Giddy Presents The Naked Truth: Great Sex With an Enlarged Prostate

I'm an AASECT-certified sex therapist and licensed professional counselor-supervisor, based in Austin, Texas. I've been in practice for 14 years, including working in corporate settings, higher education and private practice.

If you have questions you want to be answered in future columns, send me an email at askgiddy@getmegiddy.com. Privacy in all matters of intimacy is very important to me and any questions answered in this column will be entirely anonymous.

Enough about me, let's talk sex.

I am 64 years old and I'm experiencing a lot of symptoms stemming from an enlarged prostate. I've tried testosterone shots and Cialis, but my ejaculations are delayed and very painful. What can I do to have pleasurable sex again?

Frank in Utah

Having an enlarged prostate, otherwise known as benign prostatic hyperplasia (BPH), can coexist with other health problems and lead to pelvic floor pressure, which complicates sexual activity and other functions in the area. I understand how frustrating it can be when you have the desire and sexual appetite for a partner but almost want to give up on sex when experiencing pain associated with an orgasm.

Although there's no cure or perfect solution, keeping up a sustainable and pleasurable sex life is important for your relationship. Here are a few ideas for alleviating some pressure, pain and anxiety, but always make sure you include medical advice from your doctor in any major decisions.

Everybody has characteristics in their physical makeup—this includes testicular cells, organs and how much room you have in the pelvic floor. Although penetrative sex with your partner has many more perks, I would start by exploring what positions are most comfortable during masturbation and observing where you feel the least amount of pressure on your lower back and bladder.

Changing up positions in sex to accommodate your evolving body allows for more flexible movement, possible shortening of delayed ejaculation and more ease in maintaining your erection.

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A lot of anxiety is formed when your brain connects pain to what is supposed to be mind-blowing pleasure. Seeing a pelvic floor physical therapist can offer you new ideas about pelvic floor massage and prostate massage, and also provide you with a step-by-step treatment plan for reduction in ejaculation pain and possibly complications such as bladder issues and frequency in urination.

Including your partner in mutual masturbation offers pleasure together while having more control over how stimulation affects your erection. This is a great way to build trust in each other during new learning curves with your changing bodies and breaks down some of the frustrations concerning losing an erection and having delayed ejaculation. It allows you to focus on having an ejaculation as a goal—orgasms are fun and don't require an "unloading"—and connection overall.

I would advocate exploring different varieties of oral sex with your partner to see what combinations of shaft or prostate massage with mouth stimulation lead to pleasurable experiences without actually forcing pressure on yourself physically, mentally and emotionally.

Lastly, testosterone shots and Cialis are medication solutions, but it's important to keep in mind what side effects come with every new drug. Sometimes less is more and if you're able to safely reduce some use of medical assistance, make sure to observe how your body is able to naturally respond to more creative and patient sexual play and arousal. And then make decisions on the data.

Sex is for everyone regardless of age. Keep an open mind, seek alternative positions and solutions for play and have open communication. These allow for a lifelong journey to pleasure. Keep up that wonderful desire and sexual energy, it'll serve you well and it's inspirational.

Again, I'm not shy, so feel free to ask me anything. Remember, this will always be anonymous. If you have any questions about relationships, sexual activities or your partners, let me know. Tell me your first name and the state you live in so I can attribute your question. Please email me at askgiddy@getmegiddy.com. We will always respect your privacy.