The prostate is largely misunderstood and most of us take it for granted. September is prostate awareness month so I figured I would write a little about it ahead of time so you can properly prepare to celebrate this little nugget of fun. Where and what is the prostate? A healthy prostate is the size of a walnut and sits just below the bladder. When we look closely at where the prostate and the bladder meet we see that the tissue for the lower bladder seamlessly becomes the sphincter (valve) for the bladder and then seamlessly transitions into the tissue for the prostate. It is during sex that we use the prostate. It is considered by many to be an erogenous zone, or even the male “G spot,” and often gives sexual pleasure when stimulated from the outside, i.e. the rectal wall. The prostate can be stimulated from the inside but this would require urethral sounds and that guuuurl is another article! I will let those of you who don’t know what sounding is to google it. I’ll wait for you to catch up. Ready? Good.

The prostate also has two other “hoses” flowing into it each called the vas deferens, which come from the testicles to carry sperm into the prostate, where the seminal vesicles flood the area with a milky white fluid to help the sperm along their travel by giving them sugar for energy to swim as well as a low pH fluid to protect them from the acidic urethra, out the body, and into the acidic vagina, where they go on an egg hunt … at least that is the evolutionary design of things. Some deviation to the flight path may occur.

So what can go wrong? The most common issue men have with the prostate is when it gets larger called BPH or Benign Prostatic Hypertrophy. BPH is generally harmless, not being an issue typically until the guy is in his 50s. Because of the growth it can sometimes cause difficulty with urination. If you are a guy and you find yourself peeing in Morse Code then you may have an enlarged prostate. Typically this is easily handled by going in and debulking the prostate to allow normal flow of urine.

Difficulty peeing can also be caused by prostatitis, an infection of one sort or another causing the prostate to get inflamed and swollen which again narrows down the urethra. Sometimes there is pain with prostatitis but sometimes not. This is when your doctor will take a sample of the prostate fluid by milking the prostate then send it off for testing to see if you have an infection.

The issue that gives a lot of men pause is prostate cancer. Most of the time prostate cancer is slow growing, doesn’t appear in men until in their 60s and is probably not going to be the cause of death. While yes, it is still cancer, this type is usually well contained in the prostate and doesn’t go anywhere else. This does not mean you are off the hook, though. Sometimes prostate cancer appears at a younger age and is more aggressive. This is when your doctor will talk about removing the prostate, seeding it with radioactive beads, or maybe even some chemotherapy. Fortunately, due to modern technology, the removal (prostatectomy) is done with the precision of a robot. This has allowed us to spare the nerves around the prostate and preserve as much of the bladder sphincter as possible. This is key to enabling men to stay dry after the surgery. Now keep in mind that there is going to be some swelling after the surgery, which is going to cause the sphincter to not work properly for a short time, but with pelvic physical therapy we can retrain the muscles to work again. Not dissimilar from getting the quads to work again after an ACL repair or knee replacement. The best scenario for recover is pre-hab. I have seen men in my office before their surgery so we can strengthen the pelvic floor muscles as well as the sphincters before they are injured from the surgery.

So … if you are a guy and you are headed toward getting a prostatectomy or a TURP then I am your guy! Lets meet before you have the surgery so we can minimize your recovery time. I am having a free workshop at Pride Center of Maryland on Tuesday August 13th at 5 pm. Visit my website,, to register/more information.