The Guide to Getting It On (39 page)

Trouble in the Pelvic Underground

A gland that has to spend its entire life next door to a guy’s rectum is going to get uppity every now and then. We’re talking life without parole inside a human porta-potty. So if the gland is going to revolt, what are its options? Its most immediate targets are the bladder and the urethra. With a little enlargement here and there, the prostate can nearly cripple a man’s ability to do everything from peeing in a straight stream to making him drip for a long time afterward. It can cause such an urgency to urinate that he can’t hold it for more than a couple of minutes and it can make him wake up four times a night. It can also interfere with his ability to ejaculate without pain or to even walk or sit without discomfort.

Most prostates get bigger as a man gets older, yet there’s no room for expansion. As you can see from the illustration on the next page, if the gland grows one way it’s into your bladder, the other way it’s up your rectum. Or the prostate might not feel enlarged, but the growth is on the inside of the gland in the central zone, where it can push against the urethra and clamp it shut.

If this weren’t bad enough, the prostate is one of the most understudied parts of the human body. Scientifically valid studies on the prostate are few and far between. Although prostate cancer is the third-most-common kind of cancer that men get, there is little good science to guide physicians. Half of all men will at sometime have BPH or prostatitis, yet treatment remains more of an art than a science. While studies are now being done, it will be years before there is a decent body of findings to help health care practitioners make quick and accurate decisions.

Prostatitis—A Young Man’s Disease

Prostatitis is a syndrome that can include pain in the pelvis, painful ejaculation, pain with erections, an array of urination problems, and pain with life in general. Some men say it feels like they’ve got a golf ball up their butt.”

Prostatitis is often described as a young man’s disease, yet it can pummel the pelvis of any man at any age. It can be caused by anything from an infection to chronic tension in the pelvis, although infection is found in less than 10% of all cases of prostatitis. To quote a recent article in the
Journal of Urology,
prostatitis is a syndrome that is “poorly defined, poorly understood, poorly treated, and bothersome.” Or to quote our own prostate expert, “Prostatitis is a young guy’s disease that is not diagnosed properly and is not treated properly.”

If you’ve got a sudden, acute attack of pain in your pelvis, get yourself to a physician as soon as possible. This kind of prostatitis can usually be treated successfully. If you have chronic prostate problems, educate yourself about prostatitis. A good source of information is
www.prostatitis.org
. Then, after you have an idea of just how many theories there are and how complex the problem can be, find a good urologist. The prostatitis.org website usually keeps a list of urologists with whom people have had positive experiences.

Since chronic prostatitis tends to wax and wane, a lot of men take several courses of antibiotics, thinking that the antibiotics helped it improve the last time around. This is not a good idea. You need to approach chronic prostatitis with patience and intelligence.

Regarding sexual practices and prostate health, there aren’t any studies to offer guidance. Having anal sex without a condom (barebacking) makes the man who inserts vulnerable to prostatitis because E. coli can cause prostatitis, and there are abundant legions of E. coli in our rectums. There are also concerns that couples who are having vaginal intercourse can be passing some prostate infections back and forth, so if you have prostate problems, discuss this with your urologist.

BPH (Benign Prostatic Hyperplasia)—Middle-Age or Older

Let’s say you are getting close to 50 and you notice that the wall doesn’t shake anymore when you are peeing at a urinal. Or maybe you don’t make it through the night like you used to. This could be due to a prostate that is getting larger as you are getting older.

It is called BPH when your prostate gland is enlarged and physicians don’t think you have cancer. The symptoms can range from mild to severe. One of the fascinating things about BPH is that the prostate can be greatly enlarged in a man who experiences no troubling symptoms, or it can be completely normal in size but the man is going through hell. In the latter case, the swelling might be on the inside of the prostate, clamping the urethra shut.

Although BPH and prostatitis are supposed to be two different things, a man who is under 40 is likely to be given the diagnosis of prostatitis while a man who is over 50 is likely to be given the diagnosis of BPH, even if they have the exact same symptoms.

Prostate Cancer

It has been estimated that half of all grown men have an early form of prostate cancer called microcarcinoma. It usually stays where it is and you never know it is there. When this kind of cancer does grow, it often remains inside the prostate and is not aggressive. However, some forms of prostate cancer can be very aggressive. The challenge is in knowing which is which.

Prostate cancer is sometimes diagnosed on a wing and a prayer. One of the big challenges with prostate cancer is deciding when to treat it aggressively and when to take a “wait and watch” attitude.

One test that can possibly indicate the presence of prostate cancer is called the PSA test. PSA is the enzyme that makes a guy’s ejaculate go from thick to watery. When the level of PSA in the bloodstream starts to rise, it might be due to cancer of the prostate. On the other hand, BPH can also cause the PSA level to rise, and some men who have prostate cancer show no rise in their PSA level at all.

At this point, some groups are recommending against doing routine PSA tests. PSA tests can often result in a wild goose chase and sometimes do more harm than good. If you have reason for concern, check with your doctor. Researchers are trying to find ways to improve the PSA tests. Some of the things they are looking into include free vs. total PSA, PSA density in the interior part of the prostate that surrounds the urethra, PSA velocity and PSA doubling time.

Here are just a few prostate cancer suggestions:

• Newton Malerman, author of a book on prostate cancer, says: “If you are diagnosed with prostate cancer or any other serious illness, take someone with you to your doctor’s appointments. My wife was able to ask much clearer and tougher questions than I was. If you are single, or your spouse or partner is too emotional about what’s happening, take a trusted friend or family member... If you are treated to a rough digital exam, find another urologist. The procedure is not too unpleasant if the doctor has a gentle touch.”
  
• Explore several websites. Some of your best help will come from other men who have been through it before you, and they often post. However, be aware of which companies contribute funding to the websites you are searching. It is unlikely that companies will be supporting websites that question the wisdom of taking their products.
  
• If you have cancer or BPH and if surgery or radiation is being suggested, ask if it will cause incontinence, impotence, a shorter penis, dry ejaculations or if you will squirt urine when you ejaculate. Also inquire about vacuum pumping your penis after surgery. Some urologists recommend it.
  

A Healthy Prostate Diet?

Long-term studies on diet, prostate irritation and prostate cancer are just starting to come in. Check with your healthcare professional about what foods might help and which to avoid. Smoking definitely causes bladder cancer, and it causes men with prostatitis to have worse symptoms.

Prostate Massage for Pleasure

Prostate play should never feel like a rectal exam from a healthcare provider. If a healthcare provider took the time to caress and massage your anus like a lover should, he or she would probably lose their license. Or they would experience a massive decrease in billable hours due to how much extra time is involved. And they would probably be so popular it would take months to schedule an appointment.

The following tips and suggestions are from a wonderful video called
A Guide For Prostate Massage
from The Pleasure Mechanics and from Charlie Glickman’s excellent book
The Ultimate Guide to Prostate Pleasure: A Guide for Men and Their Partners.

• Lube up your fingers with massage oil.
  
• Begin with external massage just below the testicles in the perineal area. Glide a well-lubricated finger around the outside of the anal opening, making circles with it. Spend several minutes doing this, allowing your finger to make friends with it. Don’t try any penetration until the opening becomes relaxed.
  
• Don’t push your finger into the anus. If you’ve massaged the outside for long enough, the anal sphincters will relax and allow easy insertion of the finger. Gradually increase the pressure, but don’t push your finger farther in than feels comfortable for the man.
  
• Sometimes all that’s necessary is putting your finger in a quarter or half of an inch. Massage there and call it a day if going further in is not pleasurable.
  
• The sphincter muscles are like two little donuts that sit above the anal opening. If your finger encounters resistance when it reaches the sphincters, stop there. It means the man is not relaxed enough to go farther.
  
• Once you reach the prostate, you might try a “come here” motion. Also try moving your finger in circles around the prostate. It should never feel painful or uncomfortable for him. Then try gliding your finger from the outer edge to the center of the prostate.
  
• Some men experience prostate stimulation as being midway between the sensation of needing to pee and having an orgasm. Men who enjoy prostate stimulation sometimes describe it as providing wavelike sensations through their entire pelvis and body. Orgasms that occur when the prostate is being stimulated can sometimes last longer and result in prolongued sensation.
  
• When you are ready to stop, let your finger glide out slowly; never pull it out quickly.
  
• Once you get the prostate simulation down, you might try giving him oral sex or stimulating his penis with a well-lubed hand at the same time you are stimulating his prostate with a finger from your other hand. You may need to go easier on the penis stimulation, as it might be more sensitive due to the simultaneous prostate stimulation.
  (There is an
  illustration
  in Chapter 24:
  Anal Sex-Up Your Bum
  that shows prostate stimulation during oral sex.)
  
• The prostate will swell as the man becomes more aroused. You’ll be able to feel this with your finger.
  
• The prostate especially swells right before ejaculation. You should especially be able to feel this last second swelling with your finger.
  
• Some men find that direct prostate stimulation results in a super intense orgasm, while others find it’s too much or dulls the feeling of orgasm. They might prefer that your finger avoids the prostate altogether, or that you just push it against the rim of the anus.
  
• As for positions for prostate massage, there’s face up and face down. Try each one and see what works best for both of you.
  
• For men who want to stimulate their own prostates, an S-shaped lucite sex toy (Crystal Wand) or a special butt plug might help. Charlie Glickman’s prostate massage book has a lot of information about different devices for prostate stimulation. For instance, the surface area of a dildo is larger than that of a finger. This results in a different sensation on the prostate. Some men prefer the sensation of a dildo on their prostate more than a finger, others like the greater precision that finger massage offers.