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. Men are much more often concerned about another form of prostatitis - chronic abacterial, which is not associated with infection. Little is known about this for sure, and most urologists do not consider it a true diagnosis. But most problems are associated with it, 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: difficult urination, frequent emptying of the bladder in small portions, feeling of incomplete emptying;
- Some men have difficulty achieving an erection, discomfort during ejaculation and increased pain after sex. Discomfort can reduce a person'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 male population of the USA, most often men between the ages of 30 and 50. Chronic prostatitis cannot be cured with antibiotics, unlike "classic" prostatitis, and its symptoms can torment a man for several months or years. They can come and go and vary in weight.
David Lonergan was diagnosed with chronic prostatitis, and only three years later he found a way to live with it. 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 started experiencing wild sensations in the entire pelvic area. At first I felt a slight burning sensation in my rectum whenever I sat down. Then the pain became acute and spread throughout the pelvis. At the end it felt like hundreds of razor blades were stabbing into 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 orgasm and relief after it, but hours of pain followed, and when the pain intensified, I stopped having sex. The doctor prescribed prostate massage (the benefits of prostate massage are not proven) and also told me to have sex and ejaculation. 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 beyond the limit (no need to have sex and masturbate through pain, it will not improve your well-being). My wife and I have been seeing therapists for individual and couples therapy. In many ways, she helped us overcome all the problems in sex. "
Most men diagnosed with chronic prostatitis, or CPPS, experience improvement in their 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 improved within two years.
Chronic prostatitis has been little studied
Chronic prostatitis has not been sufficiently studied. Experts believe there are several possible causes, including autoimmune diseases, genetic predisposition, nerve or muscle damage near the prostate, and hormonal imbalances. Another risk factor can be psychological stress. However, it can be difficult to determine the specific cause. Treatment usually involves lifestyle changes and medication 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 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 the four-cup test (an analysis in which several portions of urine and prostate secretions are taken). Everything else is a far-fetched diagnosis without a cure. For the prevention of prostatitis there is a universal recommendation - regular sex: ejaculation should be at least once every four days, regardless of how it is achieved.
Prostatitis symptoms can be alleviated by some simple things, such as a warm bath or heating pad, and avoiding alcohol, caffeine, and spicy or acidic foods (they 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 painkillers. If you have problems with sex, your doctor can refer you to a psychotherapist or a 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 erectile 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 toAccording to many respected urologists, erectile dysfunction in patients with chronic prostatitis is caused by psychological problems. Often, a man's erection decreases immediately after saying the sentence: "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, it can affect urination and sensations in the perineal area, but it has nothing to do with sex. Unfortunately, many men and some urologists believe 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. Rather, it is 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 thatit could affect his sexual function. During intimacy he does not enjoy the process, but monitors how good his erection is. Focusing on the erection can reduce its quality and lead the man to see the connection between the diagnosis and the problems that have arisen. But the reasonis purely emotional.
If there is pain and discomfort during sex, you need to understand the reason for it. It is better to consult with a urologist who adheres to an evidence-based approach to medicine.
Dmitry Orlov adds: "If the doctor advises you to have sex more often or not to have sex at all, then there must be a medical reason for it. I don't know of any disease where increasing the amount of sex would lead to recovery. Most often, such a recommendation is due to the fact that the expert 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 a 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 a urologist, because he considers it his expertise. If the urologist finds nothing or diagnoses "chronic prostatitis", the only thing left is the office of a sexologist. The sexologist has a wide range of techniques that can help the patient: he can recommend elements of sex therapy, he can engage in psychotherapy or prescribe drugs if necessary. Statistically speaking, this is an efficient working model – on average, the problem is solved within a month. "