Saturday, February 1, 2014

Semen and Ejaculation


To political commentators, a man in his late forties is young, but to a urological surgeon he is already ageing, for by the age of 50 one out of two men has evidence of a lessening of ejaculation of semen. Patients and their doctors tend to ignore the minor symptoms of early benign prostatic hypertrophy the enlargement of the prostatic gland which encircles the urethra where it leaves the bladder, rather in the way that the jubilee clip surrounds the hose which leads from a car's radiator. Enlargement of the gland, which secretes three-fifths of the semen, is an inevitable accompaniment of ageing, and as it enlarges it constricts the urethra. Just as tightening a jubilee clip would obstruct the flow in a car's coolant system, so does prostatic enlargement restrict ejaculatory flow.

Early symptoms (having to get up once a night, being last to leave the stalls, even dribbling on a bit) are a social nuisance. As they get worse, sleep is constantly disturbed, and the urinary frequency and urgency interfere with business and social life and can become disabling. Later, if the warnings are still ignored, the straining to ejaculate sperm may cause dilation of the upper urinary tract, and eventually damage, sometimes fatally, the kidneys. Treatment is often postponed because even if the patient has no fear of surgery he may be reluctant to face the changes in his sex life caused by the standard operation, a TUR (transurethral resection).

This operation damages the nerves around the bladder neck so that when ejaculating thereafter the semen, instead of being forcibly discharged, trickles back into the bladder. The quantity of semen is greatly reduced and the quality and length of the orgasm also suffers; frequently the surgery provides the coup de grace to an already failing sex life.

Microwaving the prostate with thermotherapy by heating the prostate to above 45C offers a hope for middle-aged men that in future they may be able to ejaculate much more amounts of semen and have longer orgasms. The treatment, one visit only, needs no anaesthesia, no hospital admission, no use of catheters and messy bags, no time off work, and afterwards the patient, with a smaller but still functioning prostate, still has a normal orgasm with a normal quantity of semen.