Prostatitis is an inflammation of the prostate gland caused by bacteria. It can be episodic or prolonged. This type of prostatitis occurs in approximately one in ten cases. Much more often, men are concerned about another form of prostatitis - chronic abacterial, which is not associated with infection. Little is known about it for sure, and most urologists do not consider it a real diagnosis. But it is with it that most problems are associated, including problems with sex. Chronic prostatitis is also called chronic pelvic pain syndrome (CPPS).
The pain waxes and wanes
With chronic prostatitis, men are concerned about the following symptoms:
- discomfort or pain in the perineum, lower abdomen, groin, scrotum, penis;
- changes in urination: difficulty urinating, frequent emptying of the bladder in small portions, a feeling of incomplete emptying;
- Some men experience difficulty getting an erection, discomfort during ejaculation, and increased pain after sex. The discomfort may reduce a man's ability to become or remain aroused.
Such problems can occur in men of any age and, according to statistics, affect 10 to 15% of the US male population, most often men between 30 and 50 years old. Chronic prostatitis cannot be cured with antibiotics, unlike "classic" prostatitis, and its symptoms can bother a man for several months or years. They may come and go and vary in severity.
David Lonergan was diagnosed with chronic prostatitis, and only three years later he found a way to live with it. During the first year he took antibiotics, but they did not help (antibiotics do not help with chronic abacterial prostatitis). Here's what David says in an interview with Vice about his feelings:
"At some point I began to experience wild sensations throughout the pelvic area. At first I had a slight burning sensation in my rectum whenever I sat. Then the pain became acute and spread throughout the pelvis. Eventually it felt like hundreds of razor blades were stabbing inside my urethra. On a scale of 1 to 10, I would rate the pain an 11.
Ejaculation became excruciatingly painful. In the beginning, I felt pleasure from the orgasm and relief after it, but it was followed by hours of pain, and when the pain intensified, I stopped having sex. The doctor prescribed me a prostate massage (the benefits of prostate massage have not been proven), and also told me to have sex and ejaculate. But since sex didn't bring any pleasure, I decided to try masturbating once a day. It was a big mistake to do this twice a day - the pain was off the charts (there is no need to have sex and masturbate through pain, this will not improve your well-being). My wife and I went to a therapist for individual and couples therapy. In many ways, it was she who helped us overcome all our problems in sex. "
Most men diagnosed with chronic prostatitis, or CPPS, experience improvement in symptoms within six months. In one study, a third of men experienced complete resolution of symptoms after a year. In another large study, a third of men's condition improved within two years.
Chronic prostatitis has been little studied
Chronic prostatitis has not been studied enough. Experts believe there are several potential causes, including autoimmune diseases, genetic predisposition, damage to nerves or muscles near the prostate gland, and hormonal imbalances. Another risk factor may be psychological stress. However, the specific cause can be difficult to determine. Treatment usually involves lifestyle changes and medications to relieve symptoms. Prostatitis cannot be prevented.
Urologist Daria Chernysheva:
- Chronic prostatitis is just a combination of words that can hide pelvic venous congestion syndrome, chronic pelvic pain syndrome, interstitial cystitis, pudendal neuropathy and other conditions. According to the chief urologist of our country, Dmitry Pushkar, this is a garbage diagnosis that the doctor gives to the patient when he does not want to understand what is happening to him. Inflammatory changes in the prostate can only be confirmed by a four-glass test (an analysis in which several portions of urine and prostate secretions are taken). Everything else is a far-fetched diagnosis with no cure. To prevent inflammation in the prostate gland, there is a universal recommendation - regular sex: ejaculation should be at least once every four days, no matter how it is achieved.
Symptoms of prostatitis can be relieved by some simple things, such as a warm bath or heating pad, and avoiding alcohol, caffeine, and spicy or acidic foods (these can irritate the bladder).
If you have problems urinating, your doctor may prescribe alpha blockers - they help relax the bladder neck and muscle fibers at the junction of the prostate and the bladder. Chronic pain is treated with painkillers. If you have problems with sex, your doctor may refer you to a psychotherapist or sexologist.
Sexual problems are not associated with chronic prostatitis
Urologist Artem Loktevexpresses the following thoughts: Modern aspects of evidence-based medicine for thinking patients" writes that advertising and the media attribute erection problems to prostatitis, which is why many men associate them. But that's not true. An erection can be maintained even if the prostate is completely removed. According to many reputable urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychological problems. Often a man’s erection decreases immediately after the sentence is pronounced: "You have prostatitis. "
Sexologist, psychotherapist, psychiatrist Dmitry OrlovI am also sure that chronic prostatitis does not affect sex life:
"If something happens to the prostate gland, it can affect urination and sensations in the perineal area, but this has nothing to do with sex. Unfortunately, many men and some urologists subscribe to the concept that prostate problems can affect sexual life because the prostate is located close to the genitals. The prostate gland has a specific function: it produces fluid - a component of sperm. She's not involved in anything else. "
According to Dmitry Orlov, doctors almost never make a diagnosis of "chronic prostatitis" in world practice. It is rather a territorial diagnosis, which has no pathophysiological basis, but only a theoretical concept on the basis of which a person is prescribed treatment. A man hears the diagnosis and begins to worry that this may affect his sexual function. During intimacy, he does not enjoy the process, but monitors how good his erection is. Focusing on an erection can reduce its quality and lead a man to see a connection between the diagnosis and the problems that have arisen. But the reason is purely emotional.
If there is pain and discomfort during sex, you need to understand the reason for this. It is better to consult with a urologist who adheres to an evidence-based approach to medicine.
Dmitry Orlov adds: "If a doctor advises having sex more often or not having sex at all, then there must be a medical reason for this. I don't know of a single disease in which increasing the amount of sex would lead to recovery. Most often, such a recommendation is due to the fact that the specialist does not know how to help. There is also no need to limit or completely eliminate sex and masturbation, because regular sexual release is beneficial for both the health of the prostate gland and the psyche.
The path from the urologist's office to the sexologist's office is the standard path for men over 35–40 years old. If a man has difficulty with erection or other problems in sex, he first goes to the urologist, because he considers this his area of expertise. If the urologist finds nothing or diagnoses "chronic prostatitis, " then the only thing left is the sexologist’s office. A sexologist has a wide range of techniques that can help the patient: he can recommend elements of sex therapy, can engage in psychotherapy or prescribe medications if necessary. Statistically, this is an effective model of work - on average, the problem is resolved within a month. "