The Ins and Outs of Gay Sex (30 page)

The same antibiotics used to treat acute prostatitis are used to treat the chronic bacterial variety—only the course is much longer.
Expect to take antibiotics for twelve weeks, but even then cure rates average only 40 to 70 percent, with more than half of all men experiencing relapsing infections.
Many doctors combine antibiotics with nonsteroidal anti-inflammatory medication to reduce swelling and decrease pain.

If prostatic massage turns up only white blood cells in your urine and not bacteria, you’ve got chronic nonbacterial prostatitis.
Although no one knows which organism causes this condition, chlamydia is suspect.
Most doctors try a one-month course of tetracycline or doxycycline in the hope of wiping out whatever is causing your misery.
Don’t
expect much; failure rates are even higher than those seen in chronic bacterial prostatitis.

You’ve probably heard locker-room talk that prostatitis occurs because you don’t come enough.
Dr.
Franklin Lowe, a New York City urologist, agrees that this is one possible cause.
Abstinence leads to a prostatic secretion buildup, blocking your ducts and providing a good place for bacteria to grow.
He combines antibiotics with instructions to ejaculate at least every other day.
(Finally a prescription that’s easy to take.
)

Don’t get scared.
In medicine, the word “tumor” or “neoplasm” refers to
any
abnormal growth, whether it’s cancerous or not.
The prostate is about the size of a walnut and shaped like an inverted cylindrical heart.
Your urethra travels through it just above the heart’s indentation.
Before puberty, your prostate is quite tiny, but it undergoes rapid growth when testosterone levels climb during adolescence.
It reaches adult size by the time you are thirty.
Prostate size remains relatively stable until about age fifty, when it begins to grow again as a benign adenoma.
This growth in later life is also called benign prostatic hyperplasia (BPH), and it often produces difficulty urinating.
This type of prostate growth is noncancerous and cannot spread or kill you.

A prostatic adenoma usually originates in the part of the prostate adjacent to your urethra.
This is important.
As your adenoma enlarges, it impinges on your urethra, making urination increasingly more difficult.
The symptoms of BPH are listed in
Table 8.
1
and result from your inability to empty your bladder completely.
Your bladder still feels full even after you pee, and it isn’t long before you notice the urge to go again.
Men wake several times during the night to urinate (nocturia) and then wait while it dribbles out.
Remember how powerful your stream was as a child, capable of arching high over your head?
Then you had so little prostate impeding urine flow.
Your stream weakened during adolescence as your prostate matured, and it will weaken again when BPH develops.

TABLE 8.
1
SYMPTOMS OF BENIGN PROSTATIC HYPERPLASIA

BPH progresses at different rates in everyone.
For some it never becomes a problem, but for about one-third of men it causes significant symptoms requiring treatment.
Urine can back up to your kidneys, damaging them; or your prostate completely constricts your urethra until one day you find yourself standing over a bowl, in agony, unable to pee.
As scary as it sounds to have a catheter pushed down your penis, I’ve witnessed men begging for it, in tears because they could not urinate.

Prostatic enlargement happens gradually, and often you don’t realize it until problems arise.
You adjust to having to get up once during the night, then twice.
So what if it takes a few seconds longer to pee or if you have to shake more to avoid embarrassing stains?
Your bladder muscle strengthens
to push urine through a tighter hole, and you learn to bear down with abdominal muscles, so hard that a hernia develops.
Then one day you take a cold capsule or have surgery as minor as a cataract removal and suddenly you can’t urinate.
Many medications, including narcotics for pain and decongestants, tighten your bladder sphincter and make it harder to urinate.
These drugs can tip you over the edge from being able to force urine through a tight prostate to not being able to go at all (urinary retention).