Dear Dr G,

I am almost too embarrassed to ask for your help. But I guess my prostate troubles are simply unbearable and may need some intervention.

I have been blissfully waking up at night to urinate for many years and I have noted that the urine flow has weakened over time and there is dribbling at the end.

Apart from that, I also started having frequent urination during the day, and each urination is an effort with a lot of strain.

I always thought I had a weak bladder, but only realised my ignorance in the matter when I visited a clinic.

The doctor told me my symptoms are related to the prostate, and said as it gets bigger, it was causing the weak flow and retained urine.

He also mentioned the enlarged prostate as a cause for my occasional erectile failure. Well, I did mention occasional “softness” in my erection.

I was given medications, which helped a bit, but resulted in cessation of ejaculations.

The doctor mentioned I may need to consider an operation if the symptoms are worsened. However, he did warn me of further dire consequences to my sex life.

I hope to put Dr G on the spot for more knowledge on prostate problems and interventions.

Can you please tell me what is prostate? What is the role of this organ?

Why is the medicine causing me to have dry ejaculation?

What are prostate operations and how can they impact my sex life?

I am scared and confused? Is ignorance really bliss or a curse for me?


Prostate Pete

Charity outfit Prostate Cancer UK did a survey recently that showed nearly one in five men (17%) did not know they have a prostate.

In the same study, the researchers explored the knowledge of 1,900 British men and found 92% of them were clueless about the role of the prostatic gland, and 54% of the same group of men were also uncertain where the gland is located.

The prostate gland is a simple gland with a simple role. This walnut-sized gland is located between the base of the bladder and the penis. It surrounds the penile urethra and permits the passage of urine and facilitates semen expulsion during ejaculation.

The function of the gland is solely providing secretions that are rich in nutrients for the sperm to survive.

The prostate is considered “redundant” in men beyond the reproductive age, as it plays no further role beyond sexual and reproductive purposes. Despite the redundancy, the prostate will continue to grow. Although the growth is predominantly benign in nature, such enlargement can cause constriction of urinary flow, as the gland is intricately connected to the urinary tract.

The engorgement of the prostate gland can impede the flow of the urine, causing slow start, intermittent urinary flow, and residual urine with incomplete emptying.

The left-over urine usually causes urinary frequency both in the day and night. Such nuisance in men is generally considered as Lower Urinary Tract Symptoms (LUTS)

Some 20% oof men presented with urinary symptoms are also noted to have erectile dysfunction. Conversely, 30% of men presented with erectile dysfunction will also have concomitant prostate symptoms.

The cause and effect of this association is difficult to establish. However, such correlation demonstrates the intricate relationship between prostate glands and erectile and ejaculatory functions. This also means prostatic medical or surgical interventions of the prostate may also adversely affect sexual functions in men.

The medical interventions of the prostate can evolve around three groups of medications. These include alpha blockers, 5-alpha-reductase inhibitors, and Phosphodiesterase 5 Inhibitors.

Alpha blockers are simple medications that act as muscle relaxant to reduce the impedance of urine. Men taking such medications can expect to have better flow and emptying of urine. However, such muscular relaxation also has the side effects of causing dizziness and dry ejaculation.

The second group of medications, 5-alpha-reductase inhibitors, play the role of reducing the size of the prostate by diminishing the active component of testosterone. The side effect of such manipulation is lowering the libido in men.

Lastly, a bit of good news, Phosphodiesterase 5 Inhibitors are generally used for men with prostatic symptoms and erectile dysfunction, as the medication can improve both urinary flow and erectile function.

For men having persistent trouble despite medications, prostate operations are inevitable. The gold standard of prostate operations is the Trans Urethral Prostate Resection (TURP).

This surgical intervention involves the insertion of a camera through the penis, utilizing electric loops to remove “chips” of the prostate. The operations can instantly remove the obstruction caused by the prostate.

However, as the operation also “destroys” the inner sphincter of the prostate responsible for ejaculation, most men will also experience dry ejaculation following the intervention.

In addition, the prostate is also closely linked to the nerves that help with erection. Therefore, many men also reported weaker erections following the operations.

Although many other operations are designed to diminish sexual adversity following surgery, certain expectation management is crucial.

We often hear the phrase “Ignorance is Bliss”. While such a mentality of cluelessness and denial may not be overtly harmful, many are adopting such approaches even with the knowledge of health issues.

In reality, this is a form of escapism that brings about temporary self-comfort, but how long can we bury our heads in the sands?

Although the prostate gland is a mystery to many men, its impact on urinary and sexual health cannot be underplayed as we age. Being more prostate aware is the key to improving urinary symptoms yet minimising the adverse impact on sex.

In the historic play, Henry VI, William Shakespeare described: “Ignorance is the curse of God, knowledge is the wing wherewith we fly to heaven”.

Dr G’s advice to men who are prostate-naive is that: “Health ignorance is a curse of self destruction: Knowledge in health can prevent an early visit to heaven.”

And at least, more knowledge of prostate functions can also ensure no visit to the hell of sexual calamity!

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