Post by Admin on Jan 23, 2022 13:38:05 GMT
Intimate and Invasive
Gavin Francis
The prostate has caused difficulty for men and medicine for centuries. A new “biography of the prostate” examines the haunting terror it creates.
February 10, 2022 issue
www.nybooks.com/articles/2022/02/10/intimate-and-invasive-prostate-exams/
At the small family practice in Edinburgh where I work as a physician, I happen to be the only male staff member—all my medical, nursing, and administrative colleagues are female. Perhaps that’s why I see a great many men about their prostate problems and carry out a disproportionate number of prostate examinations. The attitude of most men is an odd mixture of anxiety and jokey bravado; they find it easier to make wisecracks about the prostate than to confess their fear of disease. I’m reminded of a routine by the Scottish comedian Billy Connolly, who joked about reaching an age when his doctor had lost interest in his balls and become curious instead about his ass (cancer of the testes being a young man’s disease).
You can feel the prostate through the thin wall of the rectum, about a finger’s length inside the anus. Visualizing it isn’t easy: imagine a tiny doughnut that sits just under the bladder. Urine passes through the hole in the middle. The usual size comparison (for a young man’s healthy prostate) is that of a walnut. I count the prostate as normal when it’s soft, smooth, symmetrical, with a groove running vertically down the middle, and not jutting back into the rectum.
The gland has a variety of functions. It secretes between a quarter and a third of the fluid that constitutes semen—most of the rest is produced in the seminal vesicles—and its muscular elements contract at ejaculation to expel semen into the urethra and out of the body. It operates as a kind of junction box or valve that controls the flow of fluids, ensuring that urine doesn’t pass out to the testicles during urination and that semen doesn’t go up into the bladder during ejaculation. It helps protect against urinary tract infections, and for some men it’s an erogenous zone.
Women too have glandular tissues around the urethra (known as Skene’s gland) that during orgasm expel fluid into the urethra or the vagina itself. Though this gland is sometimes referred to as the “female prostate,” it rarely causes medical problems. For transgender women taking feminizing hormones, the prostate is very unlikely to cause the kind of problems that I’ll be discussing in men.
The tissues of the prostate are sensitive to circulating levels of testosterone, which stimulate it to grow, and so the prostate increases in size throughout life as long as the testes continue to produce that hormone. Prostate cancers, because they’re made of prostatic tissue, usually grow in response to testosterone as well. By the age of seventy, up to three quarters of men have prostatism (some degree of prostatic obstructive symptoms), which in its more severe forms entails poor urinary flow, difficulty initiating urination, dribbling after urination, and nocturia (having to get up at night to pee). These can all be caused by the gradual growth of prostatic tissues and resultant pressure on the bladder, as well as the tightening of the space through which urine has to pass. To widen this channel and improve flow, a surgical procedure called transurethral resection of the prostate (TURP) is commonly carried out on older men.
Gavin Francis
The prostate has caused difficulty for men and medicine for centuries. A new “biography of the prostate” examines the haunting terror it creates.
February 10, 2022 issue
www.nybooks.com/articles/2022/02/10/intimate-and-invasive-prostate-exams/
At the small family practice in Edinburgh where I work as a physician, I happen to be the only male staff member—all my medical, nursing, and administrative colleagues are female. Perhaps that’s why I see a great many men about their prostate problems and carry out a disproportionate number of prostate examinations. The attitude of most men is an odd mixture of anxiety and jokey bravado; they find it easier to make wisecracks about the prostate than to confess their fear of disease. I’m reminded of a routine by the Scottish comedian Billy Connolly, who joked about reaching an age when his doctor had lost interest in his balls and become curious instead about his ass (cancer of the testes being a young man’s disease).
You can feel the prostate through the thin wall of the rectum, about a finger’s length inside the anus. Visualizing it isn’t easy: imagine a tiny doughnut that sits just under the bladder. Urine passes through the hole in the middle. The usual size comparison (for a young man’s healthy prostate) is that of a walnut. I count the prostate as normal when it’s soft, smooth, symmetrical, with a groove running vertically down the middle, and not jutting back into the rectum.
The gland has a variety of functions. It secretes between a quarter and a third of the fluid that constitutes semen—most of the rest is produced in the seminal vesicles—and its muscular elements contract at ejaculation to expel semen into the urethra and out of the body. It operates as a kind of junction box or valve that controls the flow of fluids, ensuring that urine doesn’t pass out to the testicles during urination and that semen doesn’t go up into the bladder during ejaculation. It helps protect against urinary tract infections, and for some men it’s an erogenous zone.
Women too have glandular tissues around the urethra (known as Skene’s gland) that during orgasm expel fluid into the urethra or the vagina itself. Though this gland is sometimes referred to as the “female prostate,” it rarely causes medical problems. For transgender women taking feminizing hormones, the prostate is very unlikely to cause the kind of problems that I’ll be discussing in men.
The tissues of the prostate are sensitive to circulating levels of testosterone, which stimulate it to grow, and so the prostate increases in size throughout life as long as the testes continue to produce that hormone. Prostate cancers, because they’re made of prostatic tissue, usually grow in response to testosterone as well. By the age of seventy, up to three quarters of men have prostatism (some degree of prostatic obstructive symptoms), which in its more severe forms entails poor urinary flow, difficulty initiating urination, dribbling after urination, and nocturia (having to get up at night to pee). These can all be caused by the gradual growth of prostatic tissues and resultant pressure on the bladder, as well as the tightening of the space through which urine has to pass. To widen this channel and improve flow, a surgical procedure called transurethral resection of the prostate (TURP) is commonly carried out on older men.