Your Prostate and Your Sex Life: What Every Man Should Know
September is Sexual Health Month. It’s also Prostate Cancer Awareness Month and National Prostate Health Month. Those observances belong together more than most men probably realize.
When we talk about sexual health, the conversation often centers on safer sex, STI testing, erections and sexual performance. Those things are important, but sexual health is much broader than that. It also means understanding our bodies, recognizing when something changes and taking care of ourselves so we can continue enjoying active, satisfying sex lives as we get older.
For men, that includes the prostate.
Prostate health doesn’t get talked about nearly as openly as many other health issues. Next month, during Breast Cancer Awareness Month, we’ll see pink ribbons everywhere—and that’s a good thing. Awareness gets people talking, encourages screening and reminds people to pay attention to their health. Men deserve that conversation too.
So before September ends, let’s talk about the prostate—and why taking care of it is part of taking care of your sex life.
What Does the Prostate Actually Do?
The prostate is a small gland located just below the bladder. The urethra, which carries urine and semen out through the penis, passes through it. The prostate also produces some of the fluid that becomes semen.
As men age, the prostate commonly gets larger. This is called benign prostatic hyperplasia, or BPH. It isn’t cancer, but an enlarged prostate can squeeze the urethra and cause problems with urination. Men can also develop prostatitis, an inflammation of the prostate that can cause pelvic pain, urinary problems and sometimes painful ejaculation.
And, of course, there’s prostate cancer.
When Should You Start Thinking About Screening?
There isn’t one birthday when every man suddenly needs a prostate exam. Prostate cancer screening today generally centers on a PSA blood test, although a doctor may also recommend a digital rectal exam depending on the circumstances.
For men at average risk, the American Cancer Society recommends discussing screening with a healthcare provider beginning at age 50. Men at higher risk—including Black men and men whose father or brother developed prostate cancer before age 65—should begin that conversation around 45. For men with more than one close relative who developed prostate cancer at an early age, that conversation should begin around 40.
Different medical organizations have somewhat different recommendations, and PSA isn't a simple positive-or-negative cancer test. An elevated PSA can have causes other than cancer. That's why the important thing isn't memorizing a particular birthday; it's knowing your risk and having the conversation with your doctor.
Don’t Wait for Symptoms
One of the most important things to understand about prostate cancer is that early prostate cancer often has no symptoms at all. Waiting until something feels wrong isn't necessarily a good screening strategy.
At the same time, urinary and sexual changes shouldn't automatically be dismissed as part of getting older. Talk with your doctor if you notice:
Difficulty starting urination or a weak or interrupted stream
Needing to urinate much more frequently, particularly at night
Difficulty completely emptying your bladder
Pain or burning during urination
Blood in your urine or semen
Pain with ejaculation
Persistent pain in your back, hips or pelvis
None of these symptoms means you necessarily have prostate cancer. BPH, prostatitis, infections and other conditions can cause similar problems. But they're worth investigating. If you suddenly can't urinate at all, seek prompt medical attention.
What Does Your Prostate Have to Do With Your Sex Life?
Having erection problems doesn't automatically mean something is wrong with your prostate. Erections depend on blood vessels, nerves, hormones and the brain, and erectile dysfunction can have many causes.
Where prostate health becomes particularly important sexually is during treatment for prostate cancer. The nerves involved in erections run extremely close to the prostate. Surgery can disturb or damage those nerves even when surgeons use nerve-sparing techniques. Radiation can also affect the nerves and blood vessels involved in erections, while hormone therapy can reduce testosterone, sexual desire and erectile function.
That doesn't mean prostate cancer treatment means the end of your sex life. Medications for erectile dysfunction, vacuum devices, injections and penile implants are among the options available when men experience problems after treatment. Sexual function is a legitimate quality-of-life issue and something worth discussing with your doctor before treatment, not just afterward.
There’s another thing men often aren’t told enough about: erection, ejaculation and orgasm are not the same thing. A man can have an orgasm without ejaculating, and orgasm can remain possible even when erections have changed.
After surgical removal of the prostate, for example, a man can still experience orgasm, but he will no longer ejaculate semen. This is often called a dry orgasm. Some men also notice changes in the sensation or intensity of orgasm. Because prostate surgery can affect fertility, men who may want biological children in the future should discuss fertility preservation before treatment begins.
Can You Keep Your Prostate Healthy?
Unfortunately, there isn't a magic food, supplement or sexual routine guaranteed to prevent prostate problems or prostate cancer. Be skeptical of products promising to “cleanse” or “detox” your prostate.
The better approach is much less exciting: take care of your overall health, know your family history and risk factors, don't ignore changes in urinary or sexual function, and talk with your healthcare provider about screening when the time is appropriate.
The same goes for erectile dysfunction. Persistent ED isn't something every man simply has to accept as he gets older. It can sometimes be associated with cardiovascular, metabolic, hormonal or neurological problems. If something has noticeably changed, it's worth talking about.
Sexual Health Is Health
Men can be remarkably willing to talk about their erections with their buddies and remarkably reluctant to talk about them with their doctors. Sexual Health Month is as good a time as any to change that.
If your erections have changed, ejaculation suddenly hurts, you're getting up all night to pee or your urine stream isn't what it used to be, don't just ignore it. And if you've reached the age when prostate cancer screening should be part of the conversation, have that conversation.
Taking care of your prostate isn't an admission that you're getting old, and it certainly isn't the end of being sexual.
Taking care of the equipment is part of enjoying it for as long as possible.