Posts Tagged ‘digital rectal exam’

Prostate Massage: Medically Legitimate or Snake Oil?

August 24, 2019

Andrew Siegel MD   8/24/19

massage | məˈsäZH, məˈsäj | noun the rubbing and kneading of muscles and joints of the body with the hands, especially to relieve tension or pain: massage can ease tiredness and jet lag | a massage will help loosen you up.

Hidden deep in the pelvis at the crossroads of the male urinary and reproductive systems, the prostate is arguably man’s center of gravity.  The prostate is made up of glandular tissue that functions to manufacture a milky fluid that serves as sustenance for sperm cells. At the time of ejaculation, the prostate fluid passes through ducts that empty into the urethra where it mixes with other reproductive secretions and sperm to form semen. Prostate massage is a technique that releases prostate fluid into the urethra via manipulating and compressing the organ via a rectal approach.

Digital Rectal Exam

Compressing the prostate milks prostate fluid into the ducts and thereafter into the urethra.  Illustration from Prostate Cancer 20/20 book.

In the old days

Years ago, urologists routinely performed prostate massage on patients to obtain a prostate fluid specimen (“expressed prostate secretion”) for microscopic analysis to check for bacteria and pus cells and for microbiological culture.  This practice is rarely performed anymore.  The technique involves digital rectal massage of the prostate with a gloved, lubricated finger, typically with the patient bent forwards with elbows on the exam table for support.  Vigorously compressing and kneading the prostate displaces  fluid from the glands within the prostate into the ducts and then the urethra, with a small amount of milky prostate fluid expressed at the urethral opening at the end of the penis. This fluid is then placed on a glass slide and scrutinized microscopically as well as cultured.

I checked in with my father—a retired 88-year-old urologist—concerning his use of prostate massage back in the day. He performed prostate massage primarily to obtain a prostatic fluid specimen in men with symptoms of chronic prostatitis, including painful ejaculation and urinary urgency and frequency.  In the presence of bacteria or white blood cells (pus cells) seen under the microscope or a positive culture, antibiotics were prescribed.  Toward the end of his career, this technique and test fell out of favor.

Nowadays

I surveyed my urology partners concerning the medical legitimacy of prostate massage. The senior urologist in the group occasionally uses the technique for a man with “chronic prostatitis” or alternatively, in a man who has not ejaculated for a long time and would benefit from prostate “decompression.” Another of my urology partners uses prostate massage on rare occasions to help drain an inflamed or infected pocket of the prostate to which antibiotics traditionally have poor access and effectiveness, much as a dermatologist compresses and ruptures a pimple or blackhead. Another uses the technique infrequently to provide temporary relief of symptoms, similar to what ejaculation would provide.  Another partner does not think it is ever of benefit or truly indicated, although there are patients who swear by it, similar to opinions on CBD oil. Another partner thinks that it is only of placebo benefit, similar to the benefit that some women claim from urethral dilation (using small-caliber rods to stretch the channel that drains the urinary bladder).

Historically, prostate massage was also used on a legitimate medical basis to obtain a specimen to enable a prostate cancer screening test called prostate cancer antigen (PCA3) urine test.  Prostate massage was performed and thereafter the patient urinated a small amount of urine, rich in prostatic fluid and prostate cells.  This urine was tested for the quantity of PCA3 genetic material present, with an elevated PCA3  suspicious for prostate cancer.  However, the test is rarely, if ever, performed anymore.

Another bonafide medical reason– not for a prostate massage per se–but for a massage of the pelvic floor muscles (located immediately adjacent to the prostate gland) is for the management of pelvic floor tension myalgia.  This is a condition that gives rise to pelvic pain and a host of sexual, urinary and bowel symptoms. Pelvic floor physical therapists use physical interventions that are of great benefit to those with pelvic tension myalgia, including pelvic muscle stretching and lengthening to increase muscle flexibility as well as trigger point therapy that compresses and massages the knotted and spastic muscles. Those patients so motivated can pursue self-treatment regimens using internal, manually guided trigger point release wands that aim to relieve or eliminate the knots by self-directed manipulation and massage. These devices may be obtained without a prescription and are available online.

“Recreational” prostate massage

What about prostate massage for non-medical purposes? This is not my area of expertise, but a few words about this are indicated.

The prostate is part of the male sexual/reproductive apparatus and can be thought of as an erogenous zone.  In non-medical/non-urological terminology, the prostate is at times referred to as the “P-spot,” drawing an analogy to the female “G-spot.”  (The G-Spot—named after German gynecologist Ernst Grafenberg—was first described in 1950 and was believed to be an erogenous zone located on the upper wall of the vagina, between the vagina and the urethra, the stimulation of which was thought to promote arousal and vaginal orgasm. There is little scientific to support the existence of the G-spot as a discrete anatomical entity; however, many women feel that they possess an area on the roof of the vagina that is a particularly sensitive pleasure zone. Although its existence remains controversial, the G-spot is certainly a powerful social phenomenon.)

Prostate manipulation or massage can be used for erotic/sexual purposes on a solo or a partnered basis. It can be used during foreplay, during sexual intercourse and at the time of orgasm to enhance sexual climax. There are numerous toys and product  that are intended to facilitate the practice of erotic prostate stimulation/massage.

For information about erotic prostate massage, there are numerous sources on the Internet: go to YouTube and search “prostate massage” and you will find an abundance of videos.  In one of these, urologist and sex expert Dr. Jennifer Berman spoke about prostate massage on Late Night with Conan.  However, do not for one moment believe her line that “calcifications build up in the prostate that can cause prostate cancer and that prostate massage will help eliminate these.”

Bottom Line: Prostate massage has limited therapeutic medical benefit and legitimacy.  A more natural and less invasive means of decompressing the prostate is via ejaculation.  Pelvic floor massage and trigger point release are legitimate and oftentimes effective treatments for pelvic floor tension issues.  As to prostate massage for sexual/erotic/recreational purposes, that is another story entirely.  

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.  Dr. Siegel is the author of Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.  The first part of the book provides abundant information on the prostate and prostate cancer, while the second and third parts address male urinary and sexual concerns, respectively.

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

Prostate Cancer 20/20 on Apple iBooks

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health