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 worried about another form of prostatitis - chronic bacterial, 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 him that most problems are associated, including sexual problems. 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, feeling of incomplete emptying;
- Some men experience difficulty achieving an erection, discomfort during ejaculation, and increased pain after sexual intercourse. Discomfort can reduce a man's ability to become aroused or remain aroused.
These problems can occur in men of any age and, according to statistics, affect between 10 and 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 can come and go and vary in severity.
David Lonergan was diagnosed with chronic prostatitis and just three years later he 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). This is what David says in an interview with Vice about his feelings:
"At some point I began to experience wild sensations throughout my pelvic area. At first I had a slight burning sensation in my rectum every time I sat down. Then the pain worsened and spread throughout my pelvis. Finally it felt as if hundreds of razor blades stabbing me inside my urethra. On a scale of 1 to 10, I would rate the pain an 11.
Ejaculation became unbearably painful. At first I felt pleasure from the orgasm and relief afterwards, but they were followed by hours of pain, and when the pain intensified, I stopped having sex. The doctor prescribed a prostate massage for me (the benefits of prostate massage have not been proven) and also told me to have sex and ejaculate. But since sex didn't bring me 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 (no need to have sex and masturbate despite the pain, this will not improve your well-being). My wife and I see a therapist for individual and couples therapy. In many ways, she was the one who helped us overcome all our sexual problems. "
Most men diagnosed with chronic prostatitis or CPPS experience improvement in symptoms within six months. In one study, one-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 studied enough. Experts believe there are several potential causes, including autoimmune diseases, genetic predisposition, damage to the nerves or muscles near the prostate gland, and hormonal imbalances. Another risk factor may be psychological stress. However, the specific cause may 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 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-vessel test (a test in which several portions of urine and prostate secretions are taken). Everything else is an implausible diagnosis with no cure. To prevent inflammation of the prostate, there is a universal recommendation: regular sexual intercourse: ejaculation should occur at least once every four days, no matter how it is achieved.
Prostatitis symptoms can be relieved with 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, which help relax the neck of the bladder and the muscle fibers at the junction of the prostate and bladder. Chronic pain is treated with pain relievers. 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: 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 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 due to psychological problems. Often, a man's erection decreases immediately after uttering the phrase: " "You have prostatitis. "
Sexologist, psychotherapist, psychiatrist Dmitry OrlovI am also sure that chronic prostatitis does not affect sexual 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 concept that prostate problems can affect sexual life because the prostate is located near 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, in world practice doctors almost never diagnose "chronic prostatitis. "It is rather a territorial diagnosis, which has no pathophysiological basis, but only a theoretical concept from which treatment is prescribed for a person. The man hears the diagnosis and begins to worry that this may affect his sexual function. During intimacy, he does not enjoy the process, but he controls how good his erection is. Focusing on an erection can reduce the quality of it and cause the man to see a connection between the diagnosis and the problems that have arisen. But the reason is purely emotional.
If you feel pain and discomfort during sexual intercourse, you need to understand why. It is best to consult with a urologist who follows an evidence-based approach to medicine.
Dmitry Orlov adds: "If a doctor recommends having sex more often or not 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 leads to recovery. Most of the time, this recommendation is due to the fact that the specialist does not know how to help. It is also not necessary to limit or completely eliminate sex and masturbation, because regular sexual release is beneficial for both the health of the prostate and the psyche
The path from the urologist's consultation to the sexologist's consultation is the standard path for men over 35 to 40 years old. If a man has difficulties with erection or other problems in sex, he first goes to the urologist, because he considers that this is his area of specialization. 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 sexual therapy, perform psychotherapy or prescribe medication if necessary. Statistically, this is an effective working model: on average, the problem is solved within a month. "