Locating Your Prostate

Men, try this simple exercise. With your clothes off, stand up straight facing a full-length mirror. Place one finger on your naval, then run it straight down until you reach a slightly depressed area in your groin directly above the point where the visible upper end of your penis disappears into your body. Gently push in – the hard area you feel is your pelvic bone. Now turn sideways and visualize a point inside your body behind your pelvic bone, about a third of the distance between the tip of your finger and your buttocks. Now you know the general location of your prostate gland. If you are a healthy, young, adult male, your prostate will be about the size of a golf ball.

What Is the Prostate – What Does It Do?

The prostate gland or the “prostate” is actually a combination of several small glands encased in an outer shell. The structure of the prostate resembles an orange with a firm outer skin and soft pulpy center. The individual glands inside that pulpy center do all the work, the hard outer skin provides protection.

All glands are little chemical factories that produce complex substances you need for various purposes throughout your body. Curiously, medical science has yet to understand fully the prostate’s function. It produces some but not all of the cloudy white fluid known as semen or ejaculate, probably its principal activity. Semen is the fluid medium that transports sperm cells, the male contribution to human reproduction.

The prostate may have several other functions. Some researchers speculate the prostate produces important enzymes or other chemicals. The exit ducts from the prostate lead directly into the urethra, the passage inside the penis through which semen exits the body, so the function of these chemicals should be limited to processes within the prostate or possibly reproduction. In the latter case, substances from the prostate may stimulate activity of sperm, thereby enhancing female impregnation. The prostate undergoes mechanical contractions during ejaculation that may also facilitate sperm movement.

All women have tiny glands that have been called “the female prostate,” just as men have vestigial nipples. In their early stages of development, male and female fetuses are essentially the same physically. When the male hormone testosterone appears in the male fetus, the prostate begins to grow. At the same location in the female fetus, however, cells grow more slowly, forming the vestigial female prostate. The female prostate sometimes causes problems, but never as often and rarely as seriously as the male prostate does in men.

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The Prostate and the Male Urinary-Genital System

The top of the prostate is jammed snugly beneath the bottom outlet from the bladder, directly above the upper edge of the internal portion of the penis. Because space is at a premium in this area of the male body, the prostate tightly surrounds portions of the bladder outlet and a short but critical section of the urethra, the channel through which semen and urine pass into the penis. While efficient, as men age this close proximity contributes to prostate troubles.

To understand what the prostate does, let’s trace the path a single sperm takes from its origin in your testicles until it leaves your body. Everything begins with the production of the sperm in one of your testicles. The sperm passes first through a spongy area, the epididymis. Then, unless you have had a vasectomy, it travels through one of two parallel sets of tubes known as vas deferens, before emerging into a holding area: the ejaculatory duct.

Up to that point, minor quantities of semen produced within the testicles and epididymis have provided the fluid medium that carries the sperm. But in the ejaculatory duct, the amount of semen increases with the addition of a large volume of spermless fluid produced by nearby organs-seminal vesicles. Following sexual stimulus and just before the instant of ejaculation, the combined volume of semen in the ejaculatory duct empties into an enlarged section of the urethra: the bulbous urethra.

Not until that instant does the prostate have a role. A separate duct system connects the prostate to the bulbous urethra. As ejaculation approaches, spermless semen from the prostate flows through these ducts supplementing the volume of semen already contained in the bulbous urethra. At ejaculation, semen from the bulbous urethra is propelled through the urethral channel and out the tip of the penis. This journey by a single sperm takes about three months, during which the sperm lives independently, gathering nutrients from the semen.

How the Prostate Ages

During ejaculation, powerful muscles surrounding the base of the urethra suddenly contract, causing the main physical sensation a man feels during orgasm. Simultaneous contractions of the prostate also contribute to the ejaculatory process. Even after surgical removal of the prostate, as in cases of prostate cancer; ejaculation and pleasurable orgasm can still occur.

The term “urinary-genital system” implies a body mechanism that serves a dual purpose: urination as well as the male contribution to human reproduction. All the internal plumbing carrying urine from the kidney and semen and sperm from the testicles comes together in the immediate vicinity of the prostate. Provided the prostate is healthy, it manufactures its portion of semen, assists ejaculation, and possibly manufactures some yet-to-be-proved vital chemicals. Therefore, because of these interconnections, when prostate disorders do occur; they may affect both urination and sexuality.

During most of your childhood, your prostate was smaller than a marble and remained that size until puberty. Unless you had some unusual physical problem, your prostate began to grow sometime between ages 11 and 13. By your mid-to-late teens, your prostate was approaching its normal adult weight, approximately four-tenths of an ounce. The force stimulating growth of your prostate as a teenager was your body’s greatly stepped-up production of testosterone. This male hormone also accounted for other changes, such as a deepening voice and the growth of body hair.

As a young adult and during your early middle years, not much happens with your prostate except possibly a modest increase in size. But during your fifties, your prostate begins a process known medically as “involution.” When that occurs, your prostate gradually loses vigor and its physical structure begins to show aging signs much as aging is revealed by sagging facial muscles.

This aging does not mean your prostate cannot grow. In fact, a gradual increase in its size throughout your life is associated with continuing testosterone production – a normal characteristic of the prostate. If all is normal, the size increase will be limited. Unfortunately, in some men, the prostate may grow until it reaches baseball size, or even larger. Then you have a problem.

At this time, there is little you can do or any medications you can take that will reverse or even retard the normal prostate aging process. However, there are some positive things you can do with your diet and life style that may help prevent or relieve prostate problems. These will be discussed later.

What Can Go Wrong with Your Prostate: Cancer, Congestion, Enlargement

Too many men only become aware they even have a prostate after trouble strikes, sometimes dramatically. Unfortunately, the gland is hidden deep in your body, out of sight and normally out of mind. Given its peculiar design and its location, the prostate is inherently problem prone. Following are the major prostate problems that affect men at some stage in their lives:

  • Acute and chronic prostate infections
  • Noninfectious disorders with symptoms mimicking prostate infections
  • Prostate congestion – a painful buildup of excess prostate fluid
  • Benign prostate enlargement – the presence of a noncancerous tumor
  • Prostate cancer – a cancer originating in the prostate that can spread elsewhere in the body

Prostate Infections

Prostate infections occur when a pathogenic microorganism manages to penetrate the outer casing of the gland. The prostate’s physical structure and its lack of an adequate drainage system makes it vulnerable to attack. Once invaders are inside, they usually multiply rapidly in the prostate’s hospitable environment and make a man’s life miserable. These infections can be quite acute, accompanied by fever; chills, penile discharges, and severe pain. Some prostate infections can become chronic, causing borderline feelings of misery and general malaise, similar to a persistent post-nasal drip or sinus infection.

A prostate attack can be dramatic and appear to be far more serious than it actually is. Larry and Ann, recently married graduate students, made love almost every day. One evening to their horror, they noticed that some of Larry’s semen had dripped on the white bedsheet and was bright, blood red. Early the next morning, the panicked couple appeared unannounced at my office. In one of my happier moments in medicine, I was able to tell them Larry’s condition was an easily treated prostate infection.

Most prostate infections are caused by common bacteria, especially those inhabiting the colon and other portions of the intestinal tract. Prostate infections usually respond well to antibacterial agents. But it is vital to cure completely all prostate infections, not only to protect the health of the man who harbors the illness, but because some infections can be passed to a female partner. Untreated and uncured prostate infections can also affect male infertility.

No hard statistics are available on prostate infections, but they are common and constitute a significant portion of a urologist’s practice. They can occur at any age, even in teenagers or younger boys. In my practice, I have generally encountered these infections among men in their twenties. The numbers increase significantly with patients in their mid-thirties. There is some evidence that men who are sexually active with multiple partners contract prostate infections earlier and more often.

Conditions that Mimic Prostate Infections

Sometimes men complain of stinging or burning urination and lower back pain, symptoms that mimic prostate infections. However; laboratory tests of prostate fluid taken from such patients reveal no evidence of infectious microorganisms. Medically, these effects are known as “prostatosis” and “prostatodynia,” depending on the nature of the symptoms. Men suffering from these conditions have told me they’ve been dismissed as hopeless hypochondriacs by some physicians. Unfortunately, their problems are real and with a little effort effective treatment programs can be started.

Prostate Congestion

Prostate congestion occurs when excess prostate fluid builds up within the gland. One job of the prostate is to constantly produce prostate fluid. Unless its buildup is relieved by sexual intercourse, nocturnal emission, or masturbation, pressure continues to increase within the gland. Prostate irritation, a logical consequence, can be quite painful.

Prostate congestion can occur anytime after puberty and is related to your pattern of sexual activity. Men who experience long periods of sexual abstinence or who indulge in prolonged sexual foreplay without consummation are most likely to have this problem. Paradoxically, occasional bouts of intense sex with repeated ejaculations can also trigger painful prostate irritation.

Prostate congestion can be relieved by appropriate life-style changes. Prostate massage by a urologist can also help relieve the condition.

Benign Prostate Enlargement – Not Cancerous

Benign prostate enlargement is referred to as “BPH” – benign prostate hypertrophy or benign prostatic hyperplasia, another medical name for it. BPH is not cancerous because the tumor that develops within the prostate will not spread to other parts of the body. BPH, is however, an unpleasant condition. At its worst, it can be life threatening. Fortunately, there are effective treatments with limited or manageable side effects.

Typically, men with BPH experience problems voiding urine, because of the pressure the enlarged gland places on the urethra and the neck of the bladder. Men with BPH also feel a frequent need to urinate and the act can be painful and frustratingly incomplete. At night, the need to urinate frequently is very common to BPH patients.

BPH can cause death, although that is inexcusable considering the diagnostic and treatment techniques available today. One case where proper medical treatment could have made all the difference was the death of multimillionaire tycoon Howard Hughes. His extraordinary life earned him major celebrity status, but he became increasingly eccentric and reclusive in his later years. Holed up in a hotel room surrounded by a cadre of bodyguards, he refused all medical attention, despite increasingly agonizing pain from an enlarged prostate. His death was caused when the swelling continued until it created a fatal urinary-tract blockage.

Significant prostate enlargement can occur even in young adults. Men in their late thirties with BPH symptoms are beginning to show up in my office in increasing numbers. By age 60, about half my patients have significant enlargement, along with associated voiding difficulties. In very elderly patients, it is most unusual not to find significant enlargement.

Not all men diagnosed with BPH need immediate, aggressive medical treatment. However; all men with the condition should be examined periodically by a urologist.

The term “urinary-genital system” implies a body mechanism that serves a dual purpose: urination as well as the male contribution to human reproduction. All the internal plumbing carrying urine from the kidney and semen and sperm from the testicles comes together in the immediate vicinity of the prostate. Provided the prostate is healthy, it manufactures its portion of semen, assists ejaculation, and possibly manufactures some yet-to-be-proved vital chemicals. Therefore, because of these interconnections, when prostate disorders do occur; they may affect both urination and sexuality.