Prostatitis is an inflammation of the prostate gland caused by bacteria. It can be episodic or prolonged. This type of prostatitis occurs in about one in ten cases. Much more often, men are worried about another form of prostatitis: chronic abacterial, which is not associated with infection. Little is known for sure, and most urologists do not consider it a true diagnosis. But it is with it that most of the 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, feeling of incomplete emptying;
- Some men experience difficulty getting an erection, discomfort during ejaculation, and increased pain after sexual intercourse. Discomfort can reduce a man's ability to get aroused 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, in most cases men between 30 and 50 years old. Chronic prostatitis cannot be cured with antibiotics, unlike "classic" prostatitis, and its symptoms can disturb a man for several months or years. They can come and go and vary in severity.
David Lonergan was diagnosed with chronic prostatitis and only three years later did he find a way to live with it. During the first year he took antibiotics, but they did not help (antibiotics do not help in chronic abacterial prostatitis). Here's what David says in an interview with Vice about his feelings:
"At some point I started feeling 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 became sharp and spread to my entire pelvis. At the end it felt like hundreds of razor blades were stabbing my urethra. On a scale of 1 to 10, I would rate the pain an 11.
Ejaculation became terribly painful. At first I felt pleasure from the orgasm and then relief, but hours of pain followed 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 did not bring any pleasure, I decided to try masturbating once a day. It was a big mistake to do it twice a day - the pain was off the charts (you don't need to have sex and masturbate for 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 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 a 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 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 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 with the four-glass test (an analysis in which several portions of urine and prostatic secretions are taken). Everything else is a far-fetched diagnosis without a cure. To prevent inflammation of 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.
The symptoms of prostatitis can be alleviated with some simple measures, such as a warm bath or a heating pad, and by avoiding alcohol, caffeine and spicy or acidic foods (which can irritate the bladder).
If you have trouble urinating, your doctor may prescribe alpha blockers: they help relax the neck of the bladder 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 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. Erection can be maintained even if the prostate is completely removed. According to many respectable urologists, erectile dysfunction in patients with chronic prostatitis is caused by 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 share the concept that prostate problems can affect sex life because the prostate is located near the genitals. The prostate gland 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 make a diagnosis of "chronic prostatitis". It is rather a territorial diagnosis, which has no pathophysiological basis, but only a theoretical concept on the basis of which the person is prescribed treatment. A man hears the diagnosis and begins to worry that it may affect his sexual function. During intimacy, he doesn't like the process, but he checks how good his erection is. Focusing on the 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 why. It is best to consult a urologist who adheres to an evidence-based approach to medicine.
Dmitry Orlov adds: "If a doctor recommends having sex more often or not having sex at all, then there must be a medical reason for this. I don't know a single disease in which increasing the amount of sexual intercourse can lead to recovery. Most often, such a recommendation is due to the fact that the specialist does not know how to help. Moreover, it is not necessary to limit or completely eliminate sex and masturbation, because regular sexual release is beneficial both for prostate health and for the psyche.
The path from the urologist's office to the sexologist's office is the standard path for men over 35-40 years of age. If a man has erection difficulties or other problems in sex, he first turns to the urologist, because he considers this his field of expertise. If the urologist finds nothing or diagnoses "chronic prostatitis", then 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, can engage in psychotherapy or prescribe medications if necessary. Statistically this is an effective working model: on average, the problem is resolved within a month. "