Symptoms due to chronic prostatitis can be grouped into four categories, present both in isolation and often in dramatic association:
- Painful symptoms
- Urinary symptoms
- Symptoms of the sexual sphere
- Symptoms of the reproductive sphere
Painful symptoms are usually the most immediately noticeable and the ones that should most easily lead the expert urologist to the diagnosis of chronic pain syndrome. Some are undoubtedly pathognomonic, such as the association of
- mono or bilateral testicular pain,
- painful heaviness of the perineum,
- sensation of burning stabbing and sensation of a foreign body in the anus or rectal ampulla.
Other less frequent, but equally significant, are:
- mono or bilateral inguinal discomfort with the sensation of “tight briefs”,
- suprapubic heaviness,
- pain in the buttocks or at the base of the lumbar-sacral spine.
Sometimes you may experience pain, burning or annoying hypersensitivity on the inside of one or both thighs, radiating to the perineum. All these symptoms have their origin in the aforementioned inflammation of the pudendal nerves.
A burning sensation on the tip of the penis at the beginning and/or end of urination or during ejaculation has a separate meaning. The tip of the penis can in fact be considered the external projection of the bladder neck, which, if inflamed, reacts with pain, to stretching when it opens or closes, during urination or ejaculation.
If, however, the pain or burning occurs continuously and is felt along the entire lower portion of the penis, it should be more properly referred to a situation of acute urethritis, whether or not it complicates prostatitis. A symptom that, despite its inexplicable nature (acupuncture channels?), appears with a frequency of approximately 20% of cases, is an itching/burning sensation localized on the sole of the foot (usually the left one), present above all during urination or ejaculation.
All these symptoms can either improve or worsen after ejaculation or defecation, or not be affected at all; often, however, they are affected or sometimes reappear cyclically during the seasonal changes, especially from autumn to winter and from winter to spring.
Urinary Symptoms
This group of symptoms is not exclusive to "chronic prostatitis" but is also very frequent in sclerosis of the neck of the bladder and in Benign Prostatic Hypertrophy. In the differential diagnosis, the patient will help us, young in the first two cases and advanced in the second.
In fact, the need to urinate frequently, in small quantities (pollakiuria), the need to urinate at night (nocturia), hesitation at the beginning of urination and the very unpleasant final dribbling, are in all types of patients linked to the hyperactivity of the bladder muscle, which reacts to the obstruction, on an inflammatory basis in the first case and on an obstructive basis in the other two.
Symptoms of the sexual sphere
They usually occur in patients with a long history of prostatitis/chronic pelvic pain and are the most difficult to resolve from a medical point of view due to the sometimes simultaneous overlapping of psychological problems such as performance anxiety, the need to defend the concept of oneself with respect to a disappointing sexual performance, etc.
The most frequent are disorders of sexual desire and erection associated or not with a decrease in sensitivity of the glans or on the contrary with premature ejaculation.
Erectile Dysfunction (in its various forms) can be explained by tracing everything back both to a suffering of the sensitive and motor nerve conduction pathways, and to an alteration of the vascularization of the penis due to spasm at the level of the arterial side. Furthermore, recent studies have led to the hypothesis that the cause of this Erectile Dysfunction could be the production of a reduced contraction of the venous valves of continence (with consequent loss of erection), due to the accumulation of inflammatory substances (Cytokines) at that level.
Premature Ejaculation (in its late appearance) in our ultrasound study on 115 patients affected by chronic prostatitis (2004), was significantly correlated to the presence of a lively inflammation of the veru montanum or to the presence in that location of one or more fibro-calcified formations.
In the presence of Hemospermia (blood in the semen) it is frequent to detect stones in the ejaculatory ducts.
The decrease in libido, on the other hand, up to the total disappearance of sexual interest, associated or not with the ability to reach orgasm (anorgasmia), is a problem that is often dramatically present and that in the stories of our patients is very often associated with the fear of being reinfected or of transmitting a disease to the partner or of suffering the expected painful consequences during or after ejaculation.
In these cases, in fact, the pain appears in a dull way in the perianal region, during or after ejaculation and can last for hours or even days. This pain is usually the result of an acute stretching of the urethral sphincter with exacerbation of the perineal spastic syndrome and activation of those mechanisms previously described.
Symptoms of the reproductive sphere
IN patients who suddenly become infertile, the cause is almost always to be attributed to a previous or current infection. As we have previously mentioned, the liquid secreted by the prostate has among its functions, that of giving energy and nourishment to the spermatozoa after ejaculation, in their journey towards the egg.
But if this prostatic fluid is altered by an infectious/inflammatory situation, as a consequence, the spermatozoa may be less mobile (asthenospermia), to the point of stopping completely and their life will be shorter. They may also present visible malformations (typically of the head in the presence of Chlamydia Trachomatis).