Prostatitis refers to an inflamed, swollen, and tender prostate. This painful condition can be caused by an infection (by bacteria) or by something else— doctors don’t know what causes nonbacterial prostatitis. In any case, the symptoms may include pain in the joints, muscles, lower back, and area behind the scrotum; aches, fever and chills (in acute cases); urinary trouble, including blood in the urine, pain, or burning; and painful ejaculation.

Bacterial prostatitis manifests itself in both acute (severe and requiring immediate treatment) and chronic (long-term) forms, and may be detected by bacteria in the urine; neither formm contagious, and neither form can be transmitted to a man’s sexual partner. The treatment is to combat the bacteria and thus stop the infection. For nonbacterial prostatitis, the arsenal of treatments includes muscle relaxants. A related condition, called prostatodynia, or painful prostate, may not be an actual prostate disease but may in fact be caused by muscle spasms in the pelvis.

Next we’ll take a look at how the male urinary and reproductive systems work normally, before examining what happens when the prostate—which is involved in both systems—causes trouble.

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The scrotum is the bag of skin that sits below the penis and contains the testicles, the epididymis, the vas deferens (spermatic cords), and blood vessels that lead to the testicles. The skin is normally loose and wrinkled, and sparsely covered with hair.

Testicles

The two testicles, which are located inside the scrotum, are the structures that make sperm and testosterone. (Testosterone is the hormone primarily responsible for the development of male physical characteristics.) The testicles sit away from the body to keep them below body temperature (the lower temperature is required for the production of sperm). The testicles should feel smooth to the touch and have the consistency of a hard-boiled egg. They vary in size, from the size of a large grape to the size of an egg. Normally, most men have one testicle that hangs lower than the other.

When a male infant is in the womb, the testicles start out in the pelvic area and descend into the scrotal sac. Sometimes one or both testicles do not descend; they remain in the pelvis and are not visible from the outside. This condition must be surgically corrected, since an undescended testicle is a risk for developing testicular cancer.

Every month all men should do a self-examination of the testicles, feeling for any bumps or irregularities on them, which can be a sign of testicular cancer. The testicles can be a site of infection, called orchitis, which can be caused by mumps in men who were not adequately immunized or (rarely) by sexually transmitted infections or other viruses.

The area above the testicles feels like cords of string. This area contains the epididymis, which stores sperm; the vas deferens, which carry sperm into the urethra during ejaculation,- and blood vessels going to and from the testicles.

Epididymis

The epididymis is a collection of coiled tubes, the main purpose of which is storing sperm and providing a place for the sperm to mature. The tubes also carry sperm from the testicles to the vas deferens, which carry the sperm into the urethra. Sperm move slowly and mature as they travel through the epididymis. The epididymis can become infected with sexually transmitted bacteria (such as gonorrhea and chlamydia) or nonsexually transmitted bacteria. Infection of the epididymis is called epididymitis.

Vas Deferens

The vas deferens are straight, hollow tubes that carry the sperm from each epididymis to the urethra as it travels though the prostate. These are the tubes that are cut in the sterilization procedure for men called vasectomy.

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Although prostate “trouble” does seem to be a normal part of aging, prostate cancer is not just an old man’s disease. In 1994, the American Cancer Society’s

Department of Epidemiology and Statistics estimated that two hundred thousand new cases of prostate cancer would be diagnosed in the United States, and that more than thirty-eight thousand men would die of the disease. It is now the second-leading kind of cancer in men (second only to skin cancer); and, of all cancers, prostate cancer is the one whose prevalence increases most rapidly with age.

Again, there is good news: Caught early, before it has spread, prostate cancer is curable with surgery or radiotherapy. Better surgery has drastically reduced the operation’s worst side effects, impotence and incontinence. And new research is laying careful groundwork for understanding prostate cancer and improving the hope for curative treatment even after the disease has spread.

If prostate cancer is detected early, men can be cured; they can also have a normal life. This critical message needs to be heard by doctors as well as patients. Men need to have themselves tested, and doctors need to start checking for prostate cancer earlier, and more vigilantly.

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The penis is the organ through which men both urinate and produce semen. There are no muscles or bones in the penis, which is composed of three tubes of tissue. The top two tubes are called the corpora cavernosa. These tubes are composed of spongy tissue and blood vessels that, during sexual excitement, become full of blood and thus cause an erection. When not erect, the penis is soft and limp (flaccid). The bottom tube of tissue is called the corpus spongiosum, and through it runs the urethra, the hollow tube that carries both urine and semen.

At the end of the penis is the glans or head. The corpus spongiosum is connected to the glans, and the urethra opens at the tip of it. The glans of the penis has more nerve endings than any other part of the penis, which is why it is so sensitive. Stimulation of the glans is important in sexual arousal and orgasm: it is analogous to the clitoris in women. All men are born with a retractable layer of skin, called the foreskin, which covers the head of the penis. Many males have the foreskin surgically removed at birth in a procedure called circumcision. In some men, small, shiny, painless bumps called pearly penile papules are present around the edge of the head of the penis. Although they are sometimes confused with warts by both patients and health care providers, they are a normal part of male anatomy.

James was sick with worry that he had contracted a sexually transmitted disease. When he noticed small, painless bumps along the ridge of the head of his penis, he did some research in the library, and now he was convinced that he had genital warts.

After several weeks of worrying, James finally went to a local STD clinic, where he was ecstatic to learn that the bumps weren’t warts after all, but pearly penile papules, a normal part of male anatomy. While he was there, he and the physician discussed safe sex practices and how to prevent becoming infected with an STD in the future. James learned so much and was so relieved that he wished he had gone earlier to be checked out.

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For most men, during the first forty years or so of life, the prostate is on its best behavior. But after age 40, many men—an estimated 80 percent by age 80— develop benign prostatic hyperplasia (BPH), an irritating condition that causes the prostate to swell and interfere with urine flow. BPH may trigger frequent urination (several times an hour); a sense of urgency; a long wait for urine to flow; frequent awakening in the night to urinate; interruption of the urine stream (starting and stopping); and a constant feeling of fullness in the bladder. Sometimes, BPH leads to urinary tract infections; in rare cases, it can cause damage to the bladder or kidneys.

BPH develops from the inside outward, as the prostate’s inner tissue starts to crowd the urethra, which runs through the encircling prostate like a straw held in someone’s fist. As the inner prostate cells grow, they begin squeezing the urethra; the fist tightens. For most men with BPH, this tightening causes an irritating but still tolerable change in quality of life. However, when it progresses beyond the nuisance point—when it hinders the urinary tract, for example, or causes kidney or bladder problems—it needs to be treated.

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