Patient's question:
Hello, my boyfriend suffers from prostatitis. During sexual activity, he sometimes experiences pain or issues like premature ejaculation or low sperm count. We have been together for about half a year, but I haven't been able to get pregnant yet. Is this related to his prostatitis? Is his semen normal in this situation?Doctor's answer:
Hello:Prostatitis occurs most frequently in two age groups of men: 25-32 years old and during andropause.
### I. Structure and Function of the Prostate
The prostate is located between the bladder and the urogenital diaphragm, connecting to the bladder, seminal vesicles, and vas deferens. During a prostate examination, the posterior part of the prostate can be palpated through the rectum.
The prostate has a slightly flattened, chestnut-shaped appearance. The upper end is broad and is called the base of the prostate; the lower end is pointed and is called the apex of the prostate; the middle part is called the prostate body. The posterior surface of the body is flat, with a longitudinal shallow groove in the midline called the prostatic sulcus. This groove disappears when the prostate is enlarged. The prostate is generally divided into five lobes: anterior, middle, posterior, and two lateral lobes. The middle lobe is located between the urethra and the ejaculatory duct and is a common site for prostate enlargement. When it enlarges, it can compress the urethra, causing difficulty in urination.
The prostate is the largest sex gland in the male body. Its secretions, prostatic fluid, are a major component of semen and contain various proteases and trace elements, which are closely related to semen liquefaction and sperm motility.
### The Prostate and Human Health
The prostate is a unique and largest accessory gland in males. It is located below the bladder in the lower abdomen, surrounding the posterior urethra. Its primary function is to secrete prostatic fluid. This secretion is a major component of semen, accounting for about one-third of the total volume of semen. Prostatic fluid is grayish-white, slightly alkaline, and contains various proteolytic enzymes and trace elements. It can neutralize acidic secretions in the vagina, promote semen liquefaction, and facilitate the combination of sperm and eggs.
During the young and middle adult years, the prostate is prone to prostatitis under various pathogenic factors. For example, unprotected sex, urinary tract infections that allow pathogenic microorganisms to invade the prostate retrogradely can lead to acute or chronic bacterial prostatitis. Alternatively, long-term consumption of irritating foods (alcohol, chili peppers, etc.), prolonged sitting, or frequent sexual activity can cause recurrent congestion of the prostate, leading to non-bacterial prostatitis. Regardless of the type of disease, prostatitis can alter the secretory function of the prostate and the physicochemical properties of prostatic fluid, resulting in a series of conditions such as sexual dysfunction, decreased sperm motility, increased sperm mortality, and semen liquefaction disorders.
### II. Prostatitis
Prostatitis, especially chronic prostatitis, is a common condition in adult males. A small portion is caused by bacterial infections, while the majority is non-infectious inflammation. Studies show that non-bacterial prostatitis accounts for about 90%.
Prostatitis syndrome can be classified into four categories:
1. Acute bacterial prostatitis
2. Chronic bacterial prostatitis
3. Non-bacterial prostatitis
4. Prostatodynia
The etiological factors or causes of prostatitis are diverse, such as bacterial infections, frequent sexual intercourse or masturbation, smoking and alcohol consumption, spicy and irritating foods, and cold exposure. These can all cause recurrent congestion of the prostate gland, leading to dilated acini, interstitial edema, and inflammatory cell infiltration. Clinical manifestations of various prostatitis syndromes are diverse, with both similarities and differences. Common symptoms include:
1. Urinary abnormalities: Such as urgency, frequency, dysuria, a feeling of incomplete urination, urethral burning, white cloudy secretions dripping from the urethral meatus during defecation or urination termination (commonly referred to as "urinary leukorrhea").
2. Pain: Often occurs in the lumbosacral region, lower abdomen, perineum, suprapubic region, inguinal region, testicles, and spermatic cord. The pain is usually mild and intermittent.
3. Sexual dysfunction: Such as decreased libido, premature ejaculation, painful ejaculation, nocturnal emissions, and impotence. Often caused by inflammation of the male reproductive tract, leading to decreased sperm motility and infertility.
4. Neurotic symptoms: Such as dizziness, headaches, frequent dreams, and depression.
### III. Impact of Prostatitis on Male Fertility
The prostate is the largest accessory gland in males, and its secretions, prostatic fluid, are one of the main components of semen. Normal prostatic fluid contains a large amount of citric acid and phosphatase, making it slightly acidic. It also contains many trace elements and amino acids, such as sodium, potassium, calcium, chlorine, and zinc, among which zinc plays a crucial role in maintaining normal sperm vitality. Proteolytic enzymes in the prostate can cause semen to liquefy rapidly after ejaculation. 5α-reductase converts testosterone into dihydrotestosterone, which has stronger physiological activity and promotes spermatogenesis in the testes. When suffering from prostatitis, not only does it lead to severe sexual dysfunction, such as impotence and premature ejaculation, but the quality of semen also declines significantly. Inflammatory changes in the prostate alter the composition and physicochemical properties of semen. If bacterial prostatitis occurs, bacteria and toxins may be present in the semen, inhibiting sperm vitality, causing sperm poisoning, agglutination, and death, thereby significantly reducing male fertility.
### IV. Why Prostatitis Is Prone to Recurrence
Chronic prostatitis patients often experience symptoms disappearing after a period of treatment, only to return and even worsen after stopping medication. This cycle brings immense mental distress and severely impacts daily life. Why is chronic prostatitis prone to recurrence? This is not only related to the complex etiology of the disease, which is not yet fully understood, but also influenced by other factors.
1. The anatomical position of the prostate is relatively deep, located in the pelvic cavity, with a slow onset. Its excretory orifices connect to the urethra, ejaculatory duct, and vas deferens, making it susceptible to infections from other parts.
2. The prostate has numerous glandular lobes, long and curved excretory ducts, and multiple openings, making it difficult for prostatic fluid to be expelled. Moreover, infection in one group of glands can spread to others.
3. Microscopic lesions in the prostate are difficult to diagnose and treat.
4. The prostate is surrounded by connective tissue and smooth muscle, forming a capsule that penetrates into the glandular tissue, creating a blood-prostate barrier that makes it difficult for drugs to penetrate and reach the prostate tissue.
5. Scar formation around lesions and surrounding areas makes it difficult for drugs to reach the lesions.
6. Deficiency of certain trace elements and the pH value of prostatic fluid can affect drug efficacy, weakening its power.
7. Irregular lifestyles and difficulty in cooperating with treatment.
It is these combined factors that make prostatitis difficult to treat and prone to recurrence.
### V. Traditional Chinese Medicine Treatment for Prostatitis and Treatment Methods Introduced by Zhengzhou Guangyu Hospital
Traditional Chinese Medicine (TCM) treats prostatitis with syndrome differentiation, which, although lengthy, offers stable efficacy and a low recurrence rate after recovery. Common syndrome types include:
1. Bladder damp-heat type: Symptoms include frequent and urgent urination, burning and stinging pain, a sense of fullness in the perineum, cloudy and viscous secretions from the urethral meatus, chills and fever, red tongue with yellow coating, and a slippery rapid pulse. Common in the acute phase of prostatitis. Treatment should focus on clearing heat, resolving dampness, and removing turbid phlegm.
2. Liver damp-heat type: Frequent white discharge from the urethral meatus, pain in the perineum, testicles, and lower abdomen, frequent and uncomfortable urination, constipation, bitter taste, restlessness, yellow urine and red eyes, red tongue with greasy yellow coating, and a wiry rapid pulse. Treatment should focus on clearing heat, resolving dampness, and draining the liver.
3. Kidney yin deficiency type: Common in middle-aged individuals, chronic illness with physical weakness, soreness and weakness in the lower back and knees, five-palm heat, nocturnal emissions and premature ejaculation, post-micturition dribbling, and frequent cloudy discharge from the urethral meatus. Red tongue with thin coating and a thready rapid pulse. Treatment should focus on nourishing yin, tonifying the kidneys, clearing heat, and draining fire.
4. Kidney yang deficiency type: Chronic course, frequent urination, dribbling urine, nocturia, cloudy urine, sore lower back and fatigue, cold hands and feet, decreased libido, impotence, and premature ejaculation. Pale and swollen tongue with thin white coating and a deep weak pulse. Treatment should focus on warming the kidneys, tonifying yang, consolidating qi, and solidifying essence.
5. Stasis obstruction of the semen chamber type: Cloudy discharge from the urethral meatus at the end of urination or during defecation, dribbling pain, soreness in the lower abdomen, perineum, and testicles. Dark tongue with petechiae and thin white coating, and a stasis-painful pulse. Treatment should focus on invigorating blood, resolving stasis, and unblocking collaterals to relieve pain.
### VI. Criteria for Treating Prostatitis
Some prostatitis patients, after a period of regular treatment, feel no more discomfort and stop medication, only to find that symptoms return after a short time. This is because the prostatitis has not been truly cured and stopping medication too early. This not only increases the patient's mental burden but also gives bacteria a chance to develop drug resistance, making treatment more difficult. So, how can one determine if prostatitis has been cured? Clinical criteria for curing prostatitis include:
1. Disappearance of subjective symptoms.
2. Normal or improvement in prostate examination via rectal palpation.
3. Normal results in (urine examination with localization and segmentation).
4. Normal prostate smear staining and negative bacterial culture.
Judging whether prostatitis is cured based on these criteria can provide a scientific basis for determining when to stop medication.
### VII. Precautions for Prostatitis Patients
Although treating prostatitis is challenging, it is not complex. The key lies in persistence and a combination of prevention and treatment. Interrupted treatment often worsens the condition. During treatment, patients must not only take medication on time but also avoid factors that could exacerbate the condition in daily life.
1. Pay attention to sexual hygiene, avoid unhealthy sexual habits, and never interrupt intercourse or engage in frequent masturbation. Regular sexual activity helps regularly expel prostatic fluid, which is important for treatment.
2. Minimize pressure on the perineum, avoid tight clothing, and avoid prolonged cycling, horseback riding, or other riding activities.
3. Abstain from smoking, alcohol, and spicy, irritating foods to reduce recurrence triggers.
4. Drink plenty of water and increase urination to help expel inflammatory secretions.
5. Participate actively in physical exercise to enhance physical fitness.
### VIII. How to Interpret a Prostatic Fluid Test Report
pH Value: Normal prostatic fluid is slightly acidic with a pH of 6.2-6.5. In prostatitis, the pH may increase.
Appearance: Normal prostatic fluid appears thin and pale milky white. During inflammation, the secretion becomes thick, yellow or light red, and cloudy.
Spermatozoa: If the seminal vesicles are compressed during prostate massage, sperm may be detected in the prostatic fluid.
Trichomonas and Candida: Normal prostatic fluid does not contain trichomonas or candida. If infected, these can be detected in the prostatic fluid.
This is my detailed explanation. Can you understand it? If you are satisfied, please adopt it promptly. Thank you.