A personal experience of losing one's prostate – and how the surgery affected masturbation.
[Herb is a JackinWorld reader.]
MY first awareness of having a prostate came in the doctor's office. After I mentioned to the doctor that I seemed to have to urinate a lot, he did a digital rectal examination. My gosh, what an experience. I had never had anyone do anything like that to me before. I kept telling the doctor I was going to pee on the floor. He kept saying, "No you won't. Stay still." He was right, of course, but the experience was something I wasn't too eager to repeat.
My profession, though, required frequent physicals, and at the age of 40, that included the dreaded "digital rectal exam" (DRE). But after a while the DRE became fairly routine. You learned to relax, let the doctor in to do his job, and get out. Not at all like the first time. I even occasionally inserted a finger while masturbating and felt my prostate myself. (Interesting little devil.) Anyway, they told me they were looking for an enlarged or "lumpy" prostate that could indicate problems. Through the years, mine was pronounced "normal" to "kind of big." My ability to ejaculate and urinate seemed normal.
At this point it might help to talk about what the prostate does, and where it is. As I understand it, the prostate is located at the base of the bladder, surrounding the urethral tube, which leads to the penis. Girls seem to want it to be in the scrotal sack where the testicles are, but I tell them that if they had one, it would be located about where their "G" spot is. The prostate provides seminal fluid to help the sperm ejaculate from the penis. Most of the stuff we have to clean up after a masturbation session is fluid from the prostate, not sperm. In fact, not ejaculating can cause a buildup of prostatic fluid, and after a while it will come out, either with help or at night in a "wet-dream". This is normal. I didn't know that, but I had a very active masturbatory life, and I haven't had a dozen wet-dreams in my life.
Several years ago, in a medical breakthrough, researchers discovered a prostate-health measurement called the PSA (prostate specific antigen) test. A low PSA number is good; a high number is cause for concern. To measure the PSA they draw a small amount of blood and send it to the lab for a report.
My first PSA reading was "a bit high," but not alarming. The accompanying DRE was "okay." But from physical to physical my PSA began to climb slowly, sometimes showing a slightly lower reading, and then the next time a slightly higher reading. It's been said that most men contract prostate cancer if they live long enough, and I've heard that most men die with prostate cancer, but not from prostate cancer. Talk like that can lull a man into thinking prostate cancer is not a real problem – but it is a leading killer of men, on a par with breast and cervical cancer for women. One reason it kills so many men is because we don't use the available techniques to catch it early.
As I entered my mid 50s, I began to have a weaker urine stream, sometimes even dribbling. Trips to the bathroom at night became more frequent. These are symptoms of an enlarged prostate, and yes, the doctor began to label mine "large."
Each time I was examined, my PSA crept up a bit higher. Also I began to experience a bit of erectile dysfunction (which I suspect is due to cholesterol buildup in my penis). It took more and more stimulation to get a firm erection, and I had to work to keep it for very long. But since the process of getting and maintaining an erection and the process of ejaculation are not co-dependent, masturbation still provided me with a lot of pleasure, and a very satisfying evidence of a climax.
Finally, my PSA hit a point that my urologist, who was now becoming a friend, ordered a needle biopsy. A needle biopsy is not recreational, I'll tell you, but not debilitating, either. The doctor enters through the rectum with an ultrasound transmitter and a device that pokes a needle into the prostate and takes a sample of tissue for a pathological exam. I was stabbed seven times, one in a suspicious-looking spot identified on the ultrasound. The procedure took about an hour and I was on my way home. I may have had to take a Tylenol or two, but the pain was not bad.
I had blood in my urine for about a week after that. After blood quit showing up in my urine, I was antsy as all get out to give my poor old penis some warm strokes. In a nice, comfortable setting I stroked away as usual, and at the proper time, I ejaculated what looked like pure dark blood. And since it had been over a week since I had masturbated, it was a lot of dark blood. Ugh! Still, it felt good, and it didn't seem to hurt. With time, the blood became less and less evident, and all seemed well. My biopsy report came back negative.
At the next check my PSA took another jump, and my doctor ordered another biopsy. Well, okay, I've been through this before – I'll live through it. It ain't fun, but it won't wipe me out. This time it was a ten "stick" biopsy. Once again I peed blood, and after a week or so, I ejaculated blood just like last time.
The pathology report came back positive for cancer.
Then came decision time.
But this time the pathology report came back positive for cancer. That is not the kind of news you pray for. Still, we caught it so early the prognosis was good. Just one of the "sticks" had a bit of cancer. A second opinion confirmed the cancer.
There are several treatment options for prostate cancer. If you are younger than 70, which I was, aggressive treatment is recommended. If you are over 70, depending on all of the known factors, the treatment options may be different, from aggressive to passive. Passive treatment may involve hormone therapy or other medications to shrink the prostate so urination is more comfortable. Or it can involve just "watching" a slow-growing cancer. (I think it is very risky and unwise to try any of the over-the-counter or herbal remedies we see advertised in men's magazines. I have heard of one case where a man treated himself with such remedies, and when he did discover that the problem was cancer, he had disqualified himself for the best surgical procedures. Check with your doctor first before you try any of these products.) Aggressive treatment generally falls into three types: external radiation to kill the cancer cells, implanting a radioactive "seed" in the tumor to kill it with radiation, and surgery to remove the prostate.
Of these options, surgery is the most aggressive, carries the most collateral risks, but offers the most certain cancer remission. If the surgery is done poorly, side effects could be impotence and incontinence. Most desirable is a "nerve-saving" surgery, where the nerves that control erections and the bladder are saved. A skilled surgeon can almost always save those nerves, but a clumsy or inexperienced one can leave you with a limp penis and a need for Depends. The radiation options don't carry these risks, they but don't have as good of a remission record.
I chose surgery. Get in, get that cancer out, and let me go on with life. And pray that my surgeon has a steady hand and a good technique. With any option, the first thing you do is get a bone scan, to be sure the cancer has not spread to your bones. Mine had not. I had a good feeling about that, because we had caught it so early.
My surgery was scheduled for 3 weeks later. Time to get a lot of physical things done that I would not be able to do for a while after my surgery. I was building a pole barn, so I got busy, dropping all outside activities that interfered. And each time I masturbated I savored the feelings and enjoyed the production of ejaculate. Yes, I know it is sometimes messy – and in unprotected sex it can be dangerous – but when faced with the end of my ability to produce semen, I felt I was saying goodbye to an old friend. Each time became special.
As my surgery drew nearer, I became more aware of how a woman must feel about breast cancer or a hysterectomy. I had always kind of shrugged when hearing about breast cancer. I cared, but I didn't really have much empathy. And as to a hysterectomy, hurray – now we can have some real fun, huh? Well, a woman's breasts and tubes and my prostate are kind of like two sides of the same coin: very important and not given up lightly. Today, I think I really understand and care. (Women, if you are reading this, GET YOUR PAP TESTS AND YOUR MAMMOGRAMS. Neither of those tests are designed to be recreational, but they save lives. Trust me – regular checkups have saved me a lot of grief and maybe a painful death.)
My last day before surgery I masturbated one "last time," looked with awe at my semen, said goodbye, and prepared for my trip to the hospital early in the morning.
The surgery lasted five or six hours. First they cut you open from belly button to the base of your penis. (Gratefully, I was under full anesthesia and knew nothing for the next seven or eight hours.) The first thing that's removed are the lymph nodes nearby. These are rushed to the pathologist to see if the cancer has spread to them. If so, you are closed up and treatment switches to plan B. My good luck held – my lymph nodes and a piece of my bladder were cancer-free. My cancer was "contained" and could be surgically removed. The surgeon proceeded to do just that, saving the important nerves and trying to leave me able to control my bladder functions. A vasectomy is part of the deal – no choice about that. It's very delicate surgery, but my surgeon seemed to be up to the task. At least he said he did a good job and saved my nerves.
I woke up feeling a bit weak, but not in too much pain. They said I had bled quite a bit, and that they'd had to give me the pint of blood I had "banked" for just such a need. My biggest problem was urinating. I had a catheter (tube) hanging out of my penis, going back into my bladder. I had absolutely no control over my bladder, and as I produced urine, it flowed into a plastic bag beside the bed. That was all well and good, but the feeling was of a constant need to "pee" but the inability to do so. I looked at my penis; it was all swollen and looked terrible. My scrotal sack was also swollen and ugly. And that tube hanging out of my penis was definitely not "cute." But by the next day I was up and walking, carrying my plastic bag, and I went home by noon on the next day.
Walking around with a tube hanging out of your penis feels weird. You don't "dangle" like you have all of your life, and if you touch your penis, you feel something swollen with a stiff plastic tube inside. I found it very unpleasant to touch my penis – not from pain, it just didn't feel "right." Later, as I was able to switch to a "leg bag," I could walk around – but I still didn't "dangle," and I still had the sensation of constantly wanting to urinate. I dreamed of the time when I could stand up again, hold my penis, and pee "like a man." After 17 days, that day finally came. They pulled the "cath" out and sent me home with some pads in case of "leaks."
I was also advised to start Kegel exercises to strengthen the muscles that control my bladder functions. This I did. I seemed to have pretty good control over my bladder anyway. I hadn't really touched my penis for almost 3 weeks, and my first few times trying to urinate were kind of scary. I still had the image of that swollen thing with the plastic tube in it. I was very tentative when I took hold of it and urinated.
The first time I showered without a tube hanging out, I just couldn't resist – I gave my penis a very gentle and tentative rub. Oh gosh, that felt so good. I missed it so. My post-op instructions said, "No sex while the catheter is in place." But that instrument of torture was gone, so I took a few more wonderful strokes. There was a hint that my penis would like to firm up and become erect. I didn't want to push it, though, and didn't carry it any further. But I couldn't wait until I got in the shower again. It was like when we first discover masturbation – I just couldn't stay away from it for long. And the next day, I carried it a bit further. Definite feelings of wanting to have an erection. Good job, Doc! I think that you "saved" it.
The morning of the 3rd day free of the "cath" I rubbed that little devil a bit more, taking it pretty close to a "climax," but not quite. That afternoon, my bladder shut down. By that evening, I was in the ER getting a catheter put back in. Damn, damn, damn! It would stay in a week more.
As I understand it, one of the miracles of ejaculation is that the bladder is shut down while you have an erection so you will not mix urine with your semen. We know this because it takes a while after ejaculation to urinate. I wonder if my coming so close to ejaculation didn't shut my still-tender bladder down and cause me the trouble. And you can bet I really thought about that when the catheter came out again, but I couldn't stay away from that wonderful feeling of caressing my penis. At the first chance, I took it right up to the "moment of truth" and then pushed it through to a climax.
Adios, old friend – it was wonderful while it lasted.
Well, if you think about it, I've had a vasectomy, and my prostate is in a bucket somewhere. so nothing is there to produce anything to ejaculate. My climax was gunpowder dry, but oh...it felt so good. I did miss seeing my semen shoot out, though. Adios, old friend – it was wonderful while it lasted.
Since then, I have masturbated several more times to a climax – all of the feelings with none of the mess. It does seem that the warm afterglow lasts just a few moments longer than it used to, but that could just be because I am so happy to "come home." So far, I have not achieved a full erection again, but I am firm enough to support gentle strokes, and it may just take a more intense experience to achieve a firm erection. But since ejaculation (or climax) and erection are not interdependent, masturbation is still possible – and still fun. I'm still reluctant to give myself a "full" workout until that catheter has been out a week or so. If I still have trouble achieving a full erection, I have a doctor-prescribed vacuum pump that does wonders, or I may see if Viagra will do the trick for me. I sincerely feel that my nerves are there to allow an erection to happen and hope time will restore that function for me.
Men, prostate cancer need not be the end of life for you, nor the end of satisfactory sex or masturbation activity. But if you don't catch it early, it can kill you, or at best cause you a lot of pain and grief from treatment.
Women (if any are still reading), you have a comparable problem. If you have a man in your life, encourage him to get regular prostate checks. They can save his life. And don't ignore your own health. Regular pap tests and those "wonderful" mammograms save lives. Be sure you do your part.
I'm looking forward to many more years of masturbatory pleasure, but without the cleanup problem that has been discussed at length on this site.
[For more information on the prostate and its function in the male reproductive system, read JackinWorld Science Corner: Semen Production & Ejaculation.]