Prostate: trouble down below
Along with half of all males over 50, psychosexual therapist Phillip Hodson has an enlarged prostate that plays havoc with his bladder – and his life. And as treatment can mean saying goodbye to sex, what, he asks, is a man to do?
Tuesday 06 May 2014
Nobody quite knows why the prostate grows throughout a man's life, but this irritating behaviour is a fact. Doctors suggest that if all men lived long enough, the organ would become preposterously proportioned. What's commonly called an "almond-shaped gland" doesn't exactly turn into a coconut, but over time the central core tends to thicken and swell. Since the prostate encircles the outlet to the bladder in exactly the same way that Chief Crazy Horse once surrounded General Custer, obstruction becomes inevitable. Yes, the Battle of the Little Bighorn can be refought in the discomfort of your very own perineum.
As a result, approximately 50 per cent of men over the age of 50 acquire symptoms of urinary discomfort from what's sweetly termed "benign" prostatic enlargement or BPH. From personal experience, I suggest this enlargement is entirely malicious.
All my adult life I've sympathised with women's reproductive plight. My various female friends have suffered form infertility, miscarriage, stillbirth, pre-menstrual syndrome, irregular periods, pelvic inflammation, endometriosis, fibroids, prolapse, breast pain, backache, stress incontinence, cystitis, vaginitis and cervicitis. I haven't even mentioned contraception or cancer. Then there's the menopause. By contrast, men's parts have escaped practically scot free. We've twiddled our thumbs in doctors' waiting rooms while our partners adopt the position. The main male worry has been to avoid erectile disorder or a random kick in the goolies.
I finally understand in living detail why women think gynaecology is a bloody nuisance. For Nature's gender bias belatedly tilts a little backwards. Women do not possess a prostate and they should thank the Good Lady for her foresight. The irony is that men past middle age tend to "ache in the places that they used to play" (a phrase from Leonard Cohen, who at 79 probably knows). For 30 years, that seminal organ, the prostate, has given me unadulterated joy. Now I am considering having it shot.
How did I discover my BPH? Haematospermia, in a word. The first time you ejaculate blood, it's unnerving and does nothing for your social life, though fortunately on this occasion I was alone. You certainly resolve to consult a GP although the risk of cancer is low (unlike finding blood in the urine). Haematospermia in late middle age doesn't always indicate BPH, but can be general evidence that the prostate's gone on manoeuvres, though isn't about to kill you. Crazy Horse is leaving the reservation but not on the warpath.
Your doctor will then ask endless questions about your peeing habits. Ever since I was potty-trained, urination has been pretty much off my conscious agenda. As a non-beer-drinker, I have never felt the need to unload in a hurry or, God help us, in the street. As a psychotherapist, I have sat through hours giving therapy sessions, never once thinking my bladder needed support or even counselling. Like many foolish males, I almost prided myself on not going often enough. In my catchment area, it was once a day if you were lucky.
So when I developed further symptoms of BPH it was more than annoying. From being Mr Ironsides who didn't need the loo all day long, I became Mr Desperate who was almost hyper-conscious of the nation's inhibited investment in public conveniences. In a nutshell, the problem is that you have to go when you feel you need to go, within some 20 seconds – and you'd no idea you needed to go until a moment ago, turning motorway journeys into cliffhangers of mind over bladder. Next time you sit in a few miles of M-way traffic jam, do think of the older chaps wondering whether now's the moment to break out the emergency receptacle in front of the daughter-in-law. Or buy a leg bottle.
I've always prided myself on facing facts when they're unavoidable. Nor am I typically squeamish about medical exams. I quite like operations! I've had six on my eyes, surrendered the appendix and been multi-scoped from both ends.
But yet – this fortitude also contains the seeds of its own rebellion. I refuse anaesthetics and drugs where possible; have stitches with a stick between my teeth; and cycle to and from the eye clinic for cataract and vitrectimal surgery. This may be slightly neurotic of me and I wouldn't deny the charge. But it sadly means that in the ejaculation zone, I end up just as treatment-resistant as almost every other guy. Once I'd visited London's Prostate Centre where former colleagues work and with enormous relief tested negative for cancer, I faced the recommended next steps in a spirit of revolt.
For what they said was: "Right. You have normal PSA test results; no malignant cells, no calcification, kidneys are normal, flow is reasonable but there is moderate BPH change and a large residual volume. Sleep is shallow and constantly interrupted. What we'd like you to do is swallow a pill that will shrink the prostate gland – although you may notice a drop in libido..." It was all spoken casually. But further investigation elicited further info: "This drop in libido is commonly accompanied by breast enlargement and tenderness, ejaculation problems, feeling dizzy and impotence." It was the "commonly" that got me.
Now I don't know about you, but some of my reason for living is very much summed up by trying to promote the opposite of these outcomes. I am not sure that doctors quite appreciate the nature of a choice between mere urinary embarrassment on the M25 and not being able to fuck properly while sporting pendulous boobs. Or contemplating invasive surgery.
So, personally, there it sits. Growing as I write. Irritating, but just about tolerable. To be completely fair, there are already sexual consequences. In some dire cases of BPH, men cannot ejaculate at all, or develop "retrograde" ejaculation where semen is sent backwards into the bladder. In my own case, you never can tell what trick the damn system's going to pull next. The best term for it is "sometimes saves on the laundry; sometimes doesn't".
The over-50s are 43 per cent of the population and rising, so the chances are you know someone to whom this article applies. Despite my ironic tone (to help me manage my problem), I universally urge those with any BPH symptoms to seek medical help All the more because my research for this piece did turn up one piece of great news. Speaking to an endlessly helpful urologist, I learn there's a brand new but Nice-approved, clinically researched "Urolift" treatment (urolift.co.uk) which, without going into all the ins and outs, offers a local op to "staple" the prostate out of harm's way so the lobes cease to bear down on the urethra and dramatic relief may ensue.
Existing remedies for the full range of prostate issues involve drugs to improve sphincter function; drugs to shrink the organ; surgery to reduce prostate size or you can try the full "Andrew Lloyd Webber". Our musical peer had his prostate completely removed in 2009 to avoid cancer, as told to the nation via Piers Morgan. It made him completely impotent.
And there's the rub. Alpha blockers can cause "dry or weakened orgasm". Shrink drugs can cause "loss of libido, impotence and abnormal or absent ejaculation". Surgery such as resection "prevents normal ejaculation in over 80 per cent per cent of patients" while removal means spending more time with your piano.
Consultant urologist Professor Tom McNicholas says: "Urolift is the only treatment for BPH that preserves men's sexual function. Now that it has gained Nice-approval, it should be routinely offered on the NHS. It improves symptoms nearly as much as surgery and more than drugs."
I don't know whether Urolift's for me, but I am certainly going to find out. If it is, I will report back to you with my findings. Because there's one thing I've learnt as a psycho-sexual therapist over the past 30 odd years: the majority of men, whether they ever go to bed with another partner again, do not wish to swallow drugs that negate their masculinity. Nor have potentially nerve-cutting surgery in their sexual heartlands. They'd prefer to keep their peckers up for as long as possible.
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