Why is prostatitis dangerous? Nervous prostatitis How does this disease manifest?

In addition to the physiological factor (predisposition, congestion in the pelvic area, injuries), urologists identify psychological causes of prostatitis. Practical violations in activity in 75% of cases prostate gland arose against the background of stress, problems in family life, and emotional disturbances.

If the main factor in the development of the disease is not eliminated, it will not be possible to achieve stable remission. The course of formal therapy includes the help of a psychologist.

What is the psychological cause of prostatitis?

Psychosomatics is a science that studies the influence of psychological factors on the functioning of human internal organs and systems. With regard to prostate disorders, the relationship between a man’s emotional background and the development of pathologies is especially obvious.

Urologists identify three main psychosomatic causes of prostate diseases:

Failures of erectile function - regardless of what caused the “failure” in bed, the man perceives the situation extremely acutely. The partner's goal is to calm him down. If this does not happen, subconscious anxiety and fear of failure appear, which creates the psychological preconditions for the occurrence of inflammation of the prostate gland.
Constant anxiety leads to reluctance to have sexual relations and psychological impotence. And irregular sex causes stagnation and the development of inflammatory processes.
Family problems - the psychosomatics of prostatitis are often associated with quarrels, protracted and unresolved problems with the wife. The nervous system that regulates sexual function is a complex mechanism that includes the influence of the subconscious on the emotional background and decision making.
Constant quarrels provoke psychological rejection of the sexual partner and reluctance to have intimacy with him. For psychological reasons, prostatitis or any other disorders may develop that lead to a decrease in erectile function.
Fear of the consequences of the disease - prostatitis from a psychosomatic point of view arises due to the projection of the symptoms of the disease onto oneself. As a result, inflammation of the prostate occurs even where there were no prerequisites for this.
The difficulty is that when dysuric disorders or erectile dysfunction occur, a man rarely seeks professional help. Thus, by emotionally “twisting” himself, a man subconsciously catalyzes violations.

It turns out that prostatitis can occur due to psychological and emotional trauma, fear of the disease, as well as one-time failures in bed. Mental disorders have an ambiguous effect on the functioning of the prostate: on the one hand, an increase in sexual desire is possible, on the other, a complete loss of interest in sex.

The negative psychological consequences leading to prostate disease are a compelling reason to avoid stress and quarrels and have a regular sex life.

How does prostatitis affect the psyche?

Men are quite vulnerable if the matter affects their reproductive function and penis. Any diseases and disorders associated with this create psychological discomfort, which only aggravates the situation. Emotional disturbances are constantly increasing.

Picture change psychological personality with prostatitis it looks like this:

Prostate dysfunction leads to decreased sexual desire and deterioration of erectile function. Interesting fact! Physiologically, a man is able to have sexual relations throughout the entire period of the disease, with the exception of advanced chronic inflammation. Despite this, urologists often diagnose emotional or psychosomatic impotence. Reluctance to have sexual relations leads to a worsening of the condition.
The psychology of a man with prostate diseases is often similar to the thinking of a “frightened child.” The fear of illness is stronger than the disorders themselves. The influence of prostatitis on a man’s mental state has been proven: the appearance of irritability, depression.
In fact, the patient initially projects onto himself the worst scenario: impotence, loss of family, infertility, although in his case the disease is curable and the listed complications are rare.
Prolonged prostate disease can cause a man’s neuropsychic state. At this stage, understanding from loved ones is extremely important.

In fact, prostatitis triggers a psychosomatic closed reaction. Inflammation of the prostate gland leads to decreased erection. A man develops a fear of failure in bed, which leads to psychological rejection of sex.

Lack of regular sexual relations causes the development of extensive congestion. And stagnation leads to exacerbation of inflammation and its transition to a chronic form.

Psychological symptoms of prostatitis, which urologists pay attention to in differential diagnosis:

Insomnia.
Constant irritability.
Changes in behavior and personality.
Panic fear of consequences.

To obtain a complete clinical picture, it is recommended that a regular sexual partner, who is in a civil or official marriage, be present during the interview. The survey is conducted in a confidential and calm manner.

Psychologically, men view prostatitis as a practically incurable disease that necessarily leads to impotence. Actually this is not true. Modern methods therapies help cope with the disease in 80-85% of cases. Mental disorders associated with inflammation of the prostate significantly complicate therapy and reduce the effectiveness of medications.

How to psychologically cope with prostatitis

The psychosomatics of prostate diseases at the moment is undeniable scientific fact, confirmed by many years of clinical research. A man’s mood largely determines the effectiveness of fighting the disease and even helps prevent inflammation from becoming chronic.

Psychological treatment begins with conversation. The specialist discusses with sexual partners the reasons that caused the violations. During the survey, the reasons for decreased sexual activity are established. The consequences of the disease are explained to the patient and the possibility of complete healing is indicated. To achieve stable psychological remission in case of hormonal imbalances in the body, a course of antidepressants is prescribed.

From a psychological point of view, the prostate in men is a second heart that determines behavior, psycho-emotional stability and behavioral factor. The patient’s recovery and the achievement of stable remission of the disease depend on the elimination of emotional factors, catalysts of inflammatory processes.

Emotional disturbances have great importance in the appearance of various disorders. Their role in the occurrence of many ailments has been irrefutably proven. First of all, when listing diseases that arise “from nerves”, we should remember peptic ulcer stomach and duodenum. In its development, stressful situations occupy almost a leading position.

In one of the studies conducted on the influence of emotions on the formation of ulcers, it was even revealed that its occurrence in one or another part of the digestive tract depends on the quality of the emotions experienced. It is believed that anger and irritation contribute to the appearance of stomach ulcers, and fear, melancholy, and anxiety contribute to duodenal ulcers intestines. Whatever organ is affected as a result of psychological disorders, the mechanism is approximately the same: during emotional stress, the transmission of impulses from cells to the brain is disrupted. It is not yet possible to fully explain the subtleties of the occurrence of neurogenic organ disorders, because the brain still hides many mysteries. Its structure has been studied thoroughly, but many functions remain unknown. So, today there is not even an unambiguous theory that reveals the mechanisms of sleep and memory. We can only guess about a lot, but we can say with confidence that bad emotions have an adverse effect on the functioning of organs and increase the risk of developing many ailments, including prostate diseases.

Decreased mood frequent stress and the lack of adequate rest in mild cases (fortunately, these are the majority) lead to reversible, functional disorders of sexual activity and prostatitis, that is, there are no organic disorders in the body that would forever make intimate life impossible. However, the danger of all these conditions is that often a person does not perceive the psychological changes that have occurred as something unusual, as a painful condition. Fatigue at work, constant hassle - all this is regarded as a familiar, normal phenomenon, and the development of sexual disorders sometimes becomes an unpleasant surprise for a man. Of course, such a sudden and seemingly causeless problem becomes a kind of trauma for a person. Subsequently, the man, reflecting on his condition, begins to fear a repetition of the situation, is afraid of sexual intercourse and, not suspecting that he just needs to rest and put his emotions in order, makes himself impotent.

Psychological disorders contribute to the inhibition of the functioning of brain formations that are responsible for the sexual reflex and desire. Excitation processes predominate in those areas of the cortex that are focused on the subject of experience. Thus, the gonads stop working in their usual rhythm, and the man’s potency is significantly reduced. Lack of sexual intercourse leads to congestion in the prostate gland, and this does not contribute to sexual longevity.

The severity of sexual disorders is directly proportional to the effect of emotional stress on the body. However, even with the same loads, people react to them differently: someone can withstand the hardest work and not experience any problems, while for others the very first stress causes frustration. All this depends on the characteristics of the man’s character, general health and attitude to various tense situations. Often sexual function in case of emotional disturbances, it fades away gradually, without causing strong feelings in a person about this and remaining practically unnoticed. However, every man, regardless of age, must remember that in 80% of cases, sexual weakness is psychogenic in nature, so you need to carefully monitor your state of mental balance.

Psychological problems can cause complications in the form of sexual disorders at any time. Therefore, men who are prone to depression Those who have a stressful or very hard job can be advised to do everything possible to improve their emotional background, because their own health and the well-being of family relationships are at stake.

Prostatitis is an inflammation of the prostate gland, an exclusively male disease, since this organ is found only in men. How dangerous is prostatitis and what are the consequences of the disease?

List of possible complications

There are acute and chronic inflammation of the prostate gland.

Acute prostatitis with untimely and insufficient treatment causes the following consequences:

pathological processes urinary system(kidney inflammation, Bladder, urethra);
diseases of the reproductive system (testicles and their appendages, seminal vesicles);
purulent focal inflammation in the prostate (abscess development).

Over time, acute prostatitis becomes chronic, the consequences of which for men are dire:

sclerosis of prostate tissue;
erectile dysfunction (impotence);
formation of stones in the kidneys and urinary tract;
renal failure;
adenoma;
malignant tumor;
infertility.

In addition, there appear external signs prostatitis: nervousness, aggressiveness, irritability. As a result of a decrease in sexual desire, psychological problems arise, men's self-esteem decreases, and relationships with the opposite sex are disrupted.

Urinary system

One of the functions of the prostate is to prevent the reflux of seminal fluid into the bladder, since the gland separates the process of ejaculation from urination. In addition, it prevents urinary incontinence, holds it for a certain time and ensures outflow at the right time.

The bladder and urethra are the organs that are primarily affected by prostatitis. The following consequences arise:

stagnation or incontinence of urine;
frequent urge to urinate;
feeling of heaviness in the lower abdomen;
sharp severe pain when urinating;
narrowing of the urethra.

Through a chain reaction, these pathological conditions cause renal failure and the formation of kidney stones.

Reproductive system

Bacteria that cause prostatitis provoke infection of the pelvic organs of men. First of all, this threatens with inflammation of the testicles, their appendages and seminal vesicles. These complications immediately affect the quality of sexual life. Sexual desire decreases or disappears altogether, erection weakens or is absent, ejaculation is premature and painful.

With untreated prostatitis, the infection spreads throughout the body and affects other organs. Often causes vaginal inflammation of the sexual partner.

Inflammatory processes in the reproductive system cause a man to lack an erection, which means he is unable to conceive.

In addition, with prostatitis, the secretion of prostatic juice decreases. Prostate juice is a nutrient medium for male gametes, giving them the opportunity to “live” in the uterus for up to 8 days. It liquefies sperm and ensures sperm motility. The higher their mobility, the higher the likelihood that they will reach the female egg and fertilize it. Viscous, thick sperm in a man and sedentary male cells are a guarantee that a woman will not be able to get pregnant with such a sexual partner.

Nervous system

Inflammation of the prostate gland also has detrimental consequences for the nervous system of men. Urologists distinguish two groups of reasons for the negative impact of prostatitis on the nervous system:

psychological nature;
physiological.

A man who does not have a normal erection experiences premature ejaculation, decreased libido, and feels inferior. This causes self-doubt, a feeling of constant anxiety, anger, irritability, and depression. Aggression towards the partner often manifests itself. Personal life collapses, relationships with a girl deteriorate, often irrevocably.

Inflammatory processes in the tissues of the prostate gland disrupt its functions, it stops producing certain sex hormones. Decline hormonal levels threatens serious nervous disorders in men.

Conclusion

Why is prostatitis dangerous for men? Inflammation of the genitourinary system, cancer, infertility, nervous disorders. These serious consequences do not occur with timely and correct treatment of prostate inflammation.

Sometimes men at the onset of the disease do not show or have mild symptoms of prostatitis. In this case, many prefer a wait-and-see approach, which is a big mistake. The disease progresses every day, and the sooner the doctor stops it, the better. Therefore, at the very first alarming symptoms You should consult a urologist, and it is advisable to undergo an appropriate examination annually.

Emotional disturbances are of great importance in the emergence of various disorders. Their role in the occurrence of many ailments has been irrefutably proven. First of all, when listing diseases that arise “from nerves,” we should recall peptic ulcers of the stomach and duodenum. In its development, stressful situations occupy almost a leading position.

In one of the studies conducted on the influence of emotions on the formation of ulcers, it was even revealed that its occurrence in one or another part of the digestive tract depends on the quality of the emotions experienced. It is believed that anger and irritation contribute to the appearance of stomach ulcers, and fear, melancholy, and anxiety contribute to duodenal ulcers intestines. Whatever organ is affected as a result of psychological disorders, the mechanism is approximately the same: during emotional stress, the transmission of impulses from cells to the brain is disrupted.
It is not yet possible to fully explain the subtleties of the occurrence of neurogenic organ disorders, because the brain still hides many mysteries. Its structure has been studied thoroughly, but many functions remain unknown. So, today there is not even an unambiguous theory that reveals the mechanisms of sleep and memory. We can only guess about a lot, but we can say with confidence that bad emotions have an adverse effect on the functioning of organs and increase the risk of developing many ailments, including prostate diseases.

The severity of sexual disorders is directly proportional to the effect of emotional stress on the body. However, even with the same loads, people react to them differently: someone can withstand the hardest work and not experience any problems, while for others the very first stress causes frustration. All this depends on the characteristics of the man’s character, general health and attitude to various tense situations. Very often, sexual function with emotional disorders fades away gradually, without causing strong feelings in a person about this and remaining practically unnoticed. However, every man, regardless of age, must remember that in 80% of cases, sexual weakness is psychogenic in nature, so you need to carefully monitor your state of mental balance.

World massage courses in St. Petersburg →

www.sportmassag.ru

What is the psychological cause of prostatitis?

Urologists identify three main psychosomatic causes of prostate diseases:

Failures of erectile function - regardless of what caused the “failure” in bed, the man perceives the situation extremely acutely. The partner's goal is to calm him down. If this does not happen, subconscious anxiety and fear of failure appear, which creates the psychological preconditions for the occurrence of inflammation of the prostate gland.
Constant anxiety leads to reluctance to have sexual relations and psychological impotence. And irregular sex causes stagnation and the development of inflammatory processes.

Family problems - the psychosomatics of prostatitis are often associated with quarrels, protracted and unresolved problems with the wife. The nervous system that regulates sexual function is a complex mechanism that includes the influence of the subconscious on the emotional background and decision making.
Constant quarrels provoke psychological rejection of the sexual partner and reluctance to have intimacy with him. For psychological reasons, prostatitis or any other disorders may develop that lead to a decrease in erectile function.
Fear of the consequences of the disease - prostatitis from a psychosomatic point of view arises due to the projection of the symptoms of the disease onto oneself. As a result, inflammation of the prostate occurs even where there were no prerequisites for this.
The difficulty is that when dysuric disorders or erectile dysfunction occur, a man rarely seeks professional help. Thus, by emotionally “twisting” himself, a man subconsciously catalyzes violations.

How does prostatitis affect the psyche?

The picture of changes in psychological personality with prostatitis is as follows:

Prostate dysfunction leads to decreased sexual desire and deterioration of erectile function. Interesting fact! Physiologically, a man is able to have sexual relations throughout the entire period of the disease, with the exception of advanced chronic inflammation. Despite this, urologists often diagnose emotional or psychosomatic impotence. Reluctance to have sexual relations leads to a worsening of the condition.
The psychology of a man with prostate diseases is often similar to the thinking of a “frightened child.” The fear of illness is stronger than the disorders themselves. The influence of prostatitis on a man’s mental state has been proven: the appearance of irritability, depression.
In fact, the patient initially projects onto himself the worst scenario: impotence, loss of family, infertility, although in his case the disease is curable and the listed complications are rare.
Prolonged prostate disease can cause a man’s neuropsychic state. At this stage, understanding from loved ones is extremely important.

Psychological symptoms of prostatitis, which urologists pay attention to in differential diagnosis:

Insomnia.
Constant irritability.
Changes in behavior and personality.
Panic fear of consequences.

Psychologically, men view prostatitis as a practically incurable disease that necessarily leads to impotence. Actually this is not true. Modern methods of therapy help cope with the disease in 80-85% of cases. Mental disorders associated with inflammation of the prostate significantly complicate therapy and reduce the effectiveness of medications.

How to psychologically cope with prostatitis

The psychosomatics of prostate diseases is currently an indisputable scientific fact, confirmed by many years of clinical research. A man’s mood largely determines the effectiveness of fighting the disease and even helps prevent inflammation from becoming chronic.

ponchikov.net

Be careful, there are a lot of letters!

Guys, help me out, I need your advice, some strange story happened to me with this prostatitis, well, I’ll start in order, since the story is long:

It all started in November-December last year. I recently started a new, very stressful and difficult job. There is nothing to do, you need to gain useful experience and money. And problems began, namely a burning sensation in the urethra. And nothing more. It probably burned like that for a week. I was already starting to score. Well, I did a couple of instillations of myrism into the canal, but it didn’t get much better. Then suddenly it passed and subsided for about 10 days. I forgot. Then again in a circle. At the district clinic I made an appointment with a urologist a month in advance; I couldn’t wait any longer. So I went to a private clinic at the end of December on New Year’s Eve.

There, everyone was a plane tree, they did TRUS, revealed moderate changes, but did not explain what they were. They did a test for STDs (negative), and a smear from the urethra for pathogenic flora. and took prostate juice (in urine, they just couldn’t get it). Well, they let me go for a walk until the end of the January holidays, since the test results can only be seen on January 10th.

In general, everything was great in January, I drank, walked, had a cultural rest, no complaints at all. When I went back to work after the holidays, it started again.

After the holidays, I go to this urologist, and he says: You, my friend, already have old prostatitis. STD - clear, smear - conditionally clear, they found staphylococcus in the 5th degree (as they explained in another hospital - this is within the normal range), but there are no lycithin grains in the analysis of prostate juice (as they also explained later, this is normal in urine). There are no red blood cells, no leukocytes either. Well, this doctor gave me 100+ thousand rubles worth of treatment, including all possible and impossible physical therapy, but without pills.

At first I was sad, I don’t have that kind of money, but health is more important. And then I thought it was strange - physio without pills? I doubted the honesty of the doctor’s intentions, took my tests and went to look for another urologist.

I found one local shrine. I brought him some tests. He just laughed at the prescribed treatment and the arguments of the past sculpting, changed the diagnosis to acute prostatitis, and prescribed Vitaprost+, ofloxacin, enemas and Wobenzym.

I mean, I went to get treatment. I started taking the course, drank it all for a week, and then my wife and I went abroad for 5 days (I took time off). It was already February. There, everything seemed to go away again. As soon as we entered the airport for our return flight, it burned again, and I could almost climb the wall.

So we returned and I decided to take this ailment seriously. I honestly drank everything from start to finish, except that I replaced the candles with Forte (plus I couldn’t find them). Of course, a certain relief came, the terrible burning sensation was replaced by occasional discomfort. I started drawing patterns and came up with the following:

Morning is absolutely gorgeous
Day - somewhere from 12 to 17 00 - it hurts, from mild discomfort to burning
Evening (as soon as I get home from work) - practically doesn’t bother me

On weekends it's just a cucumber.
Well, okay, I took the course and went to an appointment about a couple of weeks after graduation. He boasted about the improvements and took a test - everything was normal, except that the lecithin grains were slightly less than required. The doctor prescribed prostanorm and pumpkinol and sent me home to take a monthly course (it was already April).

I drank it through the stump of the deck, there wasn’t much improvement. That is, there was discomfort, which again went away in the evening, and on the weekend nothing hurts again.

Then in June I caught acute pyelonephritis. On the second day of illness, the tubules lit up, sparks came out of the eyes. Well, I’m not a fool, I already paid for insurance at that time. So I flew to the doctor. They found a bug in the kidneys, prescribed a lethal dose of Tavanik, cranberries, Borzhomchik and bed rest. While I was drinking tavanik and lying at home, everything was absolutely gorgeous and brilliant. I haven't felt this way in a long time. Libido was always normal during the illness, and at that moment a second and third wind opened.
In general, I was really sick.
After discharge, harsh everyday life began, work, master's degree, family life, etc. A couple of weeks later, the burning sensation began all over again.
Well, I got mad, realized that I didn’t want A/B anymore, so I bought and put 10 pieces of prostopin on myself, which seemed to relieve the symptoms a little.
And then July came. I fucking took a month off from work and flew with my wife to the south. Again, two weeks since I was born again. Then he went to stay with relatives - everything was also gorgeous. I returned from vacation and after a couple of weeks everything started all over again....

Well, if anyone has finished reading this, can you tell me, am I the only one who finds it strange that all my torment continues during the working day? Does it even happen that constant nervous tension provokes such a burning sensation and symptoms of prostatitis? But let’s just say that with my job, nervous tension is guaranteed every second, and in general, I hate what I do fiercely. The only thing that saves me is smoking, but I would have quit a long time ago.

Has anyone encountered such manifestations? If yes, tell me, is there any way to treat it? Maybe there are some kind of Uzbek exercises, or yoga or meditation. Does such a thing even happen because of nervousness?

Thank you all for your attention!

hron-prostatit.ru

Types and causes of prostatitis

Often with chronic prostatitis, bacteria form in the prostate. The disease in this case is called bacterial or infectious prostatitis.

There is also abacterial (non-infectious) prostatitis, in which autoimmune damage to the prostate occurs. In addition, it is customary to distinguish between asymptomatic prostatitis, in which there are no external manifestations of the disease, and prostatitis, accompanied by pain. In some cases, prostate disease is accompanied by inflammatory pelvic pain syndrome.

The first and most basic cause of the disease is congestion in the prostate. Many factors can contribute to their development:

violation of the norm of a man’s sexual life - excessive activity or prolonged absence of relationships, frequent unresolved erections;
sedentary, sedentary lifestyle;
excessive alcohol consumption, constant smoking;
diseases of the intestines or spine.

To avoid illness, it is also advisable to avoid anything spicy and salty. Prostate massagers have become popular as a means of preventing prostatitis. When patients use massage techniques, the symptoms of the disease gradually decrease.

Consequences and complications of the disease

Manifestations chronic prostatitis can be grouped into several types. These include pain, urinary problems, nervous disorders, and sexual problems.

The main symptoms of chronic prostatitis include increased fatigue body, loss of appetite, drowsiness, indifference to previously interesting events. Against the background of this disease, a depressed state may occur, which will lead to depression, frequent headaches and insomnia.

The pain is predominantly aching and occurs in the perineum and rectum. Painful sensations may be in the lower abdomen and in the lumbosacral region - such pain can be mistakenly confused with signs of radiculitis. Any pain in the pelvic area that lasts more than 3 months should alert the patient, especially if he experiences frequent or difficult urination with a burning sensation. Unpleasant sensations in the urethra also occur during sexual intercourse.

The consequences of prostatitis in men manifest themselves primarily in the form of impaired libido and weakening of spontaneous erections. As the disease progresses, premature ejaculation can turn into slow ejaculation, and the brightness of a man’s perception of orgasm is impaired. Due to these reasons, nervous disorders may occur.

Irritability, nervousness and depression are characteristic of almost every man suffering from prostatitis. Lack of self-confidence may lead to the need to consult a neurologist.

With inflammation of the prostate, such an unpleasant phenomenon as itching in the perineum may appear. After defecation or urination, discharge from the prostate area is possible. The consequences of the disease manifest themselves in the form of increased sweating, especially in the perineal area.

If left untreated, chronic prostatitis can lead to acute urinary retention syndrome - when the patient is unable to urinate due to a full bladder.

The consequences of prostatitis in men often result in male infertility. With this disease, prostate secretion is produced in minimal quantities, which leads to a decrease in sperm activity and reduces the likelihood of fertilization.

In some cases, chronic prostatitis contributes to the development of benign or malignant tumors prostate gland.

Timely consultation with a doctor and appropriate treatment can relieve many problems associated with the consequences of prostatitis.

zpppstop.ru

The disease is most often the outcome of acute prostate cancer. Chronic prostatitis of non-infectious origin sometimes develops as a result of stagnation of secretions in the follicles of the prostate gland. Prolonged irritation of the mucous membrane of the follicles by the decay products of stagnant secretions causes its aseptic inflammation - the so-called stagnant prostatitis. The cause of stagnation is atony (loss of tone) of the follicles and their excretory ducts due to sexual excesses, masturbation, and prolonged sexual arousal.

Pathoanatomical changes in the gland in chronic forms of inflammation are extremely diverse, both in localization and distribution, and in histological picture. At the same time, desquamative catarrh (inflammation with detachment of the mucous membrane) of the excretory ducts and small cell infiltration of their walls can be detected.

Subjective complaints in chronic prostatitis are sometimes absent, and only some sticking of the urethral sponges and a small number of threads in the urine forces the patient to consult a doctor. In this case, patients can consider themselves absolutely healthy, while the already inflammatory secretion of the prostate gland, released into the urethra, irritates the nerve endings.

Progressing, the inflammatory process leads in patients from 14 to 50 years old to partial sclerosis of the prostate tissue and their focal hyperplasia (proliferation), and from 51 to 76 years old - to atrophy (death) of the prostate gland, complicated by various pains (40 - 80%) , development of secondary lumbosacral radiculitis (in 90% of patients) due to malnutrition and toxic effects on the nerve roots of the spine, urination disorders (up to 83%), impaired renal function (68%), disorders of sexual function (74%), hemorrhoids (17%), neurovegetative and mental changes (sweating, fatigue, depression, decreased performance, insomnia, irritability, conflict), observed in 20 - 71% of patients with prostatitis. Often these patients come for an appointment not with a urologist, but with a surgeon and neurologist.

All this makes it particularly important to recognize and effective treatment chronic prostatitis. In chronic prostatitis, to identify the infectious or non-infectious nature of the prostate disease, its secretion is necessary.

To do this, you need to massage the prostate gland, as a result of which its secretion is obtained, it is sent for bacterial culture for the targeted administration of antibiotics.

In some cases, patients complain of itching in the urethra, in the anus, in the perineum, dull pain in the sacrum, lower back, in the kidney area, in the testicles, hips, along the sciatic nerve and etc.

The clinical picture of chronic prostatitis includes various pathological processes. In less than half of patients, the causative agent of the disease can be identified. In many cases, complaints are based on functional disorders of the nervous system, various changes in the rectum and urethra. Despite the widespread prevalence of prostatitis, it is often difficult to clarify the cause and origin of the disease, and doctors have different technical capabilities.

Meanwhile, chronic prostatitis can drag on for a long time, sometimes leading people to complete despair. Impaired urination and pain in various organs, loss of sexual desire and the development of impotence can make a man’s life simply unbearable.

Symptoms of chronic prostatitis can be divided into three groups: general, local and sexual disorders.

General symptoms are not specific enough. These are increased irritability, lethargy, fatigue, loss of appetite, anxiety, sleep disturbance, decreased performance and creative activity.

It happens that pain in the lower back and sacrum leads to the erroneous idea of radiculitis. In case of inflammatory diseases of the heart and joints, one should always exclude a process in the prostate gland, which is often the source of infection, as are tonsils and carious teeth. Functions of the prostate gland, as well as the gastrointestinal tract and of cardio-vascular system, are regulated by the autonomic nervous system connected to the brain. This can explain the occurrence of functional disorders of various systems in the body. Associated mental disorders lead to depression, decreased productivity, rash decisions and actions.

Mental changes, manifested to a greater or lesser extent, are observed in most patients with chronic prostatitis. The vast majority of patients have complete control over their reactions, and the right approach to the disease may already lead to some improvement. A positive outcome of treatment largely depends on the participation of the patient himself in this process, and on the support of his partner. We have to work hard to strengthen our mental and physical health. Finding a rational approach is also not easy: both reproaches and excessive care can lead to deterioration mental state. Autogenic training (a relaxation method), yoga exercises, and daily exercise can help.

Of the local symptoms, patients most often note urinary disorders and pain. As a rule, frequent urges, pain at the beginning or end of urination, constant aching pain radiating to the subpubic area, perineum, sacrum, scrotum, glans penis, rectum, and groin area are disturbing. In some patients, pain intensifies both after sexual intercourse and with prolonged abstinence. The intensity of pain often does not depend on the severity of the pathological process; in some cases, pain is considered a symptom of other diseases (cystitis, radiculitis, osteochondrosis). Often there is itching, increased sweating, and a feeling of cold in the perineum. Changes in skin color in the pelvic area associated with circulatory disorders may also appear. Other symptoms include discharge from the urethra, especially after bowel movements or physical activity. This is due to weakening of the tone of the prostate gland.

Psychologically patients suffer especially painfully from sexual dysfunction.

After suffering from gonorrheal prostatitis, a number of complications are possible: narrowing of the urethra, inflammation of the seminal tract, sexual dysfunction, infertility. Gonorrhea continues to be a common disease among young people and should not be underestimated. Frequent changes of partners and neglect of hygienic precautions are also significant in the spread of gonorrhea.

The causative agent of the disease, gonococcus, lives on the mucous membrane of the genital organs. An exception is the cornea of a newborn's eye, which can become infected during childbirth and lead to blindness. For this reason, immediately after birth, a solution of silver nitrate of men is instilled into the eyes of the child after infection, already on the second day (the incubation triode can last up to 9 days!) yellow-green mucous discharge appears from the urethra, upon microscopic examination of which a large number of leukocytes are detected (a sign inflammation) and gonococci. The body's defenses are not always able to cope with infection and remove microorganisms from secretions. Therefore, with insufficient treatment or in its absence, the pathogen from the anterior urethra moves into the next parts of the urethra and into the prostate. In addition, gonococci suppress the normal flora; after successfully getting rid of gonorrhea, an additional inflammatory process caused by other microorganisms, including chlamydia and mycoplasma, may develop.

Symptoms of gonorrhea are determined by inflammatory swelling of the mucous membrane of the sensitive urethra: burning, itching, pain and significant purulent discharge. Urination at times; so painful that waiting for it can be unbearable. More serious complications are also possible, for example, inflammation of the epididymis (epididymitis), prostate abscess, as well as inflammation of the glans penis and foreskin (balanitis, balanoposthitis). Gonococcal damage to the eyes and joints is also possible.

Acute symptoms of gonorrhea pass after a few days, minor pain and discharge, especially in the morning. This form of the disease is dangerous because it can remain contagious, while the chronic inflammatory process inevitably leads to a decrease in the ability to fertilize. Independent unqualified treatment can also lead to this: the dangerous flora does not die, but is only suppressed, remaining a source of infection and chronic inflammatory process. Therefore, underestimation of this disease leads to its further spread.

Antibacterial treatment of gonorrhea for many years has led to variability and adaptability of a number of strains of the pathogen, which has changed the course of the disease. Quite often there is no violent onset after infection, sometimes the symptoms are insignificant. It is not uncommon for several men to have one partner - the source of infection, and only some of these men became ill. A mandatory symptom of the disease is discharge. Women often consider them to be a harmless nuisance and are surprised when their partner (usually after visiting a doctor) suggests they go for a checkup. In addition, an illness that is not cured in a timely manner often gives rise to resentment, divorce and other complications in people’s relationships.

Syphilis is a disease known to mankind since ancient times. It began to be treated effectively only after the advent of antibiotics, in particular penicillin, which to this day remains the main and effective means of influencing the pathogen (treponema pallidum).

Infection with syphilis most often occurs during sexual intercourse, when pathogenic bacteria enter the body of a healthy person from the patient. There are no symptoms of the disease in the first three weeks after infection, incubation period usually ranges from 10 to 60 days. Then a small ulcer with clear contours appears on the genitals at the site of the initial introduction of the pathogen. This ulcer—a chancre—resembles a small crater with jagged, hard edges. The surface of the ulcer has a characteristic pink color, there may be one or several. A few days after the appearance of chancre, an increase in the inguinal area is noted. lymph nodes. The primary stage of syphilis lasts from one to five weeks.

If the patient does not pay attention to these ulcers, then healing occurs on their own, and for two to ten weeks there may be no symptoms of the disease and then a small rash appears on the skin, the patient may not even remember the previous suffering. Meanwhile, the appearance of such a rash indicates the beginning of the second stage of the disease. If treatment is not started, the rash may appear and disappear periodically over the next two years.

Next, the disease enters the hidden (latent) stage. It must be remembered that during the first two years the patient continues to be a source of infection for others. It is difficult to predict the subsequent development of the disease. While some people remain asymptomatic throughout their lives, others experience damage to many internal organs, including the cardiovascular system, spinal cord, brain, etc. Of course, a number of changes in these organs can often be incompatible with life.

If signs of the disease are detected, you should immediately consult a venereologist.

Trichomonas prostatitis. A significant part of non-bacterial prostatitis is inflammatory processes caused by Trichomonas. Unlike viruses and bacteria, they belong to the lower forms of the animal world - the simplest single-celled microorganisms that tend to form colonies. It is important that they are not sensitive to ordinary antibacterial drugs. Identifying trichomoniasis is important because specific medications are used to treat it. Detection of pathogens in urine is possible only with massive damage to the urethra and bladder. More precisely, a microscopic examination of the secretion of the prostate gland, which is obtained after a finger massage of the organ. This is often an unpleasant and painful procedure, but it is necessary for correct diagnosis. The research process is complemented by microscopy of vaginal discharge from the partner. It is known that the most attractive habitat for Trichomonas is a humid environment, most often in public toilets (door handles, shared towels, toilet lids), in public baths (at work), and swimming pools. Thorough, timely treatment of these surfaces is more a dream than a reality, so you should worry about precautions (disposable towels, modern disinfectants). Yet the main route of infection is sexual contact. In some cases, when the discovery of trichomoniasis is surprising, this leads to serious family quarrels.

Treatment of trichomoniasis is theoretically simple. According to statistical studies, the vast majority of patients recover after the first course of treatment with a special drug - metronidazole or new generation drugs such as secnidazole. However, in practice the situation is more complicated.

If treatment and control are insufficient or there is intolerance medicines, efficiency 10%.

Chlamydia occurs in more than half of men who have had gonorrhea.

Prostatopathy is a disease of the prostate gland, the clinical picture of which is in many ways similar to chronic prostatitis. The variety of symptoms can explain the many names of this pathology - prostatopathy, prostatodynamia, prostate neurosis, vegetative urogenital syndrome, congestive prostatitis, nervous dysregulation of the prostate.

With prostatopathy, unlike chronic prostatitis, infectious agents and inflammatory cells are not found either in the urine or in the secretions of the gland. Cytological studies also show a normal picture. It is known that the autonomic nervous system is responsible for all processes in the body that are not subject to the will, for example, for regulating the activity of digestion, heart, blood vessels, and smooth muscles. Dysregulation of the autonomic nervous system can affect almost anyone internal organ. Therefore, there are often people who complain of dysfunctions, for example, of the heart, rectum, in which no organic changes are found. Among the external manifestations, some may experience frequent redness of the facial skin. Violation of the autonomic regulation of the prostate gland can lead to changes in its functional activity and blood circulation of varying degrees of severity. A prerequisite for a violation of autonomic regulation is a certain predisposition. Evidence of so-called vegetative lability is frequent redness or paleness of the skin, cold, wet hands, palpitations, and trembling fingers.

The trigger mechanism for the disease is stressful and conflict situations in everyday life, especially sexual ones. This applies primarily to able-bodied, sexually active young men aged 20 to 40 years. Later this disease occurs less frequently. Prostatopathy can be caused by increased or decreased (service, long-term illness) sexual activity, excessive masturbation, frequent interrupted sexual intercourse, conflicts based on infidelity. To a certain extent, prostate concussions (car drivers, motorcyclists, tractor drivers, horse riders) can also contribute to this.

With prostatopathy, patients' complaints are almost identical to those with prostatitis.

Patients indicate urinary disorders that occur following a stressful situation.

Dull, vague painful sensations in the perineum and anus, a feeling of cold in the glans penis, testicles, inner thighs and groin are possible. Sexual disorders (weakening erection and premature ejaculation) have a purely vegetative, that is, mental, cause.

During examination, patients note pain even when lightly touching the prostate gland, which is quite natural, since those suffering from autonomic lability are sensitive to any touch. As a rule, a doctor requires significant attention and time to explain to the patient the true cause of the disease and help him remove the fear of eliminating the impact of adverse factors. To do this, the patient often has to take a vacation, have a positive attitude, and use physical measures to strengthen the nervous system and the whole body. Automotive training (progressive relaxation method) and yoga are useful. Intervention by a psychotherapist is also possible. Subsequently, treatment is prescribed aimed at; to improve blood circulation in the pelvic organs, reduce prostate swelling, and regulate bowel movements. Since there is no inflammatory process, antibacterial therapy is meaningless. It is important to adjust your lifestyle and diet (it is recommended to avoid spicy foods and spices, alcohol). Local heat is useful (sitz and mud baths, microenemas, short-wave therapy, woolen clothing on the lower part of the body).

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It is known that sexual disorders, as well as urinary disorders and other symptoms, are characteristic signs of a long-term chronic inflammatory process in the prostate gland. However, the relationship between sexual disorders and chronic prostatitis is ambiguous.

The history of the study of sexual disorders can be divided into three stages. The first (localizationist) stage was characterized by the fact that the whole variety of sexual disorders was reduced to one cause - the pathology of the seminal tubercle. Despite the limited (due to insufficient development of science) view of the essence of sexual disorders in prostatitis, representatives of this direction (B. A. Drobny, N. A. Mikhailov, L. Ya. Yakobson, R. M. Fronshtein) made a significant contribution to development of sexopathology. Previously, there were ideas that any violations of sexual functions in men are certainly associated with prostate dysfunction (G. G. Korik, 1983; Ghents, 1995).

The second stage was characterized by a complete denial of the role of local pathological changes (including chronic prostatitis) in the genesis of sexual disorders and is associated with the successes of psychiatric science.

Within the framework of the third stage, several theories and directions can also be distinguished. Thus, I.M. Porudominsky defined sexual disorders in patients with chronic prostatitis as a “neuroreceptor form of impotence.” The author explained sexual disorders that developed due to chronic prostatitis by damage to peripheral receptors located in the prostate gland and posterior urethra. As a result of irritation of peripheral nerve endings, the excitability of the spinal centers of erection and ejaculation increases, which is clinically manifested by increased erection and accelerated ejaculation. With a long-term inflammatory process, according to the author, functional depletion of the spinal genital centers occurs. The idea of the causes of sexual disorders in patients with chronic prostatitis was further developed in the works of N. A. Gavrilyuk, I. A. Gavrilyuk, G. G. Korika, P. I. Zagorodniy. According to these scientists, damage to the neuroreceptor apparatus of the prostate gland leads to increased excitability of the spinal genital centers. With a long-term inflammatory process, “exhaustion” of the erection center occurs with continued stimulation of the ejaculation center. Researchers explain this dissociation in the work of the spinal genital centers from the position of hysteriosis. G. G. Corik considered the inflammatory process in the prostate gland as an irritative focus that can cause reactive autonomic syndrome. An opinion is expressed (L.P. Imshinetskaya, I.I. Gorpinchenko) about the presence of neuroendocrine disorders in patients with chronic prostatitis, and sexual disorders are a clinical manifestation of these disorders. There is a theory according to which sexual weakness with prostatitis can be explained exclusively by nervous or psychogenic factors (I. B. Veynerov, A. M. Rozhinsky, V. V. Krishtal).

Data on sexual disorders with prostatitis have undergone a number of changes over the past few decades. In the 70-80s. of the last century there were quite a lot of works on sexual dysfunction in patients with prostatitis (I. I. Gorpinchenko, 1977; I. F. Yunda, 1987; A. K. Napreenko, 1983); Later studies focused primarily on erectile dysfunction and its vascular aspects, denying any effect of prostate inflammation on erection. In the last decade, scientists have paid close attention to chronic prostatitis and sexual dysfunction in patients with inflammation of the prostate gland (M. Litwin et. al., 1999; J. C. Nickel, 2003; A. Schaffer et al., 2003; B. Burger et al. , 1999; A. Mehic et al., 2001).

There have been a significant number of reports that prostatitis not only causes pain and urinary problems, but also leads to various sexual disorders (R. Alexander, 1996; J. Krieger, 1984; J. Krieger, 1996; R. Roberts, 1997). Beutel et al (2004) showed that erectile dysfunction in patients with chronic prostatitis is more common in combination with chronic pain syndrome (pelvic, back pain, joint pain).

According to scientists, sexual disorders are quite common (in 52% of men with prostatitis) (Keltikangas-Jarvmen and et al., 1981). According to the results of a study conducted by A. Memk et al (2001), 43% of patients complained of periodic or constant erectile dysfunction, and 24% complained of decreased libido.

Berghuis et al (1996) report less frequent sexual intercourse in 85% of patients with prostatitis (sometimes it is difficult to know what comes first, since infrequent sexual intercourse itself can lead to prostatitis). It has been shown that existing sexual relationships in some cases worsen or are broken (in 67% of patients), and new relationships are more difficult to form or do not arise at all (in 43% of patients). Interpersonal relationships in marriage are disrupted in 17.1% of cases, relationships with relatives and friends - in 7.3% of patients (A. Mehik et al., 2001). There is an increase in the frequency of homosexual intercourse in people with prostatitis, which can be explained by a decrease in masculinity and confidence in a satisfactory erection during sexual intercourse with a person of the opposite sex (Keltikangas-Jarvinen et al., 1989). V. V. Krishtal and co-authors (1979, 1989), Cjrriere and co-authors (1997) indicate that the sexual dysfunction observed in patients with chronic prostatitis depends on the nature of the sexual constitution of the patients.

Morita (1995) believes that the pathology of the prostate gland leads to a disruption of the sensitivity of the receptor apparatus of the penis, which, in turn, entails a disorder in the functioning of the spinal sexual centers.

So, does chronic prostatitis cause sexual dysfunction? To answer this question, let us consider the nature of the individual components of the copulatory cycle.

I. P. Pavlov (1927) notes that libido is an unconditioned reflex that already exists at birth in a latent form and is activated under the influence of the external environment.

In modern literature, the concept of “libido” includes two components: neurohumoral (energetic) and quite closely related to it cortical (conditioned reflex). This dual relationship makes it possible to regulate the congruence of partners in sexual situations (G. S. Vasilchenko, 1977, 1990). G. S. Vasilchenko divides the arousal phase into mental and erection stages. It is at the mental stage that sexual dominance arises - a system temporarily dominant in the cerebral cortex, which attracts excitation from other nerve centers, while simultaneously suppressing their activity.

It is considered an axiom that congestion of the prostate gland predisposes it to inflammation. Among the causes of congestion are sexual disorders and dysrhythmia of sexual life. A. J. Leader (1958) states that “the root cause of vesiculoprostatitis is repeated sexual stimulation without physiological emptying of secretions.” According to M. Enfedzhiev (1955), prolonged sexual abstinence, leading to retention of secretions in the prostate gland, may be the cause of its aseptic inflammation. However, other authors refute this point of view (M. L. Korikov, 1962).

The influence of increased sexual activity (masturbation, sexual excesses) on prostate function is unanimously recognized as the most likely etiological factor in the occurrence of pathological processes in the gland. At the same time, a number of authors (G. S. Vasilchenko, 1990; Ransley et al., 1992) adhere to a different point of view, citing the fact that physiologically no one has ever managed to produce persistent and irreversible destruction in any innervated system , using as a pathogenic factor a specific form of activity characteristic of a given system.

Psychopathological burden is detected in approximately 75% of patients (A. A. Kamalov, V. A. Kovalev, S. V. Koroleva, E. A. Efremov, 2001) suffering from chronic prostatitis. In 60.2% of patients, psychopathological burden precedes a sexual disorder, and in 17.8%, psychoneurological symptoms arise during long-term and ineffective treatment of the underlying disease and introduce certain specifics into the clinic of sexual disorders. The data obtained convince us of the need for more active identification and assessment of changes in mental status in patients with chronic prostatitis. Timely and targeted correction mental disorders in case of chronic prostatitis, it prevents the development of more severe mental disorders and allows for more successful treatment of somatic diseases. Such disorders are based on the fear and anxiety that patients develop about their condition, fear possible consequences. Back in the 19th century. Russian psychiatrists Kovalevsky and Popov introduced the concept of “psychotraumatic neurasthenia of survivors.” A vicious circle is created - the patient’s fear for a certain organ is reflected in the function of the latter, and increasing functional disorders further aggravate the fears.

In the public consciousness, erection appears as the main element of the sexual cycle. This situation becomes dangerous in people of an anxious and suspicious nature. The slightest deviations from the speed of erection, the degree of tension, its duration, etc. are perceived exaggeratedly, as serious illness. There is increased attention to the erection, fixation on it, and a “syndrome of anxious expectation of failure” is formed (A. M. Svyadoshch). In persons of the hypochondriacal type, in addition to fixation, hypochondriacal personality development can be observed, and fear can also affect other functions of the body. Erectile disorders observed in chronic prostatitis should be considered in the structure of asthenic, anxiety-hypochondriacal, asthenohypochondriacal, astheno-depressive syndromes, as well as hypochondriacal and depressive states in their pure form. As a rule, these conditions do not require special correction with psychotropic drugs. It is often enough to conduct an explanatory conversation, prescribe biogenic stimulants, adaptogens, a course of therapy using modern phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil), as well as impase. A good clinical effect is observed when using acupuncture.

The characteristics of patients with long-term chronic prostatitis include hypochondriacal readiness and fixation of the slightest sensations in the genitals. The presence of anxious depression in patients is evidenced by obsessive (i.e., dominant in consciousness and uncontrollable) thoughts of alarming content about one’s masculine, and therefore human, inferiority, about the incurability of the disease and the futility of treatment, about the inevitable loss of family well-being. Anxiety and fear for one’s condition determine any actions and almost every step of patients, whose behavior can be classified as “going into illness out of touch with reality.” This category of people is characterized by a tendency towards self-diagnosis and self-medication. The clinical picture of anxious depression includes sleep and appetite disorders typical for these patients, and vegetative symptoms are noted - increased sweating, pulse lability. According to our observations, sexual disorders: decreased libido (40%), decreased frequency and strength of spontaneous erections (15%), weakened adequate erections (30%) - should be considered as an inevitable manifestation of affective disorders.

Disguised depression with a predominance of sexual disorders is accompanied by complaints of accelerated or delayed ejaculation in combination with a weakened erection, and less often - a decrease in sexual desire and the severity of orgasmic sensations. Sexual disorders, as patients note, greatly complicate family relationships and often become the cause of quarrels and even divorce. During the examination, along with somatovegetative disorders characteristic of the depressive phase, signs of congestion in the prostate gland are revealed. Sexual disorders in masked depression also occur periodically (often seasonally), have daily fluctuations in intensity, are closely related to somatovegetative disorders, and are relatively resistant to psychostimulants, therapy with male sex hormones, and psychotherapy. Conversely, there is a clear positive reaction to antidepressant therapy. Often the disorders disappear spontaneously.

The topic of sexual pathology is often heard in the statements of patients with a neurosis-like form of depression, indirectly caused by various chronic forms prostatopathies. Along with depressive and asthenoneurotic conditions, erectile disorders are caused by the syndrome of anxious anticipation of failure, which occurs after one or more unsuccessful attempts coitus.

Initially, sexual disorders with uncomplicated prostatitis are manifested by a relative acceleration of ejaculation and weariness, painfulness of orgasmic sensations. As for changes in other phases of the copulatory cycle, their disturbances can be explained by concomitant pathology. Thus, a decrease in libido can have two origins. Firstly, a prolonged and painful inflammatory process, accompanied by accelerated ejaculation and smoother orgasm, can lead to a purely psychogenic decrease in libido.

Secondly, in many patients, chronic prostatitis entails a decrease in androgen saturation, which can be clinically manifested by a decrease in libido. The same mechanisms may explain the decrease in erection. The change in orgasmic sensations is due to the fact that in approximately 1/3 of patients, chronic prostatitis is combined with posterior urethritis and colliculitis, and the areas of the seminal tubercle are the place where the feeling of orgasm arises when the seed is ejected through the narrow ejaculatory orifices. A chronic, sluggish process in the urethroprostatic zone leads to constant irritation of the seminal tubercle with afferent impulses to the spinal genital centers. Clinically, this is manifested by prolonged, inadequate nocturnal erections, and then their weakening due to functional depletion of the erection center (I. F. Yunda, 1981; G. S. Vasilchenko, 1990).

Genesis of erectile disorders during exacerbations of chronic prostatitis with predominance pain syndrome, in addition to the psychogenic inhibitor - pain, also includes reflexogenic mechanisms. The painful orgasm characteristic of prostatopathy/prostatitis with more or less prolonged postorgastic pain sensations also has a certain depotentiating effect.

Sexual dysfunction in chronic prostatitis is accompanied by dysfunction of the autonomic nervous system. Due to an imbalance of the sympathetic and parasympathetic nervous system and inhibition of the spinal erection centers, some patients note a weakening and even disappearance of spontaneous (morning) erection. Some patients experience a change in the “color” of orgasm - from dull or painful to anorgasmia. Chronic prostatitis can act as a predisposing factor to the development of sexual disorders, as well as a provoking (“triggering”) and aggravating (secondary to sexual dysfunction) factor.

The works of L. P. Imshinetskaya, I. I. Gorpinchenko (1980), I. F. Yunda (1984), G. S. Vasilchenko et al. (1990) made it possible to establish that the pathogenesis of changes in the prostate in patients with sexual disorders is determined by complex interaction of endogenous and exogenous factors, the leading role among which is played by neuroendocrine disorders.

Currently, regarding the pathogenesis of sexual disorders in prostatitis, there is an opinion according to which the formation of erectile dysfunction in persons suffering from prostate diseases is caused by disturbances of androgenic function and other endocrine changes, entailing a disorder of the neurohumoral regulation of the sexual sphere. The decline of sexual function is accompanied by a gradual weakening of the conditioned reflex mechanisms of sexual activity, which further aggravates the disorder of the copulatory cycle (D. L. Burtyansky, V. V. Krishtal 1973, 1978, 1985; L. A. Bondarenko, 1977).

The functional state of the prostate gland, as shown by the work of recent decades (V. A. Samsonov, 1981; Chelsky, 1992), is determined by complex hormonal control, in which a significant role is played by the diencephalic-pituitary-gonadal connections. The prostate has a high degree of sensitivity to a variety of hormonal influences, both endogenous and exogenous. Along with hormonal regulation sexual function in recent years, the presence of neuronal regulation has been revealed, carried out at the cerebral level by compounds called neurotransmitters. They regulate and modulate the influence of sex hormones on all parts of male and female sexuality. The mechanisms of action of a number of neurotransmitters are currently not fully understood.

Thus, such a purely somatic and objectively recorded disease as prostatitis arises in this case as a result of chronic (unending) psycho-emotional stress and somatic changes, i.e. it develops according to psychosomatic mechanisms. The described psychosomatic variant of prostatitis is not the only one. Undoubtedly, there are purely infectious, traumatic and other clinical forms prostatitis, as well as non-psychosomatic variants of formation hypertension, stomach ulcers, colitis and other pathologies. Simplified ideas about the nature of the disease (prostatitis as a result of infection) lead to the fact that treatment is not focused on working with psychosomatic pathogenetic mechanisms. The same psychosomatic mechanisms also occur in prostate pathology, which is designated as prostatopathy or prostatodynia (prostatosis, congestive prostatitis, chronic pelvic pain syndrome, etc. In this case, the described psychosomatic changes in the prostate occur (spasticity, dysfunction), although the infection has not manifested itself and there is no inflammation clinic.

As for sexual disorders attributed to prostatitis and prostatopathies, the linear diagram (sexual disorders as a result of prostatitis) seems incomplete, especially since the persistence of sexual disorders after prostate sanitation is often encountered in practice. We consider both prostatitis and sexual disorders to be two independent parallel consequences of a single psychosomatic disorder. The higher the level of sympathotonia, the faster ejaculation will occur, since the first phase of ejaculation (the triggering phase) is the sympathetic phase. Orgasm (according to W. Masters and V. Johnson) serves as a release from general and local myotonia growing in the process of excitation. The higher the initial myotonia (spasticity), the faster ejaculation will occur. Thus, these mechanisms explain the reasons accelerated ejaculation, which can be considered not the result of prostatitis, but a parallel consequence of their common psychosomatic causes.

It is not the inflammation of the prostate itself that leads to impaired libido and erection, but the deficiency of testosterone that occurs during stress and the blockade of its tissue receptors (in the prostate, throughout the body and in the deep parts of the brain) by an excess of adrenal hormones. And these are no longer infectious, but endocrine mechanisms. The spastic state of the vessels of the penis will worsen erection through vascular mechanisms, and a complex of negative emotions under chronic stress will reduce sexuality through mental mechanisms.

In patients with psychosomatic prostatitis and sexual disorders, the weak somatic link is the reproductive system (weak sexual constitution, low tissue sensitivity to testosterone, weakened neurological support for sexual function, low vascular reserves for sexual reactions, etc.). Psychological factors include increased focus on the reproductive system, sexual fears, and uncertainty about potency, which are caused by intrapersonal problems. However, the described psychosomatic disorder (with a psychosomatic variant of prostatitis and sexual disorders) requires more complete and conscious work with the listed pathogenetic mechanisms. We believe that it is the psychosomatic model that allows us to better understand the mechanisms of the formation of prostatitis, sexual disorders and their relationship, as well as more effectively eliminate both by acting on the common causes that lead to them.

Based on the belief that erectile disorders are a consequence of chronic prostatitis, without delving into the nature of erectile disorders and without taking into account the psychological characteristics of the individual, the doctor subjects the patient to a significant amount of research, prescribes long courses of treatment, which in most cases does not lead to solving problems in the sexual sphere . The lack of effect from treatment significantly aggravates the course of erectile dysfunction due to the negative psychogenic influence, which increases with a negative result of treatment or inadequate assessment by both the patient and the doctor of the relationship between the goals of therapy and its expected results.

At the same time, a detailed functional and neurological examination of patients with chronic abacterial prostatitis/chronic pelvic pain syndrome, especially NIH-IIIB category, often reveals the presence of neurologically caused dysfunctions of the pelvic floor and lower muscles. urinary tract. Therefore, in our opinion, in patients with erectile dysfunction accompanying chronic abacterial prostatitis, it is necessary to take into account the possibility of the presence of hidden neurological diseases of the central or peripheral nervous system, which can lead to the development of symptoms of dysfunction of the lower urinary tract, pelvic pain and erectile dysfunction. We also believe that patients with chronic pelvic pain syndrome of non-inflammatory origin (chronic abacterial prostatitis IIIB) should undergo a detailed examination using functional diagnostic methods, including a combined urodynamic study with determination of the state of the pelvic floor and electromyography, as well as pharmacological tests for registration response of smooth muscle structures responsible for the occurrence and maintenance of an erection.

Among the first symptoms of sexual disorders with prostatitis are premature ejaculation (I. I. Gorpinchenko, 1977; T. D. Epperly, K. E. Moore, 2000), painful orgasm (J. H. Ku et al., 2002; J. N. Krieger, 1996). E. Screponi (2003) revealed the presence of inflammation of the prostate gland in 56.5% of patients with premature ejaculation. Pain during ejaculation in patients with prostatitis is observed much more often than in patients with benign prostatic hyperplasia or erectile dysfunction (J. N. Krieger, 1996). Disorders of orgasm and ejaculation are considered among the main symptoms of the interoreceptive form of copulative dysfunction (I. I. Gorpinchenko, 1997). Ejaculation disorders can be explained by increased sensitivity of interoreceptors and high tone of a1-adrenoreceptors (G. A. Barbalias et al., 1983), since the sympathetic nervous system is primarily responsible for the phenomenon of ejaculation. Premature ejaculation can also be caused by the neurotic state of patients with clinical picture hypersthenic neurasthenia.

Too intense preparation for sexual intercourse with preliminary erotic ideas can ultimately lead to a kind of “psychic copulation” that precedes the real one; The very first touch to a woman is enough to trigger the corresponding reflex. All kinds of fears, which ultimately cause coitophobia, contribute to the accelerated course of the reflex processes of erection and ejaculation. The fixation on accelerated ejaculation, which grows from failure to failure (like a neurosis of expectation with an ever greater decrease in mood in anticipation of the next “failure”), brings these patients to the point that sometimes they only have to think at the beginning of sexual intercourse about the possibility of premature ejaculation, and it immediately the same occurs (K. Wenniger et al., 1996).

Soreness or weariness of orgasm is caused by inflammation of the seminal tubercle, which is a powerful receptive zone and is responsible for the severity of orgasmic sensations, although it is not always diagnosed separately from inflammation of the prostate gland.

As for libido, its weakening can occur on a psychogenic basis - due to depression and increased anxiety of the patient, impaired orgasm and secondary weakening of erection. The patient, fearing a fiasco, consciously and subconsciously avoids sexual intercourse. In addition, according to some data (L. P. Imshinetskaya, 1982; T. N. Vakina et al., 2003), this phenomenon can be explained by hypoandrogenism inherent in patients with prolonged prostatitis. According to researchers, the prostate gland and the testicle are in a positive correlative relationship, and if the functioning of one of the organs is disrupted, the other also suffers, in this case the testicle, which produces less androgens. On the other hand, the prostate gland is an organ responsible for the metabolism of sex hormones, which can be disrupted when it is diseased.

Sexual disorders in patients with chronic prostatitis can develop in stages, according to a certain pattern. First, premature ejaculation appears, then insufficient adequate erection occurs, and then a change in libido may develop. In some cases, there is an increase in nocturnal erections due to increased hyperemia of the prostate gland (V.N. Tkachuk et al., 1989). Although this phasing is not always preserved and it is most often not possible to trace it in the same patient.

Sexual health, in addition, if we take into account the multidimensionality of its provision, is itself a psychosomatic phenomenon and can serve as a kind of model of psychosomatic relationships. The role of the trigger in sexual health disorders is played by psychogenic somatogenic or sociogenic factors, in this case the symptoms of prostatitis/chronic pelvic pain syndrome, complaints regarding sexual function. The prevailing opinion in society (often supported by doctors) about the inevitability of the development of “impotence” is also important.

It has been established that psycho-emotional problems (anxiety, depression, emotional lability, weak masculine identification) are detected in 80% of patients, and symptoms of severe disorders are detected in 20-50% of patients (L. Keltikangas-Jarvinen et al., 1981, 1982, 1989 ; J. de la Rosette, 1992, 1993; J. P. Berghuis et al., 1996). All this contributes to the development of somatic pathology (pain, dysuria, decreased erection, ejaculation disorders). These disturbances support distress and themselves turn into psychotrauma, thus closing a vicious circle.

The nature and changes in psychosomatic relationships in this case also depend primarily on the personality characteristics of the patient. As a result of personal processing of the situation, the patient either overcomes stress, which contributes to the success of treatment, rehabilitation and restoration of sexual harmony of the spouses, or the disease worsens, and often some complications develop, which, as in the previous case, leads to the formation of a vicious circle (B . V. Krishtal, M. V. Markova, 2002).

Thus, from the above, the following conclusions can be drawn.

The cause of sexual disorders in prostatitis is primarily psychosomatic disorders, depression, and anxious and suspicious personality traits. They sometimes cause or support the presence of complaints characteristic of chronic pelvic pain syndrome/prostatodynia.
Often, infrequent sex life itself leads to stagnation and causes a predisposition to prostatitis.
Manifestations of chronic pelvic pain syndrome may include premature ejaculation and painful orgasm, which negatively affect erectile function.
A direct correlative relationship between chronic prostatitis and erectile dysfunction has not been identified. Damage to the erectile component of the copulatory cycle in chronic prostatitis is no greater, and in some cases even less pronounced, than in chronic somatic diseases of other localizations. At the same time, the localization of the pathological process and its clinical manifestations determine a number of disorders of the sexual sphere, mainly on a psychosomatic basis.
When treating sexual disorders that arise against the background of chronic prostatitis, it should be remembered that the disappearance of complaints associated with prostatitis leads to a decrease in the impact of psychological trauma on the body and creates the prerequisites for the correction of erectile dysfunction. However, impaired functions do not always recover on their own, and in addition to medication, psychotherapeutic intervention is often necessary.
It is necessary to take into account that sexual disorders and the causes of their occurrence can exist on their own, and chronic prostatitis only aggravates the patient’s condition. In this case, diagnosis and treatment of sexual disorder must be carried out in parallel with the treatment of chronic pelvic pain syndrome.
Accelerated ejaculation and painful orgasmic sensations often disappear as chronic prostatitis heals. If necessary, standard treatment can be supported by special methods (anesthetic gel, shading of the seminal tubercle, sex therapy, etc.).

Thus, the treatment of sexual disorders in chronic prostatitis should be comprehensive. Undoubtedly, its pathogenetic basis is drug therapy (antibacterial, anti-inflammatory, improving microcirculation, symptomatic, etc.), methods of physical influence (magnetic laser therapy, hyperthermia, phonophoresis, prostate massage, etc.) and reflexology for the treatment of the underlying disease. We believe that the above treatment methods can be successfully combined with therapy aimed at improving sexual function, which involves three types of influences.

Correction of erectile dysfunction (modern phosphodiesterase-5 inhibitors, ultra-low dose drugs (impaza), biogenic stimulants).
The use of psychotropic drugs (anxiolytics, tranquilizers and antidepressants) and psychotherapeutic methods.
Correction of hormonal disorders (synthetic analogues of testosterone, antiestrogens, drugs that reduce the level of prolactin in the blood plasma).

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E. A. Efremov, Candidate of Medical Sciences
S. D. Dorofeev,Candidate of Medical Sciences
S. M. Panyushkin
D. A. Bedretdinova
Research Institute of Urology, Moscow

Neurogenic complications of chronic prostatitis.

Chronic inflammation of the prostate gland, as an organ extremely abundantly supplied with nerve-receptor elements and having many nerve anastomoses with neighboring organs, cannot but affect the function of these organs to one degree or another. V.P. Ilyinsky (1925) emphasized that the prostate gland has a diverse effect on the functions of the body (“the second heart of a man”), and with its diseases, various painful conditions sometimes arise both in the whole organism and in individual systems.

Therefore, reflexively caused functional disorders of urination, sexual function, various paresthesias and pain should not be considered complications in the strict sense of the word. Rather, they belong to the usual symptoms of prostatitis (see Chapter 4). Their list should, perhaps, be supplemented with a long-term reflex spasm (“blockade”) of the bladder neck. This relatively rare complication of prostatitis sometimes results in ascending infection (cystopyelitis, pyelonephritis) or congestion with the formation of hydrourethritis and hydronephrosis.

However, real complications of a neurogenic (more precisely, psychogenic) nature include those that often develop in patients with chronic prostatitis neurotic disorders. They were noticed by many researchers at the dawn of the development of the study of prostatitis. For example, Drobny in 1907 called his work “Chronic prostatitis as an etiological factor of neurasthenia.” B.N. Kholtsov (1909) wrote that, alarmed by the duration of the disease and unsatisfactory results of treatment, patients with chronic prostatitis fixate on their illness, retreat into illness, and exaggerate the disorders they have. As a result, they develop neurasthenia, which is expressed not only by local (impaired urination, sexual dysfunction, paresthesia and pain), but also by general nervous disorders (dejection, deep melancholy). According to M. Junk-Overbeck et al. (1988) and M. Deinhart (1993), pain in the lower extremities observed in such patients against the background of general asthenia was a manifestation of affective depression.

Patients with chronic prostatitis are characterized as emotionally unstable, depressive, aggressive, impulsive individuals, often having problems in relationships with partners, anxious, and introverted. In this case, the depression factor plays a major role.

As L. Keltikangas-Jarvinen et al. point out. (1989), many patients with chronic prostatitis suffered from impotence, informed the doctor about the presence of bi- and homosexual contacts, latent homosexuality and other sexual problems that either existed before or appeared during the illness.

Of all the symptoms of chronic prostatitis, the most painful impression on such patients is made by prostatorrhea and spermatorrhea, in which they see direct evidence of loss of sexual ability. Especially often, according to I.F. Junda et al. (1988), sexual disorders are observed in patients with chronic Trichomonas prostatitis. The course of sexual disorder in such patients was undulating; in the first stages of pathology development, increased sexual desire and accelerated ejaculation were more often observed due to overirritation by the inflammatory process of the posterior urethra and seminal tubercle. Later, erectile function and libido disturbances occurred; long-term inflammatory processes in the gland, as a rule, were accompanied by a decrease in its functional activity, which induced a decrease in the endocrine function of the testicles. This occurred as a type of correlative hypogonadism with changes in the peripheral and pituitary parts of the reproductive system and could be one of the reasons for the decrease in libido and sexual activity. The torpid course of trichomoniasis, frequent relapses, and genitalgia caused the patient’s attention to be fixed on the state of the genital organs and their function, general asthenia, and provoked the manifestation of accentuated personality traits, complicating the structure of the sexual disorder. Sexual disorders in genitourinary trichomoniasis occurred within the framework of interoreceptive-psychic, mixed sexual dysfunction.

Developing neurosis often comes to the fore in the clinic of chronic prostatitis, and the own symptoms of inflammation of the prostate gland often no longer attract the attention of such patients. They develop general vegetative disorders typical for secondary neurasthenic syndrome: fatigue, decreased performance, cardiovascular disorders, gastrointestinal dyskinesia, etc.

One of the factors in the development of secondary neurasthenic syndrome in chronic prostatitis may be stress.

N.S. Miller (1988) considered stress (intense workload leading to asthenia; anxiety, etc.) as an etiological factor of chronic prostatitis and treated patients with “stress prostatitis” with anti-stress therapy methods.

Despite the recognition by most researchers of the important role of the neurogenic factor in the development of chronic prostatitis, attempts to differentiate chronic bacterial prostatitis from chronic abacterial prostatitis using psychodynamic and psychometric examination methods have not been successful. Also, the hypothesis about the greater severity of psychoneurotic disorders in patients with prostatodynia compared with patients with chronic prostatitis was not confirmed. It turned out that patients with chronic prostatitis and prostatodynia have approximately the same high frequency of neurotic and general psychosomatic complaints compared to healthy people. The same studies showed that taking antibiotics can lead to the disappearance of clinical signs of chronic prostatitis, but does not guarantee the cessation of psychosomatic complaints. Taking this into account, E. Brahler and W. Weidner (1989) recommend including psychosomatic and somatopsychic drugs in the complex treatment of patients with chronic prostatitis, which should lead to a decrease in anxiety and help the patient cope with the symptoms of the disease, since, according to the hypothesis of M. Junk-Overbeck et al. (1988), emotional depression and persistence of symptoms of chronic prostatitis reinforce each other.

When treating chronic prostatitis, the entire arsenal of means should be used to prevent iatrogenic fixation of the patient’s attention on individual symptoms of the disease.