Dear Dr. G,

Like most men, as I venture into the latter part of the fifth decade of my life, I've started having some trouble in the bathroom.

Initially, I began to wake up more frequently at night for urination.

Now, I have a problem starting to urinate. As my younger colleagues have finished, I have barely started. More worryingly, I've started dribbling and occasionally the dribbling has also stained my pants.

In the last two months, my urinary symptoms have persisted. I understand this is related to prostate issues.

The worse part is, apart from having trouble in the bathroom, this has also extended to the bedroom.

I recently noticed that I hardly get proper erection for sexual intercourse. Adding insult to the injury, I am also hardly ejaculating.

I am keen to put Dr. G on the spot about the impact of prostate and sexual health.

First of all, can you tell me what exactly is prostate and why does it get bigger?

Is there really a correlation between prostate and erectile dysfunction?

I also understand that the treatment of prostate problems tend to worsen the sexual performance, is that true and unavoidable?

Is there no treatment available that will help with both conditions?

Yours truly,

Middle-aged Mike

The prostate is a secretory gland that is part of the reproductive systems in men. The function of the prostate is to contribute towards the 30% of the total constituent of semen. The prostatic fluid is milky in appearance, slightly alkaline in nature, with the core function to neutralise the acidic hostility of the vagina, assisting sperm fertilisation.

The benign enlargement of prostate is an inevitable fact of life with progressive ageing. In fact, it is believed that most organs in an ageing man will shrink apart from prostate, which continues to grow. The increase in size is mostly benign in nature, and termed Benign Prostatic Hyperplasia (BPH).

It is estimated that more than half of men aged 50 will be affected by BPH, and nearly 90% of men aged 80 will be affected. The exact etiology of such significant progression in growth is unknown, but the genetic risk factor and other association of obesity and diabetes often play a role.

The urinary symptoms as a result of BPH include night time and day time frequent urination, difficulty in initiation of urination, incomplete sensation of emptying, straining, poor flow and dribbling. The symptoms are often slowly progressive in nature, and causes significant embarrassment for men. In severe cases, BPH can also result in regular urinary tract infections, retention of urine, incontinence or even renal impairment.

The coexistence of BPH and erectile dysfunction is also well documented in the medical literature. Many highlighted it to be coincidental as the two pathologies have the shared co-morbidities. Other scientists postulated the enlargement of the prostate is responsible for the impedance of blood flow to the penis, and some cited hormonal influence that renders men impotence.

The early treatment of BPH includes lifestyle changes such as weight-loss; caffeine intake reduction and increased consumption of certain fruits and vegetables seem to be able to slow down the progression of BPH.

Men with significant symptoms may also benefit from medications such as alpha-blockers and 5-Alpha-Reductase Inhibitors. As these two medications interfere with one of men's main sexual organs, it is commonly associated with further sexual dysfunctions. Alpha-blocker relaxes the sphincters responsible for ejaculation; therefore the medication often results in retrograde ejaculation or "dry orgasm". On the other hand, 5-Alpha-Reductase inhibitor suppresses the activity of testosterone; hence it is commonly associated with loss of libido.

Although surgeries such as TURP or Laser Prostatectomy are the definitive treatment for BPH, the operative interventions are well recognised to exacerbate further sexual dysfunctions. It is estimated that up to 90% of men will encounter dry orgasm and 25% rendered impotent after the surgical intervention. Therefore the option of the surgery is often unwelcomed by men.

In recent years, the medication used for the treatment of ED, is also noted to reduce the symptoms of BPH. This has lead to the approval of 5mg tadalafil as concomitant therapy for ED and BPH. Although this seems to be a solution to kill two birds with one stone, lifestyle changes are still crucial to prevent deterioration of ED and BPH.

The word "prostate" comes from Ancient Greek word meaning "one who stands before" or "being a guardian or a protector". As men reaches middle age, the protective role of the "reproductive guardian" seem to get out of control and affecting other entities of sexual health.

The progression of the prostatic enlargement is a matter of time as men age. Regular exercise and healthy eating is believed to slow down the progression to some extent. Therefore, for the younger men who are still enjoying the "protection of your guardian angel", rejoice and continue with the healthy lifestyle to impede the progression.

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Having trouble peeing? Your prostate is likely the culprit - The Star Online