Does Chronic Prostatitis Affect Sexual Function? Painful and Premature Ejaculation

Chronic prostatitis and chronic pelvic pain syndrome present in men as long-standing pain in the groin, perineum and lower abdomen, frequently accompanied by urinary symptoms. Patients usually attend because of pain and urinary complaints; as the consultation goes deeper, however, another theme often emerges: problems with sexual function.

Painful ejaculation, increased discomfort after ejaculation, premature ejaculation and erection problems are more common in men with chronic prostatitis than is generally assumed. These complaints often go unmentioned; the patient may take them for a separate problem or feel reluctant to raise them. This article covers why chronic prostatitis affects sexual function, which complaints accompany it and how treatment is approached.

Why does chronic prostatitis affect sexual function?

There is no single reason for this link; several mechanisms play a part together.

• Tension in the pelvic floor muscles: In a significant proportion of chronic prostatitis the real problem lies not in the prostate tissue but in continuous contraction of the pelvic floor muscles. Because these muscles contract rhythmically during ejaculation, pain can arise in muscles that are already tense.
• The pain itself: Anticipation of pain can lead to reduced desire and avoidance of intimacy.
• Anxiety and a constant state of alertness: Long-standing pain increases the sensitivity of the nervous system, affecting both pain perception and the sexual response.
• Effects on sleep and mood: Sleep disturbance and low mood developing alongside chronic pain can reduce sexual desire.
• Local inflammatory process: Ongoing irritation in the prostate and surrounding tissues can cause discomfort during ejaculation.

These mechanisms feed one another. A pelvic floor tensing because of pain increases the pain; increased pain raises anxiety; and anxiety sustains the muscle tension. This is why treatment rests on a multimodal approach rather than a single method.

Why does ejaculation become painful?

Painful ejaculation is one of the most distinctive complaints in chronic prostatitis. The pain arises during ejaculation or immediately afterwards; in some patients it becomes a discomfort lasting hours. Its location varies: it may be felt at the tip of the penis, in the perineum, the testicles, the groin or around the anus.

Underlying this complaint is the fact that the structures contracting during ejaculation have already become tense and sensitive. In other words the problem is not ejaculation itself but how the muscles and nerves respond to that contraction.

Painful ejaculation leads a significant proportion of patients to avoid intimacy. Although avoidance brings short-term relief, it does not improve the picture, because the pelvic floor tension persists.

What is the link with premature ejaculation?

Premature ejaculation is frequently reported in patients with chronic prostatitis. There are several possible explanations: increased sensitivity in the area, continuous contraction of the pelvic floor muscles, and attempts to complete intercourse quickly in anticipation of pain.

An important distinction is needed at this point. Premature ejaculation developing because of chronic prostatitis is addressed differently from premature ejaculation as an independent condition. If approaches directed only at premature ejaculation are tried without treating the underlying pelvic pain process, the expected benefit may not follow.

In patients attending with premature ejaculation, therefore, asking about perineal and groin pain, urinary symptoms and painful ejaculation is decisive for an accurate diagnosis.

Do erection problems occur as well?

Some patients with chronic prostatitis report a reduction in erection quality. What predominates here is the picture created by pain, anxiety and muscle tension rather than a vascular disorder.

That said, it should not be assumed in every patient with an erection complaint that this is due to prostatitis alone. Diabetes, vascular risk factors and hormonal causes are assessed separately. Having a diagnosis of chronic prostatitis does not mean there is no other cause.

Can these complaints be treated?

Treating sexual complaints in chronic prostatitis is carried out through a multimodal approach addressing the whole picture. Antibiotics alone are not sufficient in a significant proportion of patients, because no bacterial infection is identified in most cases.

The prominent elements of treatment are:

• Pelvic floor treatment: Physiotherapy approaches aimed at relaxing tense muscles have an important place in painful and premature ejaculation. The aim here is not to strengthen the muscles but to teach relaxation.
• Pain management: Medication options targeting nerve sensitivity may be considered.
• Shockwave (ESWT) applications: One of the supportive approaches that may be considered in selected cases.
• Lifestyle adjustments: Avoiding prolonged sitting, reviewing cycling, fluid intake and dietary patterns.
• Psychological support: Addressing the cycle of anxiety and avoidance is useful, particularly where sexual complaints predominate.
• Involving the partner: Discussing the complaints as a couple can reduce tension within the relationship.

Which of these components comes to the fore is determined by the patient's complaint profile. Treatment generally responds gradually over time; expecting results within a short period can lead to disappointment.

Does chronic prostatitis cause infertility or cancer?

This frequently asked question is an important source of anxiety. Chronic prostatitis is not regarded as having a direct cause-and-effect relationship with prostate cancer. Even so, prostate assessment is carried out separately where indicated by age and findings.

In terms of fertility, an ongoing inflammatory process is known to be able to affect semen parameters; this does not mean, however, that everyone with chronic prostatitis will be unable to have children. In patients who want children, assessing a semen analysis provides sufficient information.

When should a doctor be consulted?

Assessment is advised in the following situations:

• Groin, perineal or testicular pain lasting more than a few weeks
• Persistent pain during or after ejaculation
• Urinary symptoms accompanying the pain
• Premature ejaculation beginning together with pain
• Findings such as fever, blood in the urine or inability to pass urine
• Complaints leading to avoidance of intimacy

Chronic prostatitis is a picture that can involve not only pain and urinary symptoms but also problems with sexual function. Painful and premature ejaculation are common but rarely discussed parts of it; addressing the cycle between pelvic floor tension, pain and anxiety together forms the basis of treatment. Assoc. Prof. Zülfü Sertkaya practises in urology and andrology in Istanbul; assessment and treatment planning in chronic prostatitis and pelvic pain are carried out with individual assessment and confidentiality.

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