DEAR DR. DONOHUE: My prostate is enlarged. I have to get up as often as seven times during the night to urinate. The stream starts and stops, and it is actually hard to get it started. Can you give me any ideas on what to do? – M.H.

ANSWER: The prostate is not much bigger than a peach pit, but this small gland can cause big problems. You have BPH – benign (not cancerous) prostatic hypertrophy (enlargement). By age 50, 50 percent of men have some enlargement, and by age 85, 90 percent do. Two factors account for it: aging and testosterone, the male hormone.

Not only does the gland get larger, but its muscles and the muscles of the bladder’s outlet stay contracted. There is a double effect, therefore, on urination. The large gland obstructs the urethra, the tube that empties the bladder and runs through the prostate gland. The contracted muscles add another obstructing element.

Symptoms are frequent urination, difficulty initiating the urinary stream and a stream that stutters, starting and stopping frequently.

You can help yourself by cutting down on the amount of fluids drunk after the evening meal and by eliminating caffeine and alcohol after lunch.

There are two kinds of medicine available. One relaxes the contracted bladder and prostate muscles – Hytrin, Cardura and Flomax are examples. The other shrinks the gland by counteracting testosterone’s growth effect. Proscar and Avodart are two such medicines. It can take six months for them to show an effect. The two kinds of medicine can be used together for a one-two punch.

Surgical procedures are many. The standard operation is a TURP – transurethral resection of the prostate. With a scope and instrument inserted through the penis to the location of the gland, the urologist pares away excess tissue. A newer procedure is TUNA – transurethral needle ablation, which excises prostate tissue with radio waves. The procedure is similar to the TURP, but it is a much quicker procedure and one from which convalescence is speedy.

There are many more procedures and treatments, but space doesn’t allow their discussion. Readers can order the prostate gland pamphlet to learn about hypertrophy and prostate cancer. Write to: Dr. Donohue – No. 1001, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Please tell me if having a vasectomy can cause erections to be a problem when you get older. I had one in 1968 in the Army. I am 56 now and having erection problems. – R.W.

ANSWER: A vasectomy is the procedure in which the duct that brings sperm into the seminal fluid is cut. That duct is the vas. It’s a method of birth control.

A vasectomy does not lead to erection problems immediately or in the future.

It also does not influence the chances for prostate cancer or heart disease, two other frequently asked questions.

DEAR DR. DONOHUE: I had double bypass coronary artery surgery this past July. My cardiologist prescribed Plavix for me after I was discharged from the hospital. My HMO does not authorize Plavix. The cardiologist told me to use aspirin instead. Is this a dangerous way for me to go? – K.L.

ANSWER: Aspirin stops platelets from sticking to each other and forming clots within arteries. Plavix (clopidogrel) does the same thing but in a different way. In some studies, Plavix appears to be a better choice for preventing artery-blocking clots from forming than is aspirin. In others, there is not such a significant difference.

Plenty of people rely on aspirin for the above purpose. They are not putting themselves in danger. Aspirin has an anti-inflammatory effect. Inflammation has a role in causing obstructing buildup in arteries. Aspirin, therefore, has a potential added benefit, but that has not been proven.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.