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 worry about another form of prostatitis - chronic abacterial, which is not associated with infection. Little is known with certainty, and most urologists do not consider it a true diagnosis. But this is what most problems are associated with, including sexual problems. Chronic prostatitis is also called chronic pelvic pain syndrome (CPPS).
Pain waxes and wanes
With chronic prostatitis, men worry 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 intercourse. Discomfort can reduce a man's ability to become or stay aroused.
Such problems can occur in men of any age and, according to statistics, affect 10-15% of the American 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. During 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 one point I started feeling crazy sensations all over my pelvic area. At first I had a slight burning sensation in my rectum every time I sat down. Then the pain became acute and spread throughout the pelvis. Finally, 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.
Ejaculating became excruciatingly painful. At first I felt pleasure from the orgasm and relief after it, but that was followed by hours of pain, and when the pain intensified I stopped having orgasms. sexual relations. 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 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 (there is no need to have sex and masturbate because of the pain, it will not improve your well-be). 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, see improvement in their symptoms within six months. In one study, a third of men experienced complete resolution of their 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 adequately studied. Experts believe there are several potential causes, including autoimmune diseases, genetic predisposition, damage to the nerves or muscles near the prostate, and hormonal imbalances. Another risk factor may be psychological stress. However, the precise cause can be difficult to determine. Treatment usually involves lifestyle changes and medications to relieve symptoms. Prostatitis cannot be avoided.
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 an unnecessary 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 taken). Everything else is just a far-fetched 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, regardless of how it is obtained.
Prostatitis symptoms can be relieved by a few simple things, such as a warm bath or heating pad, and by avoiding alcohol, caffeine, and spicy or acidic foods (these can irritate the bladder).
If you have difficulty urinating, your doctor may prescribe alpha blockers: they help relax the bladder neck and muscle fibers where the prostate and bladder meet. Chronic pain is treated with painkillers. 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 thoughtful patients" writes that advertising and 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 reputable urologists, erectile dysfunction in chronic prostatitis patients is caused by psychological problems. Often, a man's erection decreases immediately after the phrase is said: "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 sensation in the perineal area, but it has nothing to do with sex. Unfortunately, many men and some urologists subscribe to the idea 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. She 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 treatment is prescribed to a person. A man hears the diagnosis and begins to worry that it might affect his sexual function. During intimacy, he does not enjoy the process, but monitors the quality of his erection. Focusing on an erection can reduce its quality and cause 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 the reason. It is best to consult a urologist who adheres to an evidence-based medical approach.
Dmitry Orlov adds: "If a doctor advises having sex more often or not having sex at all, there must be a medical reason for this. I don't know of a single disease for which increasing the number of sexual relations would lead to cure. Most often, such a 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 sexual intercourse and masturbation, as 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 erection difficulties or other sexual problems, he first goes to the urologist, as he considers this to be his area of expertise. If the urologist finds nothing or diagnoses "chronic prostatitis", all that remains is the sexologist’s office. A sexologist has a wide range of techniques that can help the patient: he can recommend elements of sex therapy, engage in psychotherapy or prescribe medication if necessary. Statistically, this is an effective working model: on average, the problem is resolved within a month. »