Prostate massage: what it is, what the research says and safety

Prostate massage has a long history in medicine and a thin evidence base. It was once the most popular treatment for an inflamed prostate, and specialists have used it to collect prostate fluid for tests. People also try it for pleasure: Brook, a UK sexual health charity, notes that the prostate can be pleasurable when stimulated. This page covers what prostate massage is, how medicine has used it, what the studies found and their limits, what's known about prostate orgasm, and how to stay safe. It's written for anyone with a prostate, and for their partners.

What is prostate massage?

Prostate massage is pressing or rubbing the prostate gland. Doctors reach the prostate with a gloved finger inside the bottom, the same way they check its size in a rectal examination. In medicine, massage has been used to release fluid from the prostate for testing and, in the past, to treat prostatitis (an inflamed prostate).

What is prostate milking?

"Prostate milking" is a name used online for prostate massage done to release fluid, so the two terms have much the same meaning. Doctors call the fluid released this way expressed prostatic secretions (EPS), and a 2015 UK consensus guideline on prostatitis describes testing it, alongside urine samples, to look for a bacterial infection.

Where is the prostate, the so-called male G-spot?

The prostate, which you may see called the "male G-spot" or "P-spot" online, is a small, walnut-size gland under the bladder and behind the penis, the NHS says. It produces a thick fluid that mixes with sperm to make semen, and controls the flow of pee from the bladder to the penis.

The NHS pages and studies on this page simply call it the prostate, and the NHS writes about prostate conditions as affecting "anyone with a prostate". This page does the same.

How have doctors used prostate massage?

Doctors once used prostate massage as the most popular treatment for prostatitis, but it was abandoned as the main treatment almost three decades before 1999, according to a group of specialists writing that year. Its medical uses are now narrower: collecting prostate fluid for tests, and collecting semen from some men with spinal cord injuries.

That group, whose first author was J.C. Nickel of Queen's University in Ontario, wrote in the journal Techniques in Urology that there were almost no prospective data to show prostate massage worked. Even in 1955, an article in the journal California Medicine argued that for chronic prostatitis without signs of active inflammation, prostate massage was "usually of no therapeutic value".

By the late 1990s, the same specialists wrote that it "may be making a comeback". Some men whose prostatitis hadn't responded to standard treatment travelled to the Philippines and elsewhere for repeated prostate massage combined with antibiotics, and researchers followed what happened to them (see the table below).

The two medical uses in more detail:

• Testing for infection. The 2015 UK consensus guideline says the four-glass (Meares-Stamey) test, which compares urine samples with prostate fluid released by massage, is considered the "gold standard" for diagnosing or ruling out chronic bacterial prostatitis. It says a simpler two-glass test, using urine collected before and after massage, was shown to offer similar diagnostic sensitivity.
• Collecting semen after a spinal cord injury. In a 2007 Egyptian study of 69 men with spinal cord injuries, prostate massage produced prostate fluid in 51 (73.9%) and sperm in 22 (31.9%). The authors called it a safe and simple outpatient clinic procedure for this purpose.

NICE (the National Institute for Health and Care Excellence) advises GPs not to collect prostate fluid when acute prostatitis is suspected, because prostatic massage may lead to sepsis or a prostatic abscess, is likely to be very painful, and isn't needed for the diagnosis.

What do the studies on prostate massage show?

The studies are few and small, and the more rigorous ones found no clear benefit. Single-group studies from the 1990s reported that some men improved on massage plus antibiotics, with no comparison group. In an Egyptian study of 81 men, adding massage to antibiotics did not significantly improve the response, and a 2018 Cochrane review couldn't say whether massage reduces or increases symptoms.

Prostate massage studies at a glance

	Who took part.	What was done.	What it found.
Shoskes and Zeitlin, 1999 (US)	73 men with chronic pelvic pain syndromes, with symptoms for 6.7 years on average	Antibiotics plus prostate massage 1 to 3 times a week	Symptoms cleared in 40%, cleared then came back in 19%, improved in 21% and did not improve in 21%; no comparison group
Nickel and colleagues, 1999 (Philippines)	26 men who travelled to Manila after other treatment failed; 22 assessed	Prostate massage three times a week plus antibiotics, for 6 to 12 weeks	46% of the 22 had a drop of more than 60% in symptom severity; 12 men completed the 2-year follow-up, and 5 of the original 26 had a significant, lasting improvement; no comparison group
Ateya and colleagues, 2006 (Egypt)	81 men with chronic prostatitis	Antibiotics with regular prostate massage, or antibiotics alone	No significant difference between the men who had massage and those who did not
Mishra and colleagues, 2008 (systematic review)	4 studies covering 195 patients	Repeated prostate massage for chronic prostatitis	No high-quality evidence, because there were no randomised placebo- or sham-controlled trials (as summarised in the 2015 UK consensus guideline)
Franco and colleagues, 2018 (Cochrane review)	2 trials with 115 men with chronic prostatitis or chronic pelvic pain (one is the Ateya trial above)	Prostate massage compared with control	Uncertain whether massage reduces or increases symptoms (very low quality evidence); no information on side effects
Arafa and colleagues, 2007 (Egypt)	69 men with spinal cord injuries	Prostate massage to collect semen	Prostate fluid in 51 men (73.9%), sperm in 22 (31.9%)

The studies are small. The two 1999 studies had no comparison group, and the trials in the Cochrane review followed men up only in the short term.

As the 2015 UK guideline summarises it, the 2008 systematic review found no randomised placebo- or sham-controlled trials, and no two studies used the same protocol or outcome measurement tool, so their results couldn't be pooled. The Cochrane review found no information on side effects, sexual function or quality of life. Nickel's group summed up the state of the science in 1999: it relied on "anecdotal experiences, small, uncontrolled studies, and perhaps somewhat biased opinions".

All the studies on this page are about medical uses; none looked at prostate massage done for pleasure.

Is prostate massage good for your health?

There's no good evidence that it treats prostatitis. The NHS lists antibiotics and other medicines, CBT or counselling, physiotherapy and acupuncture where available as treatments for chronic prostatitis, and prostate massage isn't among them. The 2015 UK consensus guideline says there is insufficient evidence to recommend prostatic massage for chronic prostatitis except in a clinical trial.

Claims that it improves erections aren't backed by these studies either: the Cochrane review found no information on sexual function, and the Philippines study found no significant improvement in sexual function. If erections are the worry, our guide to erectile dysfunction covers the causes and the NHS treatments.

What is a prostate orgasm?

A prostate orgasm is an orgasm brought on by stimulating the prostate. Research on it is thin: a 2018 review in the journal Clinical Anatomy by R.J. Levin, an independent researcher in Sheffield, says current medical literature does not describe precisely how prostate orgasms are activated or how they work.

What does a prostate orgasm feel like?

None of the research on this page describes it in detail. Levin's review covers the anatomy and physiology of the prostate and its stimulation for sexual recreation, illustrated with a case history. Brook says the prostate can be pleasurable when stimulated, and that sex of any kind doesn't need to end in an orgasm.

For the wider picture, see the male orgasm explained.

Is prostate massage safe?

Its risks are those of any sexual activity involving the anus: the delicate skin of the anus tears easily, and infections can pass on through fingers, shared toys and contact with poo. Agreeing first, plenty of lube, gloves, going slowly and stopping if it hurts lower those risks. NICE advises against it when a prostate infection is suspected.

If you're looking into self prostate massage, or how to massage your own prostate or a partner's, this page doesn't describe a technique. These are the safety points UK sexual health sources give for any sexual activity involving the anus:

1. Agree first, and keep checking in. Brook says anal sex should be discussed and agreed beforehand, and either of you can stop at any point.
2. Use plenty of lube. The anus isn't self-lubricating, Brook says, and lots of lube helps prevent tearing. The NHS says not to use oil-based lubricant with latex condoms (water-based or silicone-based lubricant instead), and Sheffield's NHS sexual health service says oil-based products can break down latex.
3. Wear a glove, and wash your hands after. The UK Health Security Agency (UKHSA) advises latex or non-latex gloves for fingering, and washing your hands after sex, to reduce the spread of shigella.
4. Go slowly, and stop if it hurts. Brook says there shouldn't be any pain: if either of you feels pain, stop and check in. Tears in the anus (fissures) can take a while to heal.
5. Avoid sharing sex toys. The NHS says not to share them, and if you do, to wash them and cover them with a new condom before anyone else uses them.

If you may have prostatitis, see a GP

NICE warns that in people suspected of having acute prostatitis, prostatic massage may lead to sepsis or a prostatic abscess, and that a rectal examination should be gentle, because vigorous prostatic massage can lead to sepsis. If you have symptoms of prostatitis, see a GP instead of trying prostate massage.

The NHS lists the symptoms of prostatitis as pain when peeing, difficulty peeing, needing to pee more often than usual, pain in the penis, scrotum, testicles or bottom, pain when you ejaculate, and a high temperature.

Before a PSA blood test

The NHS asks you not to have anal sex or ejaculate in the 48 hours before a PSA test, because these can raise PSA levels, which could make the test less accurate. Studies of prostate massage itself disagree on how much it matters.

A 1997 review listed prostatic massage among the things that can cause significant rises in PSA, and a 2005 study of 51 men in Istanbul found total and free PSA rose significantly 30 minutes after massage. A 1992 US study found a falsely raised PSA in 1 of 17 men (6%) after massage, and concluded that massage has minimal effects on PSA in most patients.

When should you see a GP?

• See a GP if you have symptoms of prostatitis, or you have difficulty peeing or need to pee more often.
• Ask for an urgent GP appointment or get help from NHS 111 if you can't pee at all, have blood in your pee (it may look pink, red or brown) or pain when peeing, or you've been taking antibiotics for prostatitis for 48 hours and your symptoms haven't got better or have got worse.
• Go to A&E or call 999 if, with prostatitis, you suddenly feel confused or have slurred speech, have blue, grey, pale or blotchy skin, lips or tongue, have a rash that doesn't fade when you roll a glass over it, or have severe difficulty breathing. The NHS says these can be signs of a serious infection or sepsis. Call 999 or go to A&E too if you're bleeding non-stop from your bottom or there's a lot of blood.

For worries about infections passed on during sex, a sexual health clinic is free and confidential. For the wider basics, see our anal sex safety guide and pegging: a health and safety guide.