Ways to treat chronic prostate pains

Dear Dr G,

I HAVE been suffering from prostatitis since my early 30s and the condition has been a real pain in my life, literally.

It all started with an episode of urinary tract infection, due to severe dehydration.

I was admitted to the hospital and was prescribed antibiotics. It took a week before the fever subsided and I started urinating normally again without burning sensation.

Unfortunately, the ordeal returned and I started having intermittent pain in the groin, exacerbated by sexual activities, especially during ejaculation.

The condition became more serious when I began experiencing pelvic discomfort and intermittent difficulties urinating.

Although I never experienced blood in the semen as you described in your article, the pain of ejaculation had a real dampening impact on my sex life.

I started facing the problems of premature ejaculation and erectile dysfunction due to the pain of ejaculation.

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 urologists reckon I now suffer from prostadynia secondary to chronic prostatitis. Apparently this can also cause sexual dysfunction.

I would like to put Dr G on the spot for some clarification on prostatitis.

Exactly what is prostadynia and why is it related to prostatitis? What are the symptoms of prostatitis?

How can prostate inflammation result in sexual dysfunction?

I am really troubled by this chronic prostate inflammation. Please help me out of my misery.

Yours truly,

Prostadynia Painful Pete

“Prostadynia” is a medical terminology derived from the words "prosta" describing the prostate and "dynia" depicting the pain. The symptoms are commonly 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 nuisance to severe intense climactic pain that may last for days.

Although the causes of prostadynia is generally associated with inflammation of the prostate, other medical conditions such as pelvic radiation and occluded spermatic ducts can also result in painful ejaculation in men.

On the other hand, not all prostatitis are painful. Prostatitis can be broadly divided into two broad categories.

Acute Bacterial Prostatitis (ABP) is caused by a bacterial infection associated with severe symptoms of pain in the lower abdomen, fever, and difficulty urinating.

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 be due to infective and non-infective natures. Non-infectious prostatitis is mostly associated with unidentifiable aetiology.

Lastly, Asymptomatic Inflammatory Prostatitis (AIP) can also be discovered incidentally during biopsy for the investigations for prostate cancer.

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 USA.

Prostatitis is well recognised to affect sexual function in men. Men can be affected with weakened erection, 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 50% risk of suffering from premature ejaculation, 30% risk of erectile dysfunction and 20% risk of diminished libido.

Although the link between prostatitis and sexual dysfunction remains unclear, inflammation is thought to cause swelling and disruption of blood flow, thus disrupting physiology of erections and ejaculations.

On the other hand, painful, bloody ejaculation is also well-recognised to have adverse psychological impact in 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-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.

However, some of these medications can further exacerbate sexual dysfunctions such as retrograde ejaculations and lowered libido.

Lifestyle changes such as regular physical exercise, stress reduction techniques, and avoiding triggers like alcohol and caffeine consumption may provide some relief.

Other methods such as pelvic floor exercises and relaxation techniques can also help relieve pain.

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

Despite a sense of despair for the sufferer, adopting a healthier and active lifestyle can potentially suppress the symptoms and progression of prostatitis in the long-term.