have had the opportunity to work with his postdoc fellows on many projects. Over the years, I have also collaborated with Julie Larouche, a psychologist working in the sex and couples therapy unit at McGill University.
In 1997, Pierre Alarie, a family doctor specializing in sexual medicine, and Richard Villeneuve, a psychologist, founded the Association of Sexual Medicine of Quebec, which allowed Specialists and Family doctors to have training and meetings on sexual medicine in French. Pierre worked very closely at the University of Montreal with two prominent urologists involved nationally in CME in the field of Sexual Medicine, Drs. Luc Valiquette and François Benard. François and Luc have both been the president of the Quebec Urological Association. Dr. Valiquette has also been president of the CUA.
Pierre Assalian was a psychiatrist at McGill University. He founded the Human Sexuality Unit of the Montreal General Hospital in 1978. He was the first psychiatrist in Canada to be a certified sex therapist by the American Association of Sex Therapists. He was one of the directors of the Canadian Sex Research Forum.
Jim Pfauss, an expert in the psychology of sexual behavior, was working at Concordia University and whose work is often cited, has influenced the field.
Rosemary Basson is a clinical professor in the Department of Psychiatry and the University of British Columbia Sexual Medicine Program director. She was vice-chair of the 2nd and 3rd International Consultations on Men and Women’s Sexual Dysfunction in 2003 and 2009.
As for myself, I have been lucky to meet and know most of these individuals who impacted the field of Sexual Medicine in Canada. Many of them have become friends. Each of them has contributed to advancing the field. Many have helped me over the years and allowed me to contribute. These friendships have allowed me to become chair of the CMSHC, president of the Société Francophone de Médecine Sexuelle in Europe, and now the president of the Sexual Medicine Society of North America.
I hope you enjoy reading this glimpse of Canadian contributions to the field of sexual medicine. I apologize again if I forgot someone because I am sure I did.
Serge Carrier, MD, FRCS(C), MMgmt
President of the SMSNA