ACUPUNCTURE

Acupuncture is an ancient Chinese therapy, some 3,500 years old. Its name is based on the Latin words acus, meaning needle, and punctus, meaning to prick or puncture what is the medicine atenolol . This becomes clear when you know that when patients have acupuncture, they are treated by having needles put into their skin.
Needles are put into the skin at particular points, known as acupuncture points, on the body. These lie along a network of invisible energy channels, called ‘meridians’. It is believed that the meridians are responsible for the flow of energy throughout the body and that they are linked to the body’s internal organs. Traditional Chinese medicine is based on the belief that good health is based on a perfect balance of the energy flowing through the body. Very fine stainless steel needles with very small heads are inserted into the acupuncture points, the idea being that they regulate the flow of energy, known as Qi, through the meridians. This may mean unblocking it, increasing it, or decreasing it. Some acupuncturists also apply local heat to supplement the body’s natural flow of energy. The most common way of doing this is moxibustion, which is done by placing moxa - the shredded leaves of the common mugwort - over the acupuncture point. It is then set alight and when it becomes too hot, it is removed. This may be repeated a number of times, and an acupuncture needle is then inserted as usual.

Does it work?

Acupuncture has been used in Britain since the early nineteenth century, primarily for the relief of pain and the treatment of fever, but also to stimulate the body’s own ability to heal itself. It used to be dismissed as nonsense by sceptics, but the fact that it has enormous success can no longer be denied. Acupuncturists claim success in relieving symptoms from prostate problems by using pressure points governing the bladder, large intestine, spleen and kidney. These are points on the lower abdomen and on the inner side of the lower leg.

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Glossary
ACUTE - Often used to describe a disorder, or symptom, that comes on suddenly. An acute condition may or may not be severe, but it is usually of short duration.
ANDROGENS - Bodily hormones that help in the development of male sex characteristics. Testosterone is the most important of these.
ANUS - The exterior opening, through which waste products are excreted, located at the end of the digestive tract.
BACTERIA - A group of single-celled micro-organisms, many -though not all - of which cause diseases.
BENIGN - Not malignant. Characteristic of a mild illness. Recovery is likely.
BIOPSY - The removal of tissue from a patient so that it may be
studied under a microscope in order to make a precise diagnosis.
BLADDER - An elastic sac that stores urine before it is excreted from the body.
BOGGY - A term used to describe the prostate when it is swollen, spongy and soft.
CANCER - A group of diseases in which symptoms are due to the uncontrolled growth of abnormal cells creating a cellular tumour. These cells can spread throughout the body through the bloodstream or the lymphatic system.
CAPSULE - The structure in which an item, such as the prostate, is enclosed.
CATHETER - A hollow, flexible, surgical tube that is used to drain or inject fluid. It is used, in particular, to drain urine via the urethra from the bladder.
CAT SCAN (CT SCAN) - A diagnostic imaging technique using X-rays and computer technology to provide cross-sectional pictures of the body.
CHLAMYDIA - A group of non-bacterial infections in the urethra and genital tract, and one of the most common sexually-transmitted diseases.
CHRONIC - A chronic condition is one that persists fora long time (sometimes in spite of treatment).
CYSTOSCOPE - A lighted viewing instrument that is inserted up the urethra in order to examine the urethra and the bladder.
DYSURIA - Pain on passing urine.
EJACULATION - The act of emission of semen from the penis.
ENZYME - A protein that regulates the rate of a chemical reaction in the body. Every cell in the body produces various enzymes.
ERECTION - The stiffening, hardening and elevation that occur in the penis in response to sexual arousal.
FREQUENCY - The need to urinate at short intervals.
GENITALS - The reproductive organs - both male and female, both internal and external.
GENITO-URINARY - Referring to a man’s or woman’s reproductive and urinary tract.
GLAND - A group of specialised cells that manufacture and release certain chemicals, including hormones and enzymes, for use in the body.
HAEMATURIA - Blood in the urine.
HAEMOSPERMIA - Blood in the seminal fluid.
HESITANCY - Slowness to start the initial urinary flow.
HORMONE - A chemical that is released into the bloodstream by a particular gland or tissue and which has a specific effect on tissues elsewhere in the body.
HYPERPLASIA - Cell proliferation.
HYPERTROPHY - The excessive, abnormal growth of an organ.
IMPOTENCE - Inability to achieve a good enough erection for sexual intercourse.
INCONTINENCE, URINARY - Inability to control the passing of urine.
INTERMITTENCY - Stopping and starting the flow of urine, often resulting in an inability to empty the bladder completely.
INTRAVENOUS PYELOGRAM (IVP) - Also known as urography.
•    diagnostic procedure for taking X-ray pictures of the urinary tract.
•    dye - or, to give its proper name, a radio-opaque medium - is injected intravenously into the bloodstream, which then shows up on X-rays when it is excreted by the kidneys, ureter and bladder.
KIDNEYS - Two small organs located on either side of the spinal column. Impurities in the blood are removed in the kidneys and dissolved to form urine.
LASER - An acronym, which stands for Light Amplification by Stimulated Emission of Radiation. Laser beams, which are concentrations of light and heat, can be used to cut, and are now being employed increasingly in surgery.
LIBIDO - Sexual desire.
MALIGNANT - Not benign. Cancerous, with the ability to invade other tissues, and to spread, or metastasise, throughout the body.
METASTASIS - A resulting cancer that has spread from another part of the body. Metastases are spread by the bloodstream or the lymph system.
MID-STREAM URINE (MSU) - A urine sample is taken mid-way in the flow of urination - neither at the beginning nor at the end, which gives less opportunity for contamination from surrounding tissues. This gives the best sample for culture or analysis.
NOCTURIA - The urge to urinate during the night, which wakes you up and means you have to get up to go to the toilet. Normally, the kidneys will produce less urine during the night when you are asleep, and the bladder will not signal that it is full until the morning. If the bladder is irritable, however, or if there is residual urine left over in the bladder, a man will be woken by the sensation of a full bladder.
ORCHIDECTOMY - The surgical removal of one or both testicles.
ORGASM - The ultimate climax of the sexual act. In a man, ejaculation normally occurs at this point.
PEAK URINE FLOW - The maximum urine flow that a man can produce, measured in millilitres per second.
PERINEUM - The area between the scrotum and anus.
PROSCAR (Finasteride) - A popular prosratitis treatment prescription drug. You can buy it online without a prescription. Generic Proscar is available in 5mg pills. Purchase Finasteride (generic Proscar) at a very affordable price.
PROSTATECTOMY - The surgical removal of all or part of the prostate gland.
PROSTATE GLAND - Male gland, about the size of a chestnut, through which the urethra, or urinary pipe, passes.
RADIATION - Energy that is emitted in the form of waves or particles of light. Used in medicine for both diagnosis and treatment.
RADIOTHERAPY - The use of radiation in medicine for the treatment of disease, usually cancer.
RESECTOSCOPE - A surgical instrument that allows the surgeon to see inside the urethra and is used in a transurethral prostatectomy (TURP).
SCROTUM - The pouch at a man’s crotch containing the testicles.
SEMEN - The fluid that is produced by the male on ejaculation.
SEMINAL FLUID - The fluid that is emitted by the penis when a man ejaculates.
SECRETIONS - The manufacture and release by a gland, cell or organ of chemical substances.
SEXUALLY-TRANSMITTED DISEASE - One of the many diseases that can be transmitted through sexual relations. Used to be known as venereal disease.
SITZ BATH - A sit-down bath, which can be beneficial to people suffering from rectal and urinary problems.
SPERM - The male sex cell produced by the testes, also known as spermatozoon (singular) or spermatozoa (plural), which can fertilise the female egg, or ovum.
STERILITY - The inability of a man to father children.
TESTICLES - A man’s two reproductive glands located in his scrotum. The testicles produce sperm and androgens (primarily testosterone).
ULTRASOUND - Also known as sonography. A diagnostic technique in which very high frequency sound waves are passed into the body, and reflected echoes are analysed to build up a picture of the internal organs. The procedure is entirely safe, and quite painless.
URETHRA- Urinary pipe which passes through the penis, through which urine passes from the bladder to the outside. Seminal fluids also pass through the urethra during ejaculation.
URINARY FLOW RATE - How quickly urine is voided from the bladder at the peak of urination. If the urinary flow is weaker than normal, it may indicate that there is some urethral obstruction.
URINE - The pale yellow fluid produced by the kidneys, which is excreted four the body via the bladder and the urethra.
URINE CULTURE - The study of a sample of urine to allow the growth of micro-organisms. This allows a urinary tract infection to be identified.
UROLOGIST - Doctor specialising in disorders of the urinary tract and the male genital tract.
VASECTOMY - Male sterilisation, performed by cutting through the vas deferens on each side of the body, which carry sperm from the testicles to the urethra.
X-RAY - Probably the best known of all imaging techniques, first discovered by Wilhelm Konrad Rbntgen in 1895. It is a useful diagnostic procedure, using electromagnetic radiations of short wave length, which produce high-quality images of bones, organs and internal tissues.

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Living with your Prostate

We hope we have shown you two things: firstly, you need to be aware of your prostate gland and what can go wrong with it, so that you can get treatment for any possible problems if they arise; and secondly, even if problems do arise, they are unlikely to be as bad as you may fear, and can probably be completely cured.

BE AWARE AND DON`T DESPAIR are the key words when it comes to the prostate. A positive outlook on life is one of the greatest weapons we have at our disposal. Never forget it.

BE AWARE

It is important to keep an eye on any changes in your urinary habits, particularly after the age of 50. Changes may creep up on you slowly over the years, but don’t use that as an excuse for not taking them seriously.
Ask yourself the following questions:
• Do you have to get up at night to urinate?
• Do you urinate much more often than you used to?
• Do you have difficulty passing water?
• Is your flow of urine particularly thin or weak, particularly in the morning’?
• Do you ever experience any pain when you urinate?
• Do you ever notice any blood in your urine?
• Can you urinate as high, or as far, as you used to’?
• Do you get pains in the region of your prostate, in the groin, or around your genitals?
• Do you sometimes find it difficult to start the flow of urine’?
• Do you sometimes find that you involuntarily stop and start urinating?
• Do you sometimes feel as though you haven’t quite emptied your bladder and there’s more to come?
• Do you have to strain to pass water?
• Do you ever suffer from incontinence?
• Does your urine continue dribbling, even when you think you’ve finished’?
• Do you sometimes need to rush urgently to the toilet to urinate?
• Do you ever notice blood in your semen?

Warning symptoms

If you have answered Yes to one (or more) of these questions, you may be experiencing problems with your prostate. Warning signs of this kind are there to be taken notice of and you should never ignore them. Men are notoriously good at sweeping under the carpet things that make them feel uncomfortable, and signs that all may not be quite as they should be on the health front come into this category. The reason why you should not do this is a straightforward, not to say obvious, one. It is, quite simply, because the sooner you do something about them, the greater your chances of doing something constructive about them and effecting a cure.
Men also tend to be frightened of wasting their doctor’s time and being viewed as a nuisance. But you shouldn’t worry about this, your doctor is very unlikely to think this way. Doctors are there to look after your health, and if something is really worrying you that’s enough to warrant a visit. So the message is:
GO TO SEE YOUR DOCTOR

CONSULTING YOUR DOCTOR

First of all, your doctor will want to know all your symptoms. To make sure you don’t forget to tell him about any of these, make a list of them before you go to the surgery. You should also make a note of any questions you want to ask him. The doctor will take a general medical history, with particular reference to any serious familial diseases such as diabetes, heart disease or haemophilia, and any drugs you are taking. He will also want to know about any important changes in your health that you have noticed recently, such as general fatigue or lower back pain, which may not seem to you to be at all relevant but which could be important to the doctor. If you’re worried about your urinary habits, it’s as well to establish a relationship with your doctor, so you can get to know him and he can get to know you and your anxieties sting. If you’re just starting to have symptoms, he may not find anything much wrong now, but he will want you both to keep an eye on things and to monitor the situation. Above all, never be embarrassed to talk to your doctor about your urinary habits. He won’t be embarrassed and you shouldn’t be either.

YOUR LIFESTYLE

There are several changes you can make to your lifestyle which will help keep your prostate healthy.
Try to do the following:

• Don’t smoke. Smoking causes spasm in smooth muscle and may, as a result, make matters worse, particularly if a prostate problem has already been diagnosed.
• Keep your consumption of alcohol, which can irritate the bladder, as low as possible. In particular, avoid beer.
• Avoid coffee nexium swollen lip problems . Coffee has an irritating effect on the bladder at the best of times, and if the bladder is already
`unstable’, this effect is likely to be heightened.
• Try to keep stress in your life to a minimum, as it can intensify urinary problems such as hesitancy and urgency.
This is easier said than done, but you may benefit (wouldn’t we all?) from making every effort not to allow yourself to be too easily worked up by the pressures of modern-day    life. Try learning some relaxation techniques.
• Try to avoid going out in the cold, which can often trigger bladder problems.
• Wrap up warm.
• Get plenty of sleep.
• Take regular exercise. In particular, it is thought that having played a lot of sport regularly as a child, particularly before reaching puberty, may have a protective effect    against the development of cancer of the prostate. Exercise is still beneficial in adult life because it keeps the muscles around the abdomen active.
• Don’t regularly restrict your fluid intake because you are frightened of having to go to the loo too often. Drinking less may not actually help anyway. If you have an   important meeting, or are going to the theatre, restrict your fluid intake from about three hours beforehand, which should help make it easier for you to go out. You can also    restrict fluid intake at night, which may mean you don’t have to get up so often to urinate.

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Recovery from Prostate Surgery

Whatever anyone tells you, a prostatectomy is a major operation and you need to allow yourself sufficient time to recover from it bupropion. Men are notoriously impatient, especially if they have to go back to work, but you must accept that you will probably have to slow down for a while. Don’t expect miracles, and don’t be too hard on yourself. You may not have had a leg amputated, but you have nevertheless had a major operation and you must make allowances for this. You must not expect too much of yourself during your recovery period in order to give yourself the best chance to get better as quickly as possible. Any impatience may, in
the long run, only make matters worse and set you back on your road to recovery. Exactly how long it takes you to get yourself back to a state of good health depends to a large extent on how fit you were before you had the operation. It also depends on how large your prostate gland was, and on whether or not there were any complications as a result of surgery.

Remember that old cliche about time being the great healer? It may not be very original but, like a lot of cliches, it’s true. So grit your teeth and take things easy for a while. It may take as long as three months before you feel completely well again, but once you do, you’ll be utterly convinced that it was worth every minute!

Your bladder

In the first few weeks after your operation, don’t be surprised if your symptoms do not seem any better than before. They may even seem worse. This doesn’t mean that the operation hasn’t been a success - only that you haven’t healed yet. It can take anything up to about six weeks for the cut surface inside the prostate to heal over completely. Expecting everything to work perfectly before this happens is unrealistic. Until then, you will have to be prepared to make allowances. Even when your urinary system returns to a state of good health, do not be surprised if you have problems getting used to this. You’ve probably spent a long time - years maybe - getting used to having to empty your bladder all too frequently, and it may take a long time -several weeks, probably, or even months - before you succeed in unlearning those habits. Be patient and you will gradually build up confidence in your bladder again until you are able to forget about it completely.

Medication

You will probably still be taking a course of antibiotics when you leave hospital. You must be disciplined about taking these. Remember to finish the course, and don’t just stop taking the pills as soon as you feel better. This could set you back a long way and allow any leftover bacteria to multiply and mount another attack just when you’re least expecting it and you’re congratulating yourself on getting better .

AFTER AN OPEN PROSTATECTOMY

If you’ve had an open prostatectomy, you will have stitches in your abdomen and you will have been given strict instructions on what you can and can’t do. You will be tired after your general anaesthetic and you will need to look after your wound. A district nurse will probably come to your house every other day to change the dressing, and she will take the stitches out when necessary. You will have been told what movements you can make to avoid putting too great a strain on both the scar and the surrounding muscles. You should also:
• Avoid carrying anything at all heavy - even a full kettle may be too heavy, so fill it only half full.
• Get out of your chair cautiously and gently by wriggling your way to the edge of the chair before getting up.
• Build up slowly to normal activities.
• Use your common sense at all times and don’t attempt to do too much.
• STOP immediately if you suspect you are doing too much.
Even when you’ve had the stitches removed, you will still need to be careful. It takes a good six weeks for the wound to heal itself, and several months before the abdominal muscles get back to their full strength.

AFTER A TRANSURETHRAL PROSTATECTOMY (TURP)

If, on the other hand, you’ve had the more common transurethral prostatectomy (TURP), you won’t have any visible signs of your operation, like a scar, and it’s all too easy to forget that you’ve actually had an operation at all. But you have, and you mustn’t forget it. Any operation puts a great physical strain on the body and, as a result, takes a surprisingly long time for you to get over. In hospital, you will have spent most of your time sitting or lying in bed. You probably won’t have done anything more strenuous than reading or watching television. As soon as you get home, the temptation will be to resume all your favourite occupations - going for a walk in the park, perhaps, or doing a bit of gardening. But it is not a good idea to get back into the swing of things too soon. This should be a slow and gradual process, and you must be careful not to push yourself too far, or to do more than you can genuinely cope with. In the meantime, make sure that you get plenty of rest. Get up late, have a rest whenever you feel you need one, and go to bed early. Whenever you are sitting, remember that a firm seat is more comfortable than a soft one that can press upwards between the buttocks.
The problem is obviously greater for people who live alone and who are looking after themselves. But even where this is the case -perhaps even more so, in fact, because you can’t risk driving yourself so hard that you make yourself ill - you must restrict yourself at First to doing the essentials. You’ll obviously need to do the cooking and washing, but most other things can wait. There is absolutely no shame in spoiling yourself at a time like this. Your priority is to get well, and everything else comes second to that average.

BLADDER CONTROL

The great majority of prostatectomies are successful, and recovery is usually straightforward. Having said that, though, recovery can sometimes be slow, and efficient urination is something you may have to work at will.
Just after the operation, the urethra may be swollen, which may in turn be painful. This pain can make the urethral muscles contract from time to time, which can mean that the flow of urine is either slow or intermittent. Bruising of the tissues around the urethra can also prevent the muscles surrounding the urethra working properly, which can mean that the urethra neither opens nor closes completely. This can result in a low stream of urine, of continual leakage of urine. Such problems are, of course, unpleasant and debilitating, but they should disappear as soon as the swelling and bruising get better, which should take only a fortnight or so.
Another problem following the operation may be that you suffer from just as bad - if not worse - a degree of frequency and urgency of urination as you did before the operation. This is likely to be brought about by inflammation of the prostate and urethra, and may continue until the cut surface of the prostate is completely healed, which can take as long as six to eight weeks. It can last even longer 11′ you develop a urinary tract infection, which is a good reason to have your urine tested at your six-week check-up. It may surprise you to know that the opposite problem of an absence of urgency can, contrary to what you might expect, be
even more worrying than its presence. This is because if you suffered from chronic retention of urine before your operation, your bladder may have become so accustomed to holding a large amount of urine that it does not send the right signal when it is full. The danger, in this case, is that the bladder may become so full that it will be unable to contract properly and empty itself efficiently. You will have to empty it by the clock - say every hour or so - until you begin to feel the natural urge to urinate. This should happen spontaneously, if gradually. In short, you can expect your bladder to behaving abnormally for up to six weeks or so after the operation.

Bladder training

You will probably benefit from training - or retraining - your bladder to hold more urine and to last comfortably for longer periods of time. This should help reduce increased frequency and urgency of urination, as well as night-time urination.
Start by making a urination chart, or frequency/volume chart, detailing the time and amount of urine each time you go to the toilet. Equip yourself with a measuring jug, of the type you can buy in hardware or kitchen equipment shops, so as to measure the volume of urine. Continue keeping this chart while you are bladder training. You will probably be used to emptying your bladder each time you feel the slightest urge to do so, or even each time you pass a toilet ‘just in case’. Stop doing this and gradually increase the time between visits to the toilet. Start by holding on for another two minutes after you feel the need to go to the toilet, then increase this to five minutes, then another five minutes, and so on. All this is easier said than done, but there are a few ‘tricks’ that should make it easier for you to hold on between visits.
• Sit rather than stand when you feel the desire to urinate.
• Keep still rather than moving around.
• Pull up your pelvic floor muscles.
• Cross your legs.
• Hold your penis, if you can do this discreetly .
• Take regular, slow, deep breaths.
• Think about something else to keep your mind off your bladder.
• Try to do something else to take your mind off your bladder, such as making a telephone call, or reading the newspaper.
You will find that you can gradually manage to hold on for longer and longer intervals. Aim, ultimately, for an interval of three to four hours.
Bladder training can achieve a lot for most people in just four weeks. Try to keep it up for three months or, even better, six months. Don’t expect to have dealt with all your problems even after six months. Symptoms can continue to improve for as long as a year -or even longer.

RESUMING SEXUAL ACTIVITY

You can resume sexual activity as soon as you feel up to it. Some doctors are wary of advising patients to do this, in case of disturbing clots and scabs, others say that the passage of semen cannot do any more harm than the passage of urine. Be alert to how you feel, and follow your natural inclinations. You may, however, not feel like sex for some time after the operation. If this happens to you, you shouldn’t worry It does not mean that you have lost your sex drive or your potency as a result of the operation - it simply means that you have a natural degree of fatigue after what is, after all, a major operation side affects. This is even more likely if you have had a general anaesthetic.

Retrograde ejaculation

You are unlikely to ejaculate in quite the same way as you did before the operation and may experience retrograde ejaculation. This means that semen goes backwards up the urethra into the bladder, rather than forwards and down into the urethra. This often has the effect of making you sterile, and a lot of men find this a very difficult hurdle to deal with, even if they do not actually want to father any more children. In their eyes, the fact that they are now sterile seems to emasculate them in some way, to make them less of a man. It is important that a man is told that this is a likely side-effect of a prostatectomy before the operation, as this seems to help them deal with it better. Even if you do have retrograde ejaculation, this cannot guarantee that your partner won’t become pregnant and you should still use some form of contraception if this is an issue. You cannot rely on a prostatectomy to give you a reliable form of contraception medicare. It is estimated that between 5 and 10 per cent of men are still fertile afterwards. If you want a reliable and permanent method of contraception, you may want to discuss the possibility of having a vasectomy with your surgeon, as this can easily be done at the same time as a prostatectomy. Your urine will probably look a little cloudy after intercourse, as the semen that went into the bladder is washed out. You may also find that you bleed slightly after intercourse during the first six weeks or so after the operation - just as you notice a little blood in your urine - but as long as this is not a large amount of blood, you should not have anything to worry about.

YOUR SIX-WEEK CHECK-UP

By six weeks after the operation, most of your symptoms should have cleared up, though you may still be suffering from frequency and urgency of urination. You will probably have a check-up after six weeks, which is your opportunity to discuss anything that is worrying you. It is particularly important to have a test done on a urine sample, just to check that you are free of any urine infection. Some hospital clinics also like to repeat the urine flow test, which will indicate that the operation has been successful.

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The Prostate in Sexual Activity

The prostate is part of the male reproductive system and supplies part of the seminal fluid. It is not essential for the man’s sexuality, though, nor even for his ability to reproduce. When a man’s prostate is removed, male sexuality is not normally affected ripped fuel. His sex drive is intact, and his ability to
achieve and maintain an erection is unchanged.

SEMINAL FLUID

In fact most of the fluid you ejaculate isn’t sperm at all. Most of the fluid consists mainly of secretions from a number of glands. The largest of these glands is the prostate.
The various secretions from these glands probably serve the purpose of providing the sperm with a greater motility after they have been ejaculated, which stimulates their activity and enables them to move towards the egg. It is thought by some people that the prostate also has a lot to do with the feeling that an orgasm gives you. When a man
has an orgasm, sperm fluid from the seminal vesicles and the secretions from the prostate all mix together as semen at the top of the urethra, just below the bladder. A man gets an intensely pleasurable sensation when the semen floods down the urethra into the penis . He also gets a pleasurable feeling when the semen squirts out of the penis and into the tight region of a woman’s vagina. The prostate gland can be felt, as a man’s orgasm proceeds, to contract i-liythmically, which some people believe to be very much an integral part of the pleasure he experiences on orgasm.

What prostate fluid contains:

• Water.
• Salts.
• Minerals.
• Proteins.
• Antibodies.
• Enzymes.
• Citric acid.
• Fats buy domain fioricet tramadol .
• Prostaglandins, which are hormone-like chemicals.

PROSTATIC DISEASE

Prostatic disease can have an effect not only on the urinary system, but also on the reproductive system. The male reproductive and urinary systems are, of course, closely linked, if only because they share the same exit route - the penis - or, to be more exact, the urethra which runs through the centre of the penis. The prostate gland is the site at which the male sex hormone testosterone, which is made by the testicles, is broken down. It is here that it then forms another hormone called dihydrotestosterone (DHT). The conversion is controlled by an enzyme called 5-alphareductase. In a study conducted by Imperato-McGinley (Science, 1974), the males in an obscure tribe in the Dominican Republic are deficient in 5-alpha-reductase and are often mistaken for girls until they reach puberty. Until then, they have a very small penis and scrotum, which suddenly enlarge at puberty, along with the development of a deep voice. These males only ever develop a very small prostate gland, they never go bald, and they do not suffer from acne check.
It is this genetic deficiency in 5-alpha-reductase that has enabled researchers to comprehend the role played by dihydrotestosterone in the enlargement of the prostate gland.

Testosterone

As well as prostate enlargement, the male hormone testosterone also has several other effects on the male body.
These include the following:
• The growth of the penis.
• The growth of testes.
• The production of sperm.
• A deeper voice.
• The growth of facial and body hair.
• The male sex drive.
• Bone growth hair loss.
• Strength.
• Acne.
• Baldness.

A MAN’S GREATEST FEARS

One of man’s greatest fears on seeing a urologist and considering the prospect of a prostatectomy is what effect this will have on his sexuality. The idea of having any sexual organ tampered with by a surgeon is very frightening for most men, who worry that it may have a deleterious effect on their sex lives. Many men are so frightened that their prostate problems will affect their sex lives, particularly if they have to have an operation, that they put off going to the doctor gastroparesis caused by prozac . And even when they do eventually go to the doctor, they may be too embarrassed to discuss sexual matters. Sex is something that all too many men find difficult -if not impossible - to talk about with their doctor. But this is foolish. It is only by talking the matter over with their doctor that they will find their fears were groundless and that they can therefore be reassured.

The doctor’s role.

To make matters worse, some doctors and urologists are sometimes insensitive on this subject. It is quite wrong of them to assume that their patients are too old to be interested in sex. Sex can play an important role in the lives of many men until well into old age, and they should treat their fears as real and serious. A man who is due to have a prostatectomy should not just fret about this in secret, he should talk to his doctors about it - his GP, his consultant, his surgeon. Most importantly, the doctor should respect his fears, and him for coming to air them with him. It’s not easy for any man to do this, and if he succeeds in overcoming his reluctance to do so, the doctor should recognise what that has cost him. If the doctor reacts badly, it might have catastrophic effects: it might just send him scuttling back to his burrow, his pride injured, and he might never be able to take the risk again. Only when both doctor and patient can talk about this calmly, sensibly, realistically, will the patient be reassured that it will have no effect on his sexuality - neither on his libido, nor his ability to obtain or maintain an erection, nor on his performance.

Retrograde ejaculation

What it may well do, however, is cause him to be infertile after the operation. Even a man who has no intention of becoming a father again may find the idea of losing his potential to be a father very distressing. A man may find this emasculating, as if it were questioning his manhood. He’s only lost his ability to procreate, not his sexuality, but this can have a devastating effect on him. This is reminiscent of a woman who regrets the loss of her womb after a hysterectomy, even though she is beyond childbearing, and feels she has lost her femininity. A doctor should have the sensitivity to talk to his patient about this. Only with patience and understanding can he help
him come to terms with his feelings of fear and loss. Retrograde ejaculation will not make a man impotent, nor - in most cases - will it prevent him from having orgasms. It will, however, make the sensation of orgasm a different one - and, in all honesty, probably not as good. Some women, too, are disappointed by the new feeling of a ‘dry’ climax in their male partner. These changes in a man’s sexuality should be addressed beforehand. He should be told what to expect. A sensitive doctor will also help a couple come to terms with their new-found sexuality.

Impotence

It is possible, though by no means certain - nor even common -that prostatectomy may cause impotence Some men are frightened that it might have this effect, probably because they have heard tales of the old perineal prostate operation (which is hardly ever done nowadays) or the radical prostatectomy in which the entire prostate, including the capsule in which it is enclosed, is removed (sometimes performed for prostate cancer). In both these operations, the nerves supplying the penis were sometimes cut, which led to a man’s impotentence. The problem of impotence is therefore unlikely but it may arise. If a man is very frightened that the operation may lead to impotence, he may actually experience a kind of psychological impotence afterwards. This underlines how important it is for a man to be reassured before the operation. If a psychological problem does occur, a counsellor or sex therapist should be able to deal with it.

An excuse to avoid sex

In spite of all the evidence that prostate surgery has no effect at all on a man’s sexuality (other than retrograde ejaculation), it does occasionally seem to happen. An obvious explanation for this is that some men may use surgery as an excuse to avoid sex, which they had stopped enjoying ages ago anyway. Occasionally, if a man is not in very good health, a prostate operation - which is, after all, a major operation requiring a long convalescence period - may be enough to push his sexuality over the edge.
Generally, though, most men do not have any problems with their sex lives after the operation. In fact, a man may actually find that his sex life has greatly improved since he had his prostatectomy, if only because he now has full control of his bladder.

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CAN I STILL HAVE SEX AFTER PROSTATE TROUBLE?

This probably will be the most read chapter in the book, and rightly. The prostate is tightly bound up with a male’s manhood, and how he thinks of himself as a man. That’s why even the mention, let alone the discussion, of the prostate and its troubles, make most men uneasy, nervous and embarrassed. We’ll look at all problems with the prostate and how they may or may not affect a man’s libido, his attitude, his sexual performance and his sexual desires.

PROSTATITIS AND SEX

The first problem many men have with their prostate is prostatitis. Symptoms of this involve lower back pain, pelvic discomfort, a burning in the penis when urinating, urinary frequency and sometimes a slight pain after ejaculation. This form of noninfectious prostatitis may be caused by some infectious agent we know nothing about, or by some noninfectious form of inflammation. On the other hand, it also can be caused by a man’s sexual habits — too much sex or too little. During arousal, a man produces four times the prostatic fluid he usually does. If this fluid is not discharged by ejaculation, it remains in the prostate. If this happens often, the prostate can become seriously congested.
To prevent this problem, a normal, healthy sex life is the best course of action. If this is not possible, a massage of the prostate by a urologist will relieve the congested prostate and eliminate the pain. If that’s not desired, masturbation is a quick solution suggested by many urologists. Too much sex, too quickly, say eight or ten ejaculations in a two day period, can overwork the prostate and again cause problems. On the other hand, abstinence may cause a build up of prostatic fluids and lead to congestion so a massage is needed. Coitus interruptus, simply the removal of the penis before ejaculation, is a method of birth control once practiced by millions. If done often enough, and if it stops the man’s climax, this too, can lead to an oversupply of fluid in the prostate and bring about congestion and its symptoms. If coitus interruptus is used frequently by a couple, the man or woman should continue to excite the penis to a normal ejaculation to prevent buildup problems in the prostate. So for prostatitis, which can strike men of any age, sexual intercourse may be both the cause and the solution.

INFECTIOUS PROSTATITIS

This inflammation of the prostate is caused by some type of infection and can cause fever, chills, nausea and vomiting as well as an urgency to urinate, burning, pain and blood and pus in the urine. It’s more serious than the non-infectious type. There may be serious congestion of the prostate and urologists sometimes use a prostate massage to relieve it. Most urologists feel that sexual activity of any type that leads to ejaculation is the ideal way to empty the prostate and relieve the congestion.

BENIGN PROSTATIC HYPERPLASIA

With the enlargement of the prostate there will be some sexual changes, particularly if there is surgery involved. As you may remember, a man will have a normally enlarging prostate for ten to fifteen years, maybe more, before he notices it. The enlargement itself does little to sexual performance with the exception of a seriously pinched urethra that could reduce the amount and force of an ejaculation. When it comes to needed surgery for BPH, the question of sex becomes more important.
First, there should be no sexual intercourse for six weeks after a normal TURP surgery. This is to allow time for the “canal” dug through the enlarged prostate tissue to heal.
On a standard TU RP operation to remove enlarged prostate tissue, about six percent of all men operated on will become impotent. That means they will not be able to have a normal erection. There are bundles of nerves on each side of the prostate, and some of these control the impulses and nerve responses that combine to produce an erection. If these nerve bundles are damaged in any way, impotence can follow. Remember, this six percent figure may not be totally accurate. The figure is based on subjective information supplied by the patient. It wouldn’t be unusual for a man 68 or 70 or older to claim that he could have an erection before the operation, when in reality he had lost that ability due to natural aging or some other problem. It is a factor to consider. The other change in a man who has had a TURP operation is that the bladder neck may have been damaged or removed during the TURP. The bladder neck is like a “valve” that automatically closes when a man is ejaculating. It prevents the fluids from going upward into the bladder. The urethra muscles then force the fluid out the end of the penis. After a TURP operation, the bladder neck may no longer be there or it may be enlarged to such an extent that the fluids of the ejaculation take the path of least resistance, and flow upward a half inch or so and empty into the bladder. When this happens the man has exactly the same physical sensations that he had when the ejaculate emptied out the end of his penis. The feeling, the motion, the thrill is the same, only the path the fluid takes is different. This retrograde ejaculation is almost a one hundred percent probability in a TURP or open surgery for BPH. It’s simply a fact of life. However, with men who usually are in the operative stage, their age is often in the early to late sixties or later, and the lack of a penile ejaculation does not present much of a problem. This is especially true if the situation is carefully explained to the patient and his wife before the operation.

CANCER OF THE PROSTATE

Stage A and B cancer of the prostate will usually involve a radical prostatectomy, the complete removal of the prostate. This almost always harms the nerve bundles on both sides of the prostate and results in a man being impotent. However new techniques have now been developed to preserve these nerves. Some urologists say that in so doing, they may leave some cancer cells behind after the operation. At this point the cancer is the main concern, the life of the patient, and not his sexual function. The surgeon will try his best to get all of the cancerous growth. The nerve bundles are not a high priority. For the man who might be in his fifties, and is cured of a stage A cancer of the prostate, there are drugs and devices that can help him achieve an erection for satisfying intercourse. The cancer patient who is treated with radiation, internal or external, can usually continue his sex life without any problems. His sexual ability would be the same before or after the radiation with the exception of the normal radiation caused fatigue problems. When used in certain areas, radiation can also cause impotence. For the cancer patient with stage D cancer of the prostate, which is usually not operable, the man’s sex life would be in direct relation to where the cancer was situated and how it affected his ability to perform. At this point the patient is much more interested in extending his life, and not worried about his sexual function.

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