Men are generally less likely than women to consult doctors about their health.
Many men find it particularly embarrassing to bring up problems of a personal nature. For this reason, when serious issues occur, men often wait longer before seeing a physician.
Because we find discussions around our cock, balls and butt awkward, myths and misconceptions can arise.
This can be particular true when it comes to prostate cancer. The disease will affect around one in seven men during their lifetime.
As gay men are more likely to have anal sex, are we any more or less likely to be affected by prostate cancer?
Some say prostate massage is good for your health. Is there any truth in this? GSN decided to ask some experts.
What is your prostate?
Firstly, what is the prostate? Well, it is a small, walnut shaped gland that men, and trans women, have in their pelvis. It lies between your penis and bladder, and produces some of the fluid in your seminal fluid
It can be felt with a finger as a small, firm bump on the front wall of your anus. Receptive anal sex is known to put pleasurable pressure on the prostate, while some sex toys are designed specifically to massage it.
‘Should you have a prostate massage in terms of overall prostate health and to reduce the risk of prostate cancer?’ asks Mr Christian Brown, a consultant urological surgeon with King’s and Guy’s NHS Hospitals Trusts and London’s Prostate Centre. ‘I’ve heard that talked about before and I wouldn’t support that as a urologist. There is no evidence to support it.’
Brown says he does sometimes recommend a medical prostate massage to patients, but this is for specific reasons.
Prostate glands can become inflamed or infected. This is known as prostatitis and can lead to chronic pelvic pain or discomfort. It can sometimes be difficult to diagnose what causes it.
‘A medical prostate massage, rather than one that’s done for stimulation, is a pretty unpleasant experience,’ says Brown.
‘The prostate is massaged pretty vigorously, with the aim of getting secretions from the gland which wouldn’t normally be released through ejaculation. One of the theories behind it is that a build-up of these secretions can cause chronic inflammation, which then causes pain.’
Hence ‘milking’ the prostate to expel some of these secretions and reduce the discomfort.
However, ‘the evidence base is very, very weak for it,’ says Brown. ‘ [Massage] tends to be reserved for those cases where we’ve struggled to control the symptoms in any other way.’
In short, some men will get some benefit from it and some men won’t. And even if they do, it’s difficult to claim that the massage was responsible as chronic pelvic pain can often get better of its own accord.
‘The problem with these chronic pain syndromes is that whatever you’re doing at the time the symptoms go away you hail as a success,’ says Brown. ‘But the symptoms might have gone away anyway.’
‘Most urologists will warn the patient, “There’s not a lot of evidence for this but we’re at that stage now where we’ve run out of other options so would you like us to see if we can help you with this procedure?” You have to say, “It might work, it might not.”
Massage for diagnosis not prevention
‘The second reason for doing a prostate massage is if we want to get the secretions out to culture them in a lab, to see if there’s any bacteria there. Often GPs or sexual health clinics will try out multiple courses of antibiotics, but no one has actually cultured either the semen or prostate secretions.’
Besides this, Brown says there is simply no hard evidence that prostate massage does any good or any harm to your health.
‘There was some evidence a few years ago saying gay men were at slightly increased risk of prostate cancer, but that’s because they’re more likely than straight men to be going to sexual health clinics as part of their annual or bi-annual sexual health check-up and talking about prostate issues and are probably being screened.
‘I think now it’s been established that there is no risk factor from being a gay man that puts your risk of prostate cancer any higher than a straight guy. I think that’s an important message.’
Studies showing prostate massage benefit
Advocates of prostate massage will point towards small-scale studies that suggest prostate massage is good for you. A 2009 Chicago study looked at whether at-home prostate massage with anal stimulation devices might benefit men with chronic pelvic pain.
It analyzed 115 men, and concluded that enough men reported benefit to warrant a wider trial being undertaken at some stage.
Again, as Brown points out, some of these men may have reported an improvement of symptoms with or without massage. The study was not concerned with prostate cancer, and – statistically speaking – was a small study.
Otis Brawley, MD, is chief medical officer, American Cancer Society. He talks fascinatingly and at length about prostate cancer and its diagnosis. He pays little heed to such studies.
‘There is no data whatsoever,’ he says, to show that prostate massage reduces your risk of prostate cancer.
‘In order to prove that something reduces risk of prostate cancer you need, and this has been done with a couple of other things over the years, you need to do a study that involves following about 18,000 men. And those men need to be followed for at least eight, but usually 10-12 years.
‘Nobody has ever done a study like that looking at prostate massage.’
He agrees with Brown that prostate massage is sometimes helpful as a diagnostic tool.
‘He’s absolutely correct. Prostatitis can be caused by a number of different bacteria. It can be e-coli, or even gonorrhea or chlamydia. But most often it’s not a sexually transmitted disease – it’s most often e-coli, and we will do a prostate massage and collect a sample in an effort to get a sample of the bug or the bacteria that’s causing the inflammation of the prostate.
‘Once we figure out what the bacteria is we can figure out what antibiotic is most appropriate. But that’s not to prevent any disease. That’s a diagnostic attempt.’
Prostate cancer risks
And as for gay men and prostate cancer? Brawley agrees that there is ‘no evidence’ that gay men have a higher or lower risk of prostate cancer.
‘The risk factors for prostate cancer include age: older men tend to get it more than younger men.
‘There’s some data that men of African heritage are in higher risk of prostate cancer. And men who have family histories – that is a brother, uncle or father that have the disease – are also at higher risk of prostate cancer.’
The first step in diagnosing prostate cancer is to do a blood test to look for PSA (prostate specific antigen). This will be higher in men who have prostate cancer.
So, in Brawley’s opinion, there’s no evidence prostate massage does any harm, and no evidence it does any good?
‘The only harm it can do is that it can transiently raise PSA and it’s only a problem if the man gets his PSA measured in the days after the massage. The PSA will go down by day four. Riding a bike has the same effect.’
Prostate Cancer UK
Prostate Cancer UK agree with both doctors. Spokesperson Ali Rooke, a Senior Specialist Nurse with the organization told GSN, ‘We are aware that there have been some studies concerning the effect of sexual activity on prostate cancer prevention. These clinical studies however are not robust enough to suggest there is an effect on prostate cancer risk.
‘There is no evidence to suggest that prostate massage or stimulation of the prostate gland will reduce the risk of prostate cancer.’
She went on to confirm Brawley’s information on the risk factors. She added that there’s some research to show being overweight or obese increases your risk of getting cancer that’s more likely to spread (called aggressive) or advanced prostate cancer (which has spread outside the prostate).
Don’t be shy of asking for advice
To sum up, if stimulating your prostate gives you pleasure – whether with a finger, toy or someone else’s cock – there’s no evidence it’s doing your prostate any harm. But there’s also no conclusive evidence it will improve your health or lessen your chances of getting prostate cancer.
Do always use plenty of lubricant and stop if you’re not enjoying it.
But the most important message to take away from this? If you have any pain or symptoms you’re unsure about, don’t be embarrassed to ask your doctor’s advice! Too many guys continue to leave it too late before seeking help or asking questions.