Patient's question:
Hello, my boyfriend suffers from prostatitis. During sexual activity, he sometimes experiences pain or issues like premature ejaculation and 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 is slightly flattened in the front and back, resembling a chestnut, with a broad upper end called the base, a pointed lower end called the apex, and the middle part called the body. The posterior surface of the body is flat, with a longitudinal shallow groove called the prostatic sulcus, which 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 secretion, prostatic fluid, is a major component of semen and contains various proteases and trace elements, which are closely related to semen liquefaction and sperm motility.
### Prostate and Human Health
The prostate is the largest accessory gland unique to males. It is located below the bladder in the lower abdomen and surrounds the posterior urethra. Its primary function is to secrete prostatic fluid. This fluid is a major component of semen, accounting for about one-third of its total volume. 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.
In young and middle-aged men, the prostate is prone to prostatitis under various pathogenic factors. For example, unprotected sex and urinary tract infections can cause pathogenic microorganisms to invade the prostate, leading 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, resulting in non-bacterial prostatitis. Regardless of the type of prostatitis, it can alter the secretory function of the prostate and the physicochemical properties of prostatic fluid, leading to a series of diseases such as sexual dysfunction, reduced sperm motility, increased sperm mortality, and semen liquefaction issues.
### 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 of prostatitis are diverse, including bacterial infections, frequent sexual activity or masturbation, smoking and alcohol consumption, spicy and irritating foods, and cold exposure. These can 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 orifice during defecation or urination, commonly known 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 reduced libido, premature ejaculation, painful ejaculation, nocturnal emissions, and impotence. This is often due to inflammation of the male reproductive tract, reducing sperm motility and leading to infertility.
4. Neurological symptoms: Such as dizziness, headaches, frequent dreams, and depression.
### III. Impact of Prostatitis on Male Fertility
The prostate is the largest accessory gland in the male body, and its secretions are a major component 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. 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 treatment for a period, only to return and even worsen after stopping medication. This cycle causes immense mental distress and severely impacts daily life. Why is chronic prostatitis prone to recurrence? This is not only due to the complex and yet-to-be-fully-understood etiology but also influenced by other factors.
1. The prostate has a deep anatomical location 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 glands with long, curved, and multiple openings, making it difficult for prostatic fluid to be expelled. Additionally, 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 a capsule composed of connective tissue and smooth muscle, which penetrates into the gland, forming 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 affected sites.
6. Deficiency of certain trace elements and the pH of prostatic fluid can weaken drug efficacy.
7. Irregular lifestyle and difficulty in cooperating with treatment.
These combined factors 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 has a longer course but offers stable efficacy and a lower risk of recurrence. Common syndrome types include:
1. Bladder damp-heat type: Symptoms include frequent and urgent urination, burning and stabbing pain, a sense of fullness in the perineum, cloudy white sticky secretions from the urethral orifice, chills and fever, red tongue with yellow coating, and a rapid, slippery pulse. Common in the acute phase of prostatitis. Treatment involves clearing heat, resolving dampness, and removing turbidity.
2. Liver damp-heat type: Frequent white discharge from the urethral orifice, pain in the perineum, testicles, and lower abdomen, frequent and uncomfortable urination, constipation, bitter taste, restlessness, yellow urine, red eyes, red tongue with greasy yellow coating, and a wiry, rapid pulse. Treatment involves clearing heat, resolving dampness, and draining the liver.
3. Kidney-yin deficiency type: Common in middle-aged individuals, chronic illness, and physical weakness. Symptoms include soreness and weakness in the lower back and knees, restlessness, night sweats, nocturnal emissions, premature ejaculation, dribbling after urination, and frequent cloudy white discharge from the urethral orifice. Red tongue with thin coating and a thready, rapid pulse. Treatment involves nourishing yin, tonifying the kidneys, clearing heat, and resolving fire.
4. Kidney-yang deficiency type: Chronic course, frequent urination, dribbling, nocturia, cloudy white 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, thready pulse. Treatment involves warming the kidneys, tonifying yang, consolidating qi, and solidifying essence.
5. Stasis obstruction of the seminal vesicles type: Cloudy white discharge from the urethral orifice at the end of urination or during defecation, dribbling pain, swelling in the lower abdomen, perineum, and testicles. Dark tongue with petechiae and thin white coating, and a stasis-painful pulse. Treatment involves invigorating blood, resolving stasis, and promoting collateral circulation to relieve pain.
### VI. Criteria for Treating Prostatitis
Some prostatitis patients, after a period of regular treatment, feel no discomfort and stop medication, only to experience symptoms returning shortly after. This is because the prostatitis has not been truly cured due to premature discontinuation of treatment. This not only increases the patient's mental burden but also provides opportunities for bacteria to develop drug resistance, making treatment more difficult. So, how can one determine if prostatitis is cured? Clinical criteria for treating prostatitis include:
1. Disappearance of subjective symptoms.
2. Normal or improved prostate on digital rectal examination.
3. Normal results in localized and segmented urine tests.
4. Normal prostate smear staining and negative bacterial culture.
Judging whether prostatitis is cured based on these criteria can provide a scientific basis for when to stop medication.
### VII. Precautions for Prostatitis Patients
Although treating prostatitis is challenging, it is not complicated. 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 can 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. Quit smoking and alcohol, and avoid spicy and irritating foods to reduce recurrence triggers.
4. Drink plenty of water and increase urination to facilitate the excretion of 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. Inflammation causes the secretion to become thick, yellow or light red, and cloudy.
Eosinophils: Normal prostatic fluid contains no or very few red blood cells, not exceeding 10 per high-power field. In prostatitis, red blood cells may exceed 10–15 per high-power field.
Leukocytes: Normal prostatic fluid contains no more than 10 white blood cells per high-power field. In prostatitis, white blood cells can significantly exceed 10, with the report showing +–+++ (each + represents 10 white blood cells).
Sperm: If the seminal vesicles are compressed during prostatic massage, sperm may be detected in the prostatic fluid.
Trichomonas and Candida: Normal prostatic fluid contains no 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.