The relationship between prostate health and semen ejaculation

The current consensus of evidence-based medicine in the global urological community is that regular and moderate ejaculation (including sexual intercourse, masturbation and other legal and compliant methods of ejaculation) has more benefits than harms for overall prostate health. There is neither a saying that "ejaculation harms the prostate" nor the logic of "abstinence to nourish the prostate". On the contrary, long-term uncontrolled excessive ejaculation or deliberate long-term abstinence may increase the risk of prostate-related diseases.

Last week, I met a 27-year-old young man who works as an e-commerce operator in the outpatient clinic. He read about a health blogger who said, "You can maintain your prostate without losing semen." He had been holding back semen for more than three months. At first, he just had an occasional bloating in his lower abdomen, but in the end it hurt so much that he couldn't stand it even after sitting for half an hour. He checked the prostate fluid and found that the white blood cells were three times higher than the normal limit. This is a typical chronic non-bacterial prostatitis caused by accumulation of prostate fluid.

In fact, regarding the relationship between ejaculation and the prostate, both traditional Chinese medicine and Western medicine had different understandings in the early years. For example, traditional Chinese medicine has a saying of "one drop of semen and ten drops of blood", which advocates minimizing ejaculation to preserve the essence. This statement has a certain rationality in the context of material scarcity in ancient times and common people's malnutrition, but now the understanding has been updated. Modern Chinese medicine also generally agrees that moderate ejaculation and unblocking of glandular ducts are beneficial to the circulation of qi and blood in the lower Jiao.

Western medicine has done tracking on large samples earlier. A cohort study released by the American Urological Association in 2022 covering 32,000 men with a 10-year follow-up period showed that the risk of prostate cancer among those who ejaculate more than 21 times a month is about 20% lower than those who ejaculate 4-7 times a month. Of course, this data is only a correlation conclusion. It does not mean that you will not get cancer if you ejaculate more. The core is the word "regular".

You can think of the prostate as a small processing factory that specializes in producing prostatic fluid. Prostatic fluid accounts for about 30% of semen. Every time semen is ejaculated, the smooth muscle of the prostate contracts, and the prostatic fluid stored in the acini is discharged together with the semen, which is equivalent to regular inventory clearance. If it is not discharged all the time, the inventory will pile up, the glandular ducts will be blocked, and inflammatory metabolites cannot be discharged, which will naturally cause swelling and pain. This is what we often call aseptic prostatitis.

But conversely, more is not always better. In the past, I also treated a young man who had just entered college. He was in love several times a day. After a week of continuous urination, he had frequent and urgent urination and had to run to the toilet every ten minutes. This was because the prostate was repeatedly congested for a long time. It is equivalent to asking a small factory to work overtime continuously. The machines are hot and worn out, and problems will naturally arise.

Of course, this issue is not without controversy. For example, for patients who have suffered from acute bacterial prostatitis, some doctors believe that ejaculation will aggravate prostate congestion and edema, and recommend complete abstinence until the inflammation subsides.； Another school of thought believes that moderate ejaculation after the symptoms of the acute phase are relieved can discharge inflammatory secretions containing bacteria, which in turn can shorten the course of the disease. The current clinical consensus is also relatively flexible: if the pain in the acute stage is so painful that you cannot touch it, then rest first until the pain is not so severe. As long as there is no obvious discomfort after the discharge, there is no need to hold it in deliberately.

Many people ask me "How many times a week is appropriate?" There is really no unified standard answer. If a young man in his early 20s wakes up three or four times a week and feels refreshed and has nothing wrong with him the next day, that is appropriate.； For middle-aged men in their 40s, if they feel a little sore in their backs after finishing, they may need to reduce the frequency. The core indicator is whether they feel any discomfort after ejaculation. Don’t stick to the “age multiplied by 9” formula posted online. That thing is just a rough reference, so there’s really no need to stick to it.

There is also a common misunderstanding: Many people think that masturbation and semen ejaculation during sex have different effects on the prostate. In fact, there is no difference at all from a physiological level. As long as it is moderate and hygienic ejaculation, no matter which method is used, it will not cause additional damage to the prostate. There is no need to label masturbation as "prostate damage".

To put it bluntly, the prostate is a bully. If you are too used to it and don't let it work at all, it will get clogged easily.； If you squeeze it too much and use it to death, it will explode easily. Don't believe those extreme health rumors on the Internet. Everything should be done just right. If you really have persistent lower abdominal distension, frequent urination, urgent urination, or painful urination, don't frighten yourself by blindly checking. Go to a regular hospital to register for a urology appointment. It costs more than ten yuan, which is more reliable than visiting ten health bloggers.