P is for Prostate Problems

If you are a man, and you are past a certain age, prostate problems are not so much a matter of ‘if’ they happen but of ‘when’. Pretty much, having a problematic prostate is a given at some point between the ages of 40 and 80 (most men experience it in their 50s and 60s but it can happen at any time, really): it’s just a matter of {1} when said problems will manifest, and {2} what form they will take.

Two of my partners have experienced prostate problems:

• My husband found, after a routine examination and blood testing, that he had an elevated PSA. There’s a lot to that story, including two biopsies and the bloody aftermath of the second, but as of his most recent (last month) urology appointment, the point is (still) moot.
• My paramour, who experienced problems with his prostate in his 40s, came into my life long after the resultant surgery (and subsequent changes to his sex life as a result) had taken place. In some ways his was a more severe situation than my husband’s, and is something he still needs regular check-ups for.

When their individual problems arose, neither my spouse nor my S.O. really knew what they were in for, I don’t think. And as a partner, I didn’t really know what to expect.

So for the purposes of this post, I’m just going to share some information. Not so much for the purpose of educating others (though you might learn something!) but with the intention of sharing my experience. Because you – or a loved one – might be (now or in the future) and over-40 male, and maybe knowing what this looked like for another person/partner will be helpful to you (or to me, as a reminder!) in the future. 🙂

Identifying the Issue

In October of 2017, my husband – after much cajoling from me – went to his PCP (that’s Primary Care Physician, for those of you whose abbreviations may be different) for a general physical exam. He didn’t want to go (and I don’t really blame him), because he goes to the doctor all the time. But going to your kidney specialist and meeting with your dialysis team is not the same as having a full-on check-up/work-up, so he bowed to the mighty wisdom of Feve eventually saw reason and agreed to go.

The result was, his blood tests showed an elevated PSA (Prostate-Specific Antigen).

Generally speaking, PSA is supposed to be under 4.0 ng/mL (nanograms per milliliter). His was 9.0.

A subsequent test showed that the level had risen to 11.0. A biopsy was scheduled.

His initial biopsy came back negative for cancerous cells, but because his PSA levels continued to rise (one month after biopsy it was 13.0) and because he was (and still is) awaiting a kidney transplant, these rising levels put into motion a mass of additional testing/monitoring that – finally, after having a second negative biopsy and waiting additional time – culminated in his medical team saying, “Hmnh. Well I guess it’s not a problem after all.”

And it’s really not.

It can be. But my spouse never had any symptoms. He still doesn’t.

So while for some folks elevated PSA means PROBLEM! DANGER WILL ROBINSON!!!…

The same is not true for everyone.

Is his prostate enlarged? Yes, but only slightly. He experiences no difficulty with urination (other than the low amount of urine he produces due to failed kidneys, which is a whole ‘nother kettle of fish), does not have pain in that area (except he *did* have pain – somewhat severe pain – after the second biopsy; I’m not surprised, considering the bloody aftermath ~ but that’s not ’cause’, it’s ‘effect’), and has generally proceeded through this whole prostate fiasco without issue.

In actuality, the ‘issue’ was not – and is not – an ‘issue’ at all.

Pain, and Piecing Together the Problem

My paramour, on the other hand, had a *definite* issue with his prostate. At the age of 43, in otherwise middle-agedly mediocre health, he started experiencing textbook symptoms for prostate problems: difficulty urinating, inability to empty his bladder, pain in the urinary tract / prostate region.

After meeting with his PCP about the problem, he was referred to a Urologist, who did some tests and determined that his prostate was enlarged. After he, too, underwent a prostate biopsy and was cleared for cancer, the diagnosis was that his enlarged prostate was essentially acting as a block. The muscle that needs to ‘flap’ open in one direction or the other – to allow either urination or ejaculation – was essentially being forced closed by the enlargement.

Surgery was determined to be the best course of action, and – in his own words –

[My doctor] chose to do a procedure called the Green Light Laser surgery, where they snaked a flexible laser/camera up my urethra (I was fully anesthetized) and burned off the flap muscle. This meant I could now pee but my ability to ejaculate is nil to maybe a little (the ‘door’ either doesn’t open or just lets a little leak out, edging can increase this, but no guarantee). Most of my ejaculate would end up in my bladder (and then void when I pee). Seeing my swimmers (and feeling them) in my pee is still a slightly disturbing experience even now over a decade later.

Which leads to a Very Good Question:

How does it affect your sex life?

With my husband…

Other than the Worry Factor, the scheduling inconvenience, and (literal) pain in the ass that having multiple biopsies entailed… It didn’t affect his/our sex life at all. Perhaps it’s because we’re already accustomed to meeting medical challenges head-on; perhaps we both subconsciously understood that his lack of symptoms would likely lead to lack of any real issue. Or maybe – honestly – the whole thing was just so exhausting (on top of all the other stuff we deal with on a regular basis) that we powered through it (or power-exchanged through it 😉 ) the way we do everything else.

With my paramour…

I wasn’t with him when he was experiencing his symptoms, and didn’t meet him until after his surgery, so I only know what sex is like (for me, with him) after the fact. So there is no before-and-after comparison to make.

For him, however, certain aspects of post-surgical sex have been difficult to accept. Viewing certain types of porn and/or reading about heavy loads of ejaculate can be difficult for him to mentally/emotionally process, because it’s no longer an act he can perform. The act of cumming on/for a partner is denied to me, he says, and so it is both a turn off (a depressive reminder of a perceived shortcoming) and a turn on (I want to do that).

He’s also talked to me about how it feels – or rather, how it doesn’t feel – to orgasm now, compared to before.  One of the biggest effects is how I feel when I orgasm. While prior to my surgery my ejaculate was never a large amount, the near total lack of anything cumming out, makes me feel like it’s not finished. For some partners, that lack of ejaculate was a blessing, but in one case it was grounds for ending the relationship.

And one thing I didn’t expect: He says it’s given him the ability to fake an orgasm. (Only in the dark and never with a regular partner. But still.)

That’s not often thought of as something men do (or are capable of doing!), but there you have it.

Recommendations

Prostate problems may be affecting your life right now, or they may be something you’ll never have to deal with. Statistics vary, but in the United States:

• Approximately 50% of men over 50 have *some* type of prostate problem.
• One in nine men will be diagnosed with prostate cancer in their lifetime.
• One in 41 men will die of prostate cancer.

(Reliable and detailed statistics & analysis can be found here.)

With that in mind, I’d highly recommend to all men that they seek medical attention immediately if/when they experience symptoms, and that they schedule regular screenings with their PCPs once they reach the age of 50.

While there is not a lot that can be done in terms of preventing prostate problems, there is much that can be done if any problems that *do* exist are caught early and dealt with quickly.

Have you experienced prostate problems?
Do you have any recommendations for promoting prostate health?