Patient's question:
Do I lose libido if I have prostatitis?Doctor's answer:
Disease Analysis: Prostatitis is one of the common diseases among adult males. Although it is not a life-threatening condition, it significantly affects patients' quality of life. Prostatitis accounts for 8% to 25% of urology outpatient cases, and approximately 50% of men will experience prostatitis at some point in their lives. Prostatitis can affect adult males of all ages, with a higher prevalence in those under 50. The onset of prostatitis may also be associated with factors such as season, diet, sexual activity, urogenital tract infections, benign prostatic hyperplasia or lower urinary tract syndrome, occupation, socioeconomic status, and psychological factors.Guidance on Treatment:
Type I Prostatitis
Antibiotic treatment for Type I prostatitis is necessary and urgent. Once a clinical diagnosis is made or blood and urine culture results are available, antibiotics should be administered immediately. Intravenous antibiotics are recommended initially, followed by oral medication once the patient's fever and other symptoms improve. The treatment course should be at least 4 weeks. For acute bacterial prostatitis with urinary retention, suprapubic bladder puncture drainage or catheterization may be used, but the indwelling catheter should not exceed 12 hours. If an abscess forms, options include transrectal ultrasound-guided fine-needle aspiration, transurethral incision of the prostatic abscess, or perineal puncture drainage.
Type II and III Prostatitis
The primary goal of treating chronic prostatitis is to relieve pain, improve urinary symptoms, and enhance quality of life. Efficacy evaluation should focus on symptom improvement.
1. General Treatment
Health education, psychological, and behavioral counseling are beneficial. Patients should abstain from alcohol, avoid spicy and irritating foods, avoid holding urine or sitting for long periods, maintain warmth, and engage in regular exercise.
2. Medication
The most commonly used medications are antibiotics, α-blockers, plant extracts, and nonsteroidal anti-inflammatory analgesics. Other drugs may also provide varying degrees of symptom relief.
(1) Antibiotics
Currently, antibiotics are the first-line treatment for prostatitis in clinical practice, but only about 5% of chronic prostatitis patients have confirmed bacterial infections.
- Type II: Antibiotics should be selected based on bacterial culture results and their ability to penetrate the prostate. After a diagnosis of prostatitis, antibiotic treatment should last 4–6 weeks, with periodic efficacy evaluations. Prostatic intravenous injections are not recommended.
- Type IIIA: Antibiotic treatment is mostly empirical, based on the assumption that certain routinely culture-negative pathogens cause this type of inflammation. Therefore, oral fluoroquinolones are recommended for 2–4 weeks, followed by a decision on continued treatment based on efficacy feedback. Antibiotics should only be continued if clinical symptoms clearly improve. The recommended total course is 4–6 weeks.
- Type III B: Antibiotic treatment is not recommended.
(2) α-Blockers
α-Blockers relax smooth muscles in the prostate and bladder, improving lower urinary tract symptoms and pain, making them a fundamental treatment for Type II/III prostatitis. Different α-blockers can be selected based on patient conditions. Recommended α-blockers include doxazosin, afipidil, tamsulosin, and terazosin, with comparative studies showing varying degrees of improvement in urinary symptoms, pain, and quality of life.
(3) Plant Extracts
Plant extracts are increasingly recognized in the treatment of Type II and III prostatitis and are recommended. These extracts primarily include pollen-based formulations and plant extracts, with broad pharmacological effects such as non-specific anti-inflammatory, anti-edema, promoting bladder contraction, and relaxing urethral smooth muscles. Recommended plant extracts include Prostat, Serenoa repens, and its extracts. Dosage and duration vary based on individual conditions, typically measured in months. Adverse effects are minimal.
(4) Nonsteroidal Anti-inflammatory Analgesics
Nonsteroidal anti-inflammatory analgesics are used empirically to treat symptoms associated with Type III prostatitis, primarily to relieve pain and discomfort.
(5) M-Blockers
For patients with symptoms like urinary urgency, frequency, and nocturia without urinary obstruction, M-blockers (e.g., tolvaptan) can be used.
(6) Antidepressants and Antianxiety Drugs
For chronic prostatitis patients with comorbid depression or anxiety, these drugs can be used alongside prostatitis treatment to improve mood disorders while alleviating urinary abnormalities and pain. Prescribing these drugs requires strict adherence to regulations and awareness of potential adverse effects. Common options include selective serotonin reuptake inhibitors and tricyclic antidepressants.
(7) Traditional Chinese Medicine (TCM)
TCM treatment should follow guidelines from the Chinese Acupuncture and Moxibustion Association or the Association of Integrated Traditional Chinese and Western Medicine.
3. Other Treatments
(1) Prostatic Massage
Prostatic massage is a traditional treatment. Studies show that appropriate massage can promote prostate duct emptying and increase local drug concentration, alleviating symptoms in chronic prostatitis patients. It is recommended as an adjunctive therapy for Type III prostatitis but contraindicated in Type I.
(2) Biofeedback Therapy
Studies indicate that chronic prostatitis patients often have pelvic floor muscle coordination disorders or urethral external sphincter tension. Biofeedback combined with electrical stimulation can relax pelvic floor muscles, improve coordination, and relax the external sphincter, thereby relieving perineal discomfort and urinary symptoms.
(3) Heat Therapy
Heat therapy utilizes various physical methods to increase blood circulation in the prostate, accelerate metabolism, reduce inflammation, eliminate tissue edema, and relieve pelvic muscle spasms. Short-term symptom relief is possible, but long-term efficacy is unclear. It is not recommended for unmarried or childless individuals.
(4) Prostatic Injection Therapy / Transurethral Prostatic Irrigation
Efficacy and safety have been confirmed.
Type IV Prostatitis
Generally, no treatment is required. However, if the patient has elevated PSA levels or infertility, differential diagnosis and corresponding treatment should be considered.