11 hours Ago
Dear Dr G, I read with interest your recent articles on infections of various sexual organs. I hope you can also help me with my dilemma in the pelvis. I have been suffering from prostatitis since my early thirties, and the condition has been a real pain in my life.
It all started with an episode of a urinary tract infection after fasting during Ramadan. I was admitted to the hospital for intravenous antibiotics, which took a good week before the fever subsided. I started urinating normally again without a burning sensation, and as I thought my ordeal was over, I began having intermittent pain in the groin, exacerbated by ejaculation.
I constantly face issues of pelvic discomfort and intermittent difficulties in urination. The pain on ejaculation has a real dampening impact on my sex life, as I have been depriving myself of sexual activities to avoid the pain. I also started facing problems of premature ejaculation and erectile dysfunction following the diagnosis of prostatitis.
My wife tells me the sexual dysfunctions are all in my mind and asked me to seek help from the psychiatrists. Instead, I went to a urologist for an opinion. The urologist reckons I now suffer from prostadynia secondary to chronic prostatitis.
Apparently, this can also cause my sexual dysfunctions, such as erectile dysfunction and premature ejaculation. I would like to put Dr G on the spot for some clarification on prostatitis. Exactly what is prostadynia, and how is it related to prostatitis? What are the usual symptoms of prostatitis? How can prostate inflammation result in sexual dysfunction? I am really troubled by the chronicity of my prostate inflammation.
I am feeling hopeless with all the pain; I am deeply helpless. Yours truly, Hopeless and Helpless Hussain Prostatitis is caused by inflammatory changes in the prostate. It can be broadly divided into Acute and Chronic Prostatitis.
Acute Bacterial Prostatitis (ABP) is caused by a bacterial infection associated with severe symptoms of pain in the lower abdomen, fever, and difficulty urinating. On the other hand, Chronic Bacterial Prostatitis (CBP) is a persistent low-grade bacterial infection that lasts for several months or even years. The symptoms are similar to ABP but tend to be less severe and long-lasting.
Chronic prostatitis can also be due to non-infective causes. Non-infective prostatitis is mostly associated with unidentifiable aetiology. Lastly, asymptomatic Inflammatory Prostatitis (AIP) is usually discovered incidentally during a biopsy.
Although prostatitis is generally not life-threatening, it is one of the commonest reasons why men seek help from healthcare providers. This is reported to constitute about 20% of all General Practitioners’ consultations for young men in the United States. On the other hand, "prostadynia" is a medical term derived from the words "prosta," describing the prostate, and "dynia," depicting the pain.
These are common symptoms presented by men under the umbrella of conditions generally known as Pelvic Pain Syndrome. Men with prostadynia often describe discomfort upon ejaculations. This can range from transient mild discomfort that is a bit of a nuisance to severe intense climactic pain that may last for days.
Although the causes of prostadynia are generally associated with the inflammations of the prostate, other medical conditions such as pelvic radiation and occluded spermatic ducts can also result in painful ejaculation in men. Prostatitis is well recognised to affect sexual function in men. Men can be affected by weakened erections, painful ejaculation, premature ejaculation, and declining libido.
In a recent study of more than 11,000 men presented with prostadynia, men with such symptoms are noted to have a 50% risk of suffering from premature ejaculation, a 30% risk of erectile dysfunction, and a 20% risk of diminished libido. Although the exact mechanism of prostatitis causing sexual dysfunction is unknown, the inflammation is thought to cause swelling and disruption of blood flow, disrupting the physiology of erections and ejaculations. On the other hand, painful and bloody ejaculation is also well-recognised to have an adverse psychological impact on men, causing erectile dysfunction.
The treatment option for prostatitis is mainly antibiotics for bacterial-induced ABP and CBP. Appropriate longer-term antibiotics are often prescribed for chronic bacterial prostatitis, while pain relievers and anti-inflammatories are necessary to manage pain and discomfort. Other important medications such as alpha blockers, 5 alpha-reductase inhibitors, NSAIDs, and PDE5-I are often necessary to manage the symptoms.
However, it is also crucial to take into account that some of these medications can further exacerbate sexual dysfunctions such as retrograde ejaculations and lowered libido. In addition, lifestyle changes such as regular physical exercise, stress reduction techniques, and avoiding triggers like alcohol and caffeine may provide some relief. Other treatments such as pelvic floor exercises and relaxation techniques can also help to relieve pain.
The bacterial and nonbacterial inflammatory changes of the prostate and its association with chronic prostatitis often generate uncertainty for both the suffering men and their treating physicians. Moreover, the chronicity of prostatic inflammation forming an unwanted alliance with sexual dysfunction such as erectile dysfunction, ejaculatory derangement, and dwindling libido is another form of uncertainty and hopelessness. Despite the sense of despair for the sufferer, the reality is that a healthier and active lifestyle can potentially suppress the symptoms and progression of prostatitis in the long term.
The Swiss poet and philosopher, Henri-Federic Amiel, once said: "Uncertainty is the refuge of hope." When Dr G is put on the spot for his opinion on the hopelessness of prostatitis and the helpless sequelae of sexual dysfunction, his opinion is: "A healthier lifestyle is the hope that sees the end of helpless refuge and uncertainty!".
