Prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome

The aim of this study was to assess the prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome.

A group of 399 patients with symptoms suggesting prostatitis without urethral discharge attending an outpatient Prostatitis Clinic was considered. All were evaluated by the same urologist according to a protocol comprising medical history, physical and transrectal ultrasound examination. Patients had a urethral swab, a four-specimen study and culture of the seminal fluid. Patients were classified according to NIDDK/NIH on the basis of the results of the microbiologic and microscopic four-specimen study and of the culture of the seminal fluid. Subjective symptoms were scored by CPSI questionnaire and by non validated general assessment questions inquiring loss of libido, quality of erection, premature loss of erection, pain on ejaculation, hemo-spermia, pyo-spermia, premature ejaculation, and presence of semen abnormalities.

Of all the patients evaluated, 138 (34%) had erectile and 220 ejaculatory dysfunctions (55%). Loss of libido, premature ejaculation and presence of semen abnormalities were more frequent in subjects younger than 50 years. Rates of impaired erection and of semen abnormalities were significantly higher in patients with bacterial chronic prostatitis with respect to patients with chronic pelvic pain syndrome. Premature ejaculation was more frequent (p = 0.02) in patients with 10-30 leukocytes (36%) or > 30 leukocytes (32%) in VB3 urine than in those with 10 or less leukocytes (22%). Painful ejaculation was significantly associated to the sonographic demonstration of enlargement (p = 0.000), asymmetry (p = 0.001) or inflammatory changes (p = 0.038) of the seminal vesicles, whereas hemo-spermia was significantly associated to asymmetry (p = 0.000) or inflammatory changes (p = 0.013, respectively) of the seminal vesicles. Men with erectile (p = 0.001) and ejaculation dysfunction (p = 0.001) had more severe CPSI scores than men without such complaints. The presence of erectile and ejaculation dysfunction was related to significantly higher scores for domains of pain and quality of life.

Although mental distress and impaired quality of life related to illness could contribute to sexual dysfunction observed in patients with CP/CPPS, the presence of erectile and ejaculatory disorders is more frequently related to symptoms and imaging suggestive of a more severe inflammatory condition.