The troubling myths of prostatitis and abstinence

Dear Dr G,

I am a 30-year-old man who is happily married with an active sex life.

A few months back, I started feeling discomfort in my lower abdomen accompanied by trouble when urinating.

Basically, I experience frequent urination during the day and at night and it is accompanied by dribbling at the end.

I went to see a doctor who told me I suffer from prostatitis and prescribed antibiotics to help to get rid of the infection.

The doctor also advised me not to ejaculate, the reasoning being that abstinence from sex can give the reproductive system a break.

However, I continued to experience these symptoms despite not ejaculating for a month, and began ejaculating again.

Since then, I also started having premature ejaculation - which I have never experienced before.

As my sexual issues were getting worse, I went to a specialist who confirmed that I suffer from prostatitis.

The advice given by this doctor was the opposite of what I had been told earlier; the doctor asked me to ejaculate more often so the infection can be “drained” out of the prostate.

I am so confused that I need to put Dr. G on the spot to debunk the myth of abstinence and prostatitis.

Firstly, can you please tell me what exactly is prostatitis and how did I get it?

Can you also tell me what is the correlation between frequency of intercourse and prostate inflammation?

Lastly, why am I getting premature ejaculation with my prostatitis?

Regards

Prostatitis Peter

Prostatitis is a complex medical condition used as an umbrella term describing a variety of medical conditions, including illnesses in the pelvic region with with a bacterial or non-bacterial origin

In contrast with the plain meaning of “inflammation of the prostate” the diagnosis may not always involve inflammation, prostatitis is classified into acute and chronic as well as symptomatic and non-symptomatic and chronic pelvic pain syndrome.

Although the condition is common, it is difficult to treat as the nature of the disease is complex.

Prostatitis is usually caused by inflammatory conditions in the prostate and seminal vesicles. The commonest cause of such inflammation is an infection induced by E. Coli, which constitutes around 40% of all causes.

Most of the infections are “innocent” in nature, though sexually-transmitted infections are probable for men with a history of sexual promiscuity. However, no specific and non-infectious cause of prostatitis are determined in around 60% of the cases.

In fact, the director for the Men’s Health Centre of Taiwan Hospital reported that men who do not ejaculate regularly risk the formation of prostatic stones and this may lead to prolonged inflammation.

The rationale is when the frequency of ejaculation is reduced, the mineral-rich stagnant semen will accumulate and precipitate.

Such semen is linked to the formation of prostatic stones and inflammations. However, such a report is based on a speculative opinion without scientific scrutiny; therefore, it carries less weight than proper evidence-based medicine. It is important to highlight prostatic stones and prostate inflammation are both common clinical manifestations which are benign in nature.

One small study with 34 single male patients who suffered from chronic non-bacterial prostatitis were encouraged to masturbate regularly at least twice a week and re-evaluated 6 months later.

Of the 18 patients who adhered to the recommendations, two (11%) experienced complete relief of symptoms, whereas six (33%) had marked improvement, six had moderate improvement and four (22%) did not benefit.

On the other hand, two other studies have highlighted the worsening of prostatitis with frequent ejaculation. Collins et al. found that having more than seven ejaculations per month was associated with a 1.2–1.5-fold increase in the odds of prostatitis.

Furthermore, another study by Itza found that excessive ejaculation can cause pelvic musculature spasms and tenderness that are likely to be associated with acidosis from frequent sex.

Prostatitis is a common problem as it is diagnosed in 8% all male urologist visits and 1% of all primary care physician consultations for all male genitourinary symptoms. It is impossible to simplify the link of frequent sex with anything. It seems like too much sexual activity can exacerbate pain and yet total abstinence can also create painful pelvic congestions. The key is clearly a fine balance of moderation.

When Dr. G is put on the spot for his opinion on whether men should or should not ejaculate frequently his view is that every healthy relationship carries with it the seed of love with greater benefit of overall health.