Prostate, a walnut-sized gland, is susceptible to various problems that impair its function. The likelihood of developing prostate-related conditions increases with age or in the presence of other risk factors.
Prostatitis is a common prostate disease with uncomfortable symptoms and can induce complications if you don’t address it properly. But, is erectile dysfunction one of those problems?
Could prostatitis harm the strength and hardness of your erections? Read on to learn more.
What is prostatitis?
Prostatitis is an inflammation of the prostate gland. In fact, the suffix –itis means inflammation in general. For example, thyroiditis is an inflammation of the thyroid gland.
As one of the most common diseases in urology practices in the United States, prostatitis accounts for about 2 million outpatient visits a year. Approximately 25% of male patients with genitourinary symptoms receive a prostatitis diagnosis. What’s more, autopsy studies have revealed a histologic prevalence of prostatitis of 64% to 86%.
About 8.2% of men have prostatitis at some point in their lives. The most common form of prostatitis is chronic prostatitis, i.e., chronic pelvic pain syndrome accounting for 90% to 95% of all cases of this disease.
While prostate cancer and enlarged prostate are widely discussed, prostatitis deserves more attention too.
Prostatitis is the most prevalent prostate problem in men under the age of 50. Not all cases of prostatitis are the same; several types of this disease exist. The cause of prostatitis inflammation depends on the type you develop.
Types of prostatitis include:
- Acute bacterial prostatitis – accounts for about 10% of all prostatitis cases, and its incidence peaks in men who are 20 to 40 years old and patients older than 70. Common strains of bacteria often cause acute bacterial prostatitis. The infection starts when bacteria in urine leak into the prostate. Although this is the least common type of prostatitis, symptoms are usually severe, including acute urinary tract infection.
- Chronic bacterial prostatitis – a recurrent bacterial infection of the prostate gland. Between the “attacks,” the symptoms are mild, and in some cases, patients are asymptomatic.
- Chronic prostatitis/chronic pelvic pain syndrome – nonbacterial prostatitis; the most common type of prostatitis, but also the least understood. Chronic pelvic pain is inflammatory or non-inflammatory depending on the presence or absence of infection-fighting cells in the urine, semen, and prostatic fluid. Since patients don’t have bacteria in urine, this condition is also known as chronic nonbacterial prostatitis.
- Asymptomatic inflammatory prostatitis – patients don’t have prostatitis symptoms, but they do have inflammation in the prostate. The doctor usually detects inflammation through prostate biopsy or analysis of semen.
Every man can develop prostatitis, but some risk factors make you more susceptible to this condition. Common risk factors include:
- Previous history of prostatitis
- Being young or middle-aged
- Having undergone prostate biopsy
- Infection of the bladder or urethra
- History of pelvic trauma, e.g., an injury from horseback riding or bicycling
- Recent use of a urinary catheter or a recent urologic procedure
- Enlarged prostate gland
- Having a structural or functional urinary tract abnormality
The exact signs and symptoms of prostatitis depend on the cause. They may appear slowly or come quickly. Urinary symptoms are the most common.
In some cases, the symptoms of prostatitis improve rapidly, or they may last for several months and keep recurring (in the case of chronic prostatitis). The severity and rapidity of onset of symptoms are more pronounced in acute bacterial prostatitis.
They may include the following:
- Blood in the urine
- Cloudy urine
- Difficulty urinating such as hesitant urination or dribbling
- Dysuria, i.e., pain and burning sensation when urinating
- Flu-like symptoms (common in bacterial prostatitis)
- Malaise and body aches
- Nocturia or frequent need to urinate at night
- Pain in the abdomen, lower back, and/or groin, discomfort in pelvic floor
- Pain in the perineum (the area between rectum and scrotum)
- Ejaculatory dysfunction in the form of painful ejaculation
- The sensation of pain and discomfort in the penis and testicles
- Urethral discharge
- Urgency to urinate
Can prostatitis affect your sex life?
Problems affecting this small gland can affect your sex life. For example, BPH and even prostate cancer treatment such as radiation therapy can contribute to sexual problems. So, what about this disease then?
Prostatitis has a significant impact on a man’s health and quality of life. The disease can affect the urinary tract, but also your sexual performance.
A growing body of evidence confirms that prostatitis can cause erectile dysfunction (ED), a common sexual problem where a man cannot achieve or maintain an erection for pleasurable intercourse.
Below you can learn more about prostatitis erectile dysfunction.
A study from PLoS One found that nearly half (45.4%) of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) had erectile dysfunction. Just over half of men with erectile problems had moderate to severe ED.
Chronic prostatitis is commonly accompanied by anxiety, depression, hypochondriasis, relationship disorders, and even suicidal tendencies. Patients with these psychological manifestations have a high prevalence of erectile dysfunction, too.
Another study carried out by Italian scientists found that chronic prostatitis can lead to erectile dysfunction. For the study, scientists identified and analyzed 285 cases of chronic prostatitis. Results showed the frequency of ED was higher among subjects with chronic prostatitis and prostate problems.
Moreover, the presence of hemospermia and premature ejaculation was linked with a four-fold increased risk of ED. That being said, the presence of benign prostatic hyperplasia (BPH), i.e., prostate enlargement, didn’t increase the risk of erectile dysfunction in this study. Scientists concluded that the direct relationship between the severity of chronic prostatitis symptoms and ED frequency and severity could support the hypothesis that organic mechanisms mediate the link between the two.
The Korean Journal of Urology also published a study that looked into prostate diseases’ impact on sexual function. The paper showed that both prostatitis and enlarged prostate could cause sexual problems. Prostatitis-related pain, localized to the perineum, suprapubic area, and penis, may induce sexual dysfunction, including ejaculatory difficulty and ED.
The study reported findings from Chinese research that revolved around 1786 patients. In this research, the overall prevalence of sexual dysfunction in patients with chronic prostatitis was 49%. The prevalence of premature ejaculation and ED in the same patients was 26% and 15%, respectively.
The underlying mechanisms through which prostatitis causes erectile dysfunction require further studies in rat models or human subjects. In the more severe forms of the disease, a man feels ejaculatory pain. Painful ejaculation can certainly, interfere with sexual pleasure and contribute to erectile difficulties.
Chronic prostatitis affects the penile tissue, which, in turn, leads to ED. Two main mechanisms in this relationship may include:
- Inflammatory agents released during inflammation
- Neural damage due to the expansion of the inflammation to the periprostatic genital nerves
Let’s focus on these mechanisms a little bit
Chronic prostatitis induces a systemic inflammatory response that disrupts the endothelial function of the corpus cavernosum smooth muscle. During the inflammatory process, cytokines (inflammatory cells) and other cellular adhesion molecules, both byproducts of inflammation, create lesions in the endothelium.
As a result, endothelial inflammation develops in the vascular wall. The inflammation causes dysfunction of the vascular wall. When that happens, the vascular wall becomes less elastic, and its ability to relax decreases. In the penile vasculature, atherosclerotic lesions may form and impair erectile function. Remember, strong and hard erections require proper blood flow. The blood needs to fill penile chambers to make the penis engorged. Impaired blood flow leads to erectile problems.
The second mechanism involves the cavernous nerves from the peri-prostatic nerve plexus that carry the sympathetic and parasympathetic nerve signals. These particular nerves are responsible for the vascular changes that cause erection and detumescence (volume reduction). The inflammatory process in chronic prostatitis spreads to all prostate tissues, including those surrounding genital nerves.
The inflammation can cause edema that strangulates the nerves progressively. Moreover, inflammation can alter the signal along the nerve course and produce down-regulation in permanent cavernosal tissue stimulation. The reduced neural signals cause a chronic reduction in blood flow, oxygen, and antioxidant agents.
As a result, oxidative stress develops and impairs erectile function. This happens due to impaired relaxation of cavernosal tissue. Compromised elasticity aggravates the blood flow and thereby makes it difficult for you to get an erection.
Most data linking lower urinary tract symptoms and erectile dysfunction suggest that lower urinary tract symptoms impair the overall quality of life. For example, this prostate condition can cause pelvic pain and thus make it tricky for you to get aroused. This contributes to or causes erectile dysfunction.
Managing the condition
A great deal of a man’s confidence and self-esteem lies in sexual prowess. The impact of erectile problems goes beyond poor sex life and extends to impaired confidence and quality of life. After all, every man wants strong, hard, and long-lasting erections.
If you have prostatitis, especially chronic, erectile dysfunction is a possibility. But it doesn’t mean you’re entirely powerless. To get stronger and harder erections, you need to manage the condition that caused them.
Everything starts with a visit to a doctor’s office upon experiencing symptoms of chronic prostatitis. Describe symptoms you experience and answer to doctor’s questions truthfully. To diagnose the problem, your doctor will have to rule out other conditions with similar symptoms. The doctor will perform a physical exam and order some diagnostic tests such as:
- Blood tests – to look for signs of infection and other prostate problems.
- Imaging tests – include CT scan of urinary tract and prostate or a sonogram of your prostate.
- Post-prostatic massage – the doctor may massage the prostate and test the secretions (this test is rare)
- Urine tests – to look for signs of infection.
After setting a diagnosis, the doctor will recommend the most suitable treatment option. The treatment course depends on the type of prostatitis (chronic or acute prostatitis) and the severity of symptoms. The most common treatment approaches are:
- Alpha-blockers- to help relax the bladder neck and muscle fibers in the area where the prostate gland joins the bladder. These medications alleviate symptoms such as painful urination.
- Antibiotics – the exact choice of antibiotics depends on the type of bacteria you have. Intravenous antibiotics help patients with severe prostatitis symptoms. In most cases, patients take oral antibiotics for four to six weeks. Men with chronic or recurring prostatitis may take antibiotics longer.
- Anti-inflammatory agents – the use of non-steroidal anti-inflammatory drugs (NSAIDs) may help tackle discomfort.
In addition to the medications, you can also try home remedies and make lifestyle modifications. For example, soaking in a warm bath (sitz baths) can alleviate discomfort. A heating pad can also help out with this.
When it comes to lifestyle modifications, you should try the following:
- Avoid activities such as prolonged sitting or bicycling because they irritate your prostate.
- Drink caffeine-free beverages to urinate more and flush out bacteria
- Limit consumption, or avoid entirely, spicy foods, alcohol, caffeine, and acidic foods because they irritate the prostate gland
- Try acupuncture to alleviate discomfort.
- Maintain weight in a healthy range
- Increase physical activity levels (but don’t overtrain)
- Manage stress
Erectile problems, on the other hand, are usually treated with PDE5 inhibitors to release nitric oxide. This dilates blood vessels and encourages blood flow to the penile chamber, and produce erections. Lifestyle modifications are essential for healthy erections too.
Prostatitis is a common problem. Young men can have prostatitis as well as older adults. Various types of prostatitis can affect a patient and induce uncomfortable symptoms. Studies show that chronic prostatitis can cause erectile dysfunction.
Multiple mechanisms are involved, including neural damage and problems induced by inflammation. To improve erectile function, you need to manage prostatitis. The treatment for this condition consists of the intake of medications, lifestyle changes, and home remedies such as sitz baths.