Prostatitis is an inflammation of the prostate 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 worried about another form of prostatitis - chronic bacterial, which is not associated with infection. Little is known for sure about the subject and most urologists do not consider it a real diagnosis. But it is with it that most problems are associated, including sexual problems. Chronic prostatitis is also called chronic pelvic pain syndrome (CPPS).
The pain increases and decreases
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, feeling of incomplete emptying;
- Some men experience difficulty getting an erection, discomfort during ejaculation, and increased pain after sex. Discomfort can reduce a man's ability to get or stay 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 of age. Chronic prostatitis cannot be cured with antibiotics, unlike "classic" prostatitis, and its symptoms can bother a man for several months or years. They can come and go and vary in severity.
David Lonergan was diagnosed with chronic prostatitis and just three years later found a way to live with it. For the first year he took antibiotics, but they didn't help (antibiotics don't help with chronic bacterial prostatitis). Here's what David said in an interview with Vice about his feelings:
"At some point I began to feel wild sensations throughout my pelvic region. At first, I felt a slight burning sensation in my rectum whenever I sat down. Then the pain became sharp and spread throughout my pelvis. Eventually, it felt like that hundreds of razor blades were piercing my urethra. On a scale of 1 to 10, I would rate the pain an 11.
Ejaculation became excruciatingly painful. At first I felt pleasure from the orgasm and relief afterwards, 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 extraordinary (no need to have sex and masturbate in pain, this will not improve your well-being). My wife and I went to a therapist for individual and couples therapy. In many ways, she was the one who helped us overcome all of our sexual problems. "
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 one year. In another large study, the condition of a third of men improved within two years.
Chronic prostatitis has been little studied
Chronic prostatitis has not been sufficiently studied. Experts believe there are several potential causes, including autoimmune diseases, genetic predisposition, damage to nerves or muscles near the prostate, 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 alleviate 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 rubbish 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 removed). 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 occur at least once every four days, regardless of how it is achieved.
Prostatitis symptoms can be relieved with a few simple things, such as a hot bath or a heating pad, and avoiding alcohol, caffeine and spicy or acidic foods (these can irritate the bladder).
If you have trouble urinating, your doctor may prescribe alpha blockers - they help relax the bladder neck and the muscle fibers at the junction of the prostate and bladder. Chronic pain is treated with analgesics. If you have sexual problems, 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 this is not true. An erection can be maintained even if the prostate is completely removed. According to many renowned 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 and psychiatrist Dmitry OrlovI am also sure that chronic prostatitis does not affect sex life:
"If something happens to the prostate, 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 view that prostate problems can affect sex life because the prostate is located close to the genitals. The prostate has a specific function: it produces fluid - a component of sperm. It is not involved in anything else. "
According to Dmitry Orlov, doctors almost never diagnose "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 treatment is prescribed to a person. A man hears the diagnosis and begins to worry that it 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 the 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 best to consult a urologist who follows an evidence-based approach to medicine.
Dmitry Orlov adds: "If a doctor advises to have sex more often or not to have 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, This 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 prostate health and the psyche.
The path from the urologist's office to the sexologist's office is the standard path for men over 35 to 40 years old. If a man has difficulty with an erection or other problems with sex, he first goes to the urologist, as he considers this his area of expertise. If the urologist finds nothing or diagnoses "chronic prostatitis", the only thing left is the sexologist's office. The sexologist has a wide range of techniques that can help the patient: he can recommend elements of sexual therapy, he can perform psychotherapy or prescribe medication if necessary. Statistically, this is an effective working model – on average, the problem is resolved within a month. "