Can prostatitis dampen sexual performance?

Dear Dr G,

I email you with alarming concern about what is happening to my prostate.

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 an urinary tract infection, followed by high fever and difficulties in urination.

I was taken to the doctors, luckily after the antibiotics treatment, urination has been smooth and no further pain or fever.

I thought my ordeal was over, but I started having intermittent pain and the urgency of urination from time to time.

When the condition was more serious, I would experience pelvic discomfort and intermittent difficulties in urination.

I was completely terrified with one recent episode of blood in my ejaculation.

I am also wondering whether the condition has resulted in diminishing libido and erectile dysfunction.

The urologist reckons I now suffer from chronic prostatitis and this can also cause my sexual dysfunction.

What is prostatitis and what causes the inflammation?

What are the symptoms of prostatitis?

How can inflammation of the prostate result in sexual dysfunction?

I am really troubled by the chronic inflammation of the prostate and my wilting manhood, and hope you can help.

Yours truly,

Prostatitis Peter

Men commonly suffer from prostatic conditions which can affect different stages of life. The ageing process of the prostate associated with Benign Prostate Hyperplasia (BPH) gradually affects men in urinary flow and erection. More serious prostatic conditions such as prostate cancer also tend to affect men with advancing age with positive family history. On the other hand, inflammatory changes of the prostate resulting in prostatitis tends to affect men of all ages. It has been estimated 10-15% of men experience prostatitis symptoms at some point in their lives. There is an undeniable connection between the prostate gland and sexual function, and therefore prostatitis is known to have an impact on physical and sexual health.

Prostatitis can be broadly divided into four different categories. Acute Bacterial Prostatitis (ABP) is usually caused by a bacterial infection resulting in 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. Another type of prostatitis is Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). The condition is not caused by bacterial infection, but mostly associated with unidentifiable aetiology. This makes the CP/CPPS challenging to treat.

Lastly, Asymptomatic Inflammatory Prostatitis (AIP) can also be discovered incidentally during medical examinations. While treatment of AIP may not be necessary, monitoring the situation through regular check-ups is advisable.

Prostatitis is a common cause affecting sexual function in men, however the aetiology and pathogenesis are largely unknown. Men can be affected with weakened erection, painful ejaculation, premature ejaculation and declining libido. The inflammation is thought to result in swelling and disruption of blood flow, making achieving and maintaining an erection a bit more difficult. On the other hand, painful and bloody ejaculation is also well-recognised to have adverse psychological impact in men causing erectile dysfunction.

In addition, prostatitis can also dampen one’s desire for intimacy. The constant discomfort and pain associated can definitely make it difficult for men to get in the mood. Although not every individual with prostatitis experiences a decrease in libido, research has shown that men with prostatitis may have lower levels of testosterone. Although the association of prostatitis with premature ejaculation is well-documented in the medical literature, the exact mechanism and pathogenesis are completely unexplained.

The treatment option of prostatitis is mainly symptomatic, apart from bacterial induced ABP and CBP. Appropriate antibiotics are often prescribed for bacterial prostatitis, while pain relievers and anti-inflammatory 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. In addition, lifestyle changes such as regular physical exercise, stress reduction techniques, and avoiding triggers like alcohol and spicy foods may provide some relief. Other treatments such as pelvic floor exercises and relaxation techniques can help relieve muscle tension and pain.

The bacterial and nonbacterial inflammatory changes of the prostate and its association with chronic prostatitis often generate uncertainty for both patient and physician.