Sexual Dysfunction: Insights on Prostatitis and Treatment Options - Urology

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Understanding sexual dysfunction, particularly in relation to prostatitis, can be complex and often requires a multifaceted approach to diagnosis and treatment. Your concerns about the potential diagnosis of prostatitis and the treatment options available are valid, especially given the varying opinions from different healthcare providers.

Firstly, it’s essential to clarify the relationship between sexual dysfunction and prostatitis. Prostatitis, which can be either bacterial or non-bacterial, is known to cause symptoms such as pelvic pain, urinary issues, and sexual dysfunction, including erectile difficulties and changes in ejaculation. The psychological aspect of sexual dysfunction cannot be overlooked, as anxiety and stress related to sexual performance can exacerbate physical symptoms.

From your description, it seems that you have experienced a range of symptoms following an episode of "holding back" ejaculation, which you refer to as "憋精." This practice, while sometimes used as a technique to manage premature ejaculation, can lead to discomfort or dysfunction if done excessively or improperly. The medical community does recognize that excessive retention can lead to pelvic floor tension and discomfort, which may contribute to sexual dysfunction. However, the extent to which this practice affects sexual health can vary significantly among individuals.

Regarding your experiences with different doctors, it's not uncommon for patients to receive varying opinions on their condition. The diagnosis of prostatitis, particularly chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), can be challenging. The standard diagnostic approach often includes a thorough history, physical examination (including a prostate exam), and sometimes urine tests or prostate secretions. However, as you noted, many doctors may not follow the rigorous testing protocols that involve multiple urine samples or prostate fluid analysis, which can lead to frustration for patients seeking clarity.

The concern about over-treatment with antibiotics is also valid. Antibiotics are typically prescribed for bacterial prostatitis, which is relatively rare, accounting for only about 5-10% of all prostatitis cases. If your symptoms are not due to a bacterial infection, prolonged antibiotic use could lead to unnecessary side effects and contribute to antibiotic resistance. The choice of antibiotic can depend on the suspected causative organism, and while doxycycline and levofloxacin are commonly used, the effectiveness of these medications can vary based on the specific bacteria involved.

In terms of treatment, if prostatitis is confirmed or highly suspected, the choice of antibiotic should ideally be guided by culture results and sensitivity testing. If your doctor has prescribed a specific antibiotic, it’s essential to discuss any concerns about its appropriateness and duration of treatment. If you are experiencing side effects or if your symptoms persist despite treatment, seeking a second opinion or returning to your healthcare provider for further discussion is advisable.

Additionally, lifestyle modifications can play a significant role in managing prostatitis symptoms. Regular exercise, pelvic floor physical therapy, and stress management techniques can help alleviate symptoms. It's also crucial to maintain open communication with your healthcare providers about your symptoms and any changes you experience during treatment.

In conclusion, while navigating the complexities of prostatitis and sexual dysfunction can be challenging, it is essential to advocate for your health. Ensure that you are receiving a comprehensive evaluation and that any treatment plan is tailored to your specific needs. If you feel uncertain about the advice given, don’t hesitate to seek further opinions or consult specialists in urology or sexual medicine who may provide more targeted insights into your condition.