Premature ejaculation and chronic prostatitis

A.A. Kamalov et al. (2000) believe that sexual dysfunction in patients with chronic prostatitis is characterized by a staged development that corresponds to the course of the inflammatory process. First, there is premature ejaculation (or accelerated compared to previous indicators), then the quality of adequate erections deteriorates, and then the libido decreases. Ejaculation disorder is sometimes combined with soreness of orgasmic sensations. In a number of cases, there is an increase in nocturnal erections due to increased hyperemia of the prostate. Change in orgasmic sensations is due to the fact that in about 1/3 of patients chronic prostatitis is combined with posterior urethritis and colliculitis, and the zones of the seminal tubercle are the place where the sensation of orgasm arises when the seed is ejected through narrow ejaculatory eaves. A chronic sluggish process in the urethroprostatic zone leads to a constant irritation of the seminal tubercle with afferent impulsation into the spinal sexual centers. Clinically, this is manifested by prolonged inadequate nocturnal erections, and then by their weakening due to functional exhaustion of the erection center.

One of the most common types of sexual disorders in chronic prostatitis is premature ejaculation. According to OB Loran et al. (1996), out of 420 patients with chronic prostatitis, 35% had premature ejaculation, and half of them with urethroscopy also showed a characteristic pattern of colliculitis. Liang S.Z. Et al. (2004) found PE in 26% of patients on chronic prostatitis of Chinese. E. Screponi et al. (2001), E. Jannini et al., (2002) also associate premature ejaculation with the inflammatory process in the prostate: the authors detected chronic prostatitis in 56.5% of patients with premature ejaculation, of which bacterial prostatitis - in 47,8% of patients.

With chronic inflammation of the prostate, the back of the urethra and the seminal tubercle, the sensitivity of the peripheral nerve endings is disturbed, which by a reflex path leads to changes in the excitability of the corresponding spinal centers. Thus, premature ejaculation, resulting from urological diseases, is closely related to spinal premature ejaculation, only in the first case the spinal sexual centers are involved in the process by a secondary reflex pathway.

Some authors point out the presence of signs of erectile dysfunction in patients with chronic prostatitis in 60-72% of cases, which is significantly higher than that in the general population. However, damage to the erectile component of the copulatory cycle in chronic prostatitis is no more, and in some cases even less pronounced than in chronic somatic diseases of other localization. According to A.L. Vertkina and Yu.S. Polupanova (2005), the frequency of erectile dysfunction in hypertensive disease is 35.2%, with coronary heart disease - 50.7%, with type I diabetes - 47.6%, type II - 59.2%.

Berghuis JP et al. (1996) reported that prostatitis leads to a reduction in the incidence of sexual intercourse in 85% of patients, prevents or leads to the termination of sexual relationships (67%) and prevents the establishment of new sexual relations in 43% of cases. The reason for this is hypochondria, depression and hysteria, which are more often manifested in patients on chronic prostatitis of an autoimmune nature.

As for the libido, its weakening can occur on a psychogenic basis in connection with depression and increased anxiety of the patient, a violation of orgasm and a secondary easing of the erection. The patient, fearing a fiasco, deliberately and unconsciously avoids sexual intimacy. In addition, this phenomenon can be explained by the hypoandrogenism inherent in patients with protracted prostatitis, according to some data. According to the researchers, the prostate gland and testicle are in a positive correlation, and if one of the organs is violated, another one suffers. In this case, the testicle produces less androgen. On the other hand, the prostate is the organ responsible for the metabolism of sex hormones, which can be disturbed by the disease of the gland.

Scientists examined 638 patients for chronic prostatitis of infectious nature and non-infectious prostatitis aged 19 to 60 years (an average of 36.1 + 11.9). Of these, 216 people (33.9%) presented complaints about various sexual disorders. Among these 216 patients, 32 complained of a decrease in libido (14.8% of patients with sexual disorders and 5% of all patients with chronic prostatitis). The deterioration of the quality of erection was revealed in 134 patients (62 and 21%, respectively), including a deterioration in the quality of spontaneous and adequate erections in 86 people (39.8 and 13.47%) and a deterioration in the quality of adequate erections in 48 people (22.2 and 7.5%).

Eighty patients complained of accelerated ejaculation (41.7% and 14.1%). 8 patients (1.25 and 3.70%) had an erasure of the emotional color of orgasm, in 1 patient (0.46 and 0.16%) - complete absence of orgasm.

Traditionally, the main sexual disorder, the most disturbing man, is erectile dysfunction. Accordingly, the efforts of the pharmaceutical and medical industry, research has focused mainly on the improvement / recovery of erection. Admittedly, the successes in this field have been impressive: with rare exceptions, erectile function can be restored in one way or another. However, sexual intercourse can not be reduced only to an erection, it includes both attraction (libido), and ejaculation - the expression of orgasm. Unfortunately, these two components of sexual intercourse are not given enough attention. As a result, we often have a patient with a great erection, but, nevertheless, unsatisfied with his sexual life.

The main parameter in the definition of premature ejaculation is IELT-the time interval between the introduction of the penis into the vagina and the onset of ejaculation. A clear and unambiguous definition of premature ejaculation as a pathological condition does not exist. One of the first definitions was suggested by American sexologists Masters and Johnson in 1970, who regarded ejaculation as premature if it came before the woman got orgasm in 50% of cases and the bowl.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), issued by the American Psychiatric Association (1994), suggests the following definition of premature ejaculation: "Persistent or recurring ejaculation with minimal sexual arousal during or shortly after the introduction of the penis into the vagina before partners would like to; this state causes them inconvenience and anxiety, breaks the relationship. " However, it is not specified, which means "repeating" - every 2, 5, 7 times? "Minimal sexual stimulation" for each pair of its own, "soon after" - when exactly, "causes anxiety" - is very individual.

This uncertainty is also present in the guidelines for the premature ejaculation of the American Urological Association (2004), in which premature ejaculation is "ejaculation that occurred earlier than desired, before or shortly after insertion of a member into the vagina that harasses one or both partners."

In 1992, in the USA, a direct survey of 1,243 men aged 18 to 59 years found that 28 to 32% of them noted premature ejaculation; frequency depended on age, sexual habits, etc. When analyzing the answers to the questionnaires of 100 married men, premature ejaculation was noted in 36. According to Aschaka, S. Et al. (2001), 66 out of 307 patients experienced premature ejaculation at least once in their life.

Waldinger MD et al. (2005) regard premature ejaculation as neurobiological dysfunction with an unacceptably high risk of developing sexual and psychological problems throughout life. The authors measured the duration of the sexual intercourse with a stopwatch in 491 patients from five countries (Netherlands, United Kingdom, Spain, Turkey and the USA) and concluded that men with IELT of less than 1 min can be classified as "definitely" prematurely ejaculating, and with IELT from 1 to 1.5 min- to "possibly" suffering this. The degree of severity of premature ejaculation (absent, mild, moderate, severe) was suggested to be determined by the psychological state.

A wide range of figures is due to the lack of a clear definition and diagnostic criteria, the lack of quantitative expression of premature ejaculation. In other words, while we are unable to estimate the true prevalence of premature ejaculation in a population, although such a problem is obvious. Patients do not often consult a doctor with the problem of premature ejaculation due to shyness, ignorance of the possibilities of modern medicine, not understanding the danger of this disease. Premature ejaculation, of course, reduces sexual self-esteem, negatively affects family relationships. The quality of the sexual life of male partners with accelerated ejaculation, as a rule, is also lowered.

There is a primary premature ejaculation that has been observed since the onset of sexual activity; In the case of the formation of persistent premature ejaculation after several years of normal sexual life, one should speak about the acquired disease.

The most capacious characteristic of primary premature ejaculation was suggested by Waldinger MD et al. (2005) - as a set of the following symptoms:

• ejaculation occurs too early in almost every encounter;
• almost with any partner;
• marked with the first sexual experience;
• about 80% of sexual intercourses are completed in 30-60 seconds and in 20% of cases 1-2 minutes continue;
• the time of ejaculation is constant throughout life (70%) or even decreases with age (30%).

Some men have ejaculation already during the prelude, before the introduction of the penis into the vagina. Prospects of drug therapy in such cases are low, but sometimes you can achieve improvement.

Acquired (secondary) premature ejaculation has a different nature and depends on the patient's somatic and psychological state. As a rule, a man had a normal sexual life before, but at some point this disorder suddenly or gradually arose. The cause of acquired premature ejaculation may be urological diseases, especially erectile dysfunction and chronic prostatitis, thyroid dysfunction and other endocrine disorders, family problems, etc., so a patient with secondary premature ejaculation needs a comprehensive clinical and laboratory examination.

[1], [2], [3], [4], [5], [6], [7], [8]

Treatment of premature ejaculation

The acquired forms of premature ejaculation, like the primary ones, can be extremely severe, manifested by ejaculation already during prelude or at the time of entering the vagina, but the secondary disease can be cured.

• Daily intake of serotonergic drugs. Several controlled studies were conducted to study the effectiveness of daily intake of antidepressants: paroxetine, sertraline, clomipramine, fluoxetine. Meta-analysis has shown the absolute effectiveness of antidepressants in terms of lengthening IELT, but this method of treatment is fraught with serious side effects: increased fatigue, nausea, weight gain, decreased libido and erection.

However, daily intake of antidepressants is the method of choice in the treatment of primary premature ejaculation. Its advantage over the use of drugs "on demand" - the possibility of spontaneous intercourse. The effect usually comes to the end of the second week, but it is not known what percentage of men received a long course of treatment and what are the long-term results.

• Antidepressants "on demand." This method of treatment is devoted to only a few studies; since all of them are very different in methodology, it is impossible to make a unified conclusion about the results. The main disadvantage of taking the drug "on demand" is the need to accurately calculate the time of admission - for 4-6 hours before sexual intercourse.
• Local anesthesia. It is possible to apply on the head of the penis spray or ointment containing lidocaine, 15-20 minutes before the sexual intercourse. Although this method is known for a very long time, there have been practically no scientific studies to determine its effectiveness. Local anesthesia is not always effective, in some patients it causes irritation of the mucous membrane of the urethra, reduces the erection. However, this method should be recommended to patients who refuse to take antidepressants, and also as a first, trial treatment for those who first sought help.
• The use of "on demand" phosphodiesterase type V inhibitors (PDE-5). Several studies have shown the efficacy of this group of drugs in patients with premature ejaculation. However, the design of these has been studied and does not allow one to make an unambiguous conclusion; a double-blind, placebo-controlled study of the effect of PDE-5 inhibitors on the rate of onset of ejaculation is needed. The explanation of the mechanism of action through raising the ejaculation threshold appears speculative.
• Behavioral therapy. For a long time, premature ejaculation was seen as a psychological problem, and various special postures, a special technique for sex, were offered to solve it. However, there is no evidence of the effectiveness of these techniques, other than the personal experience of individuals.

None of the described treatments for premature ejaculation (antidepressants, PDE-5 inhibitors, local anesthesia) have been approved by the US Food and Drug Administration, since there are no randomized placebo-controlled trials demonstrating their effectiveness.

Thus, premature ejaculation occurs quite often and is very disturbing for the patient and his partner. However, there is still no effective and safe method of treatment.

An open, incomparable prospective study was conducted to determine the efficacy of domestic phytomedication prostanorms and phyto-nonsense in normalizing the neurophysiological parameters of the sexual act.

28 patients were monitored for chronic prostatitis aged 21 to 58 years, an average of 36.4 ± 5.7 years, also noted premature ejaculation. Duration of the disease is from 2 to 18 years, on average 4.8 ± 2.3 years. The frequency of exacerbations is 1-3 times a year. In all patients, before the disease with chronic prostatitis, there was a normal sexual act that satisfied the duration and quality of orgasm of both the patients themselves and their partners. At present, everyone complained about a decrease in sexual desire, acceleration of ejaculation, erasure of orgasm.

At admission and a month after the start of therapy, standard tests were conducted: a general blood test, a 3-glass urine sample, Nechiporenko's test, biochemical tests (blood sugar, cholesterol, bilirubin, transaminases), blood pressure monitoring. All patients underwent rectal examination with cautious prostate massage. Light microscopy of the native and Gram-stained secretion of the prostate secretion and its seeding for the detection of nonspecific microflora, detailed study of the ejaculate, PCR-diagnosis of the secretion and scraping of the mucous membrane of the urethra on DNA of the main sexual infections (chlamydia, mycoplasma, ureaplasma) were performed. The main parameters of the spermogram that were analyzed were the volume of the ejaculate, its viscosity, the number of spermatozoa, the specific gravity of mobile forms, the presence of an increased number of leukocytes and red blood cells in the ejaculate.

Also, patients independently completed a questionnaire on the evaluation of their sexual function. The severity of the sign was estimated by points (6 points):

• 0 - no indication;
• 1 - very poorly (very mildly expressed);
• 2 - bad (poorly expressed);
• 3 - satisfactory (moderately pronounced);
• 4 - good (well expressed);
• 5 - excellent (strongly pronounced).

All patients underwent the same treatment for 4 weeks: at 8.00 and at 14.00 - 0.5 teaspoon extract of prostaroma in water or on sugar for 30-40 minutes before meals; at 20.00 - 0.5 teaspoon of phyto vermis extract, dissolved in a small amount of water, 1-1.5 hours after dinner.

The choice of treatment scheme was due to the following considerations. Prostanorm is a liquid extract of St. John's wort, Canadian goldenrod grass, licorice root and rhizomes with roots of purple Echinacea. Phyto Novosed is also an extract of plant raw materials: melissa herbs, rose hips and hawthorn, herbaceous leaves of motherwort and herbs of Echinacea purpurea. The properties of these medicinal plants allow us to normalize the processes of excitation and inhibition in the central nervous system, which contributes to the regulation of sexual intercourse. In addition, beneficially influencing the course of inflammatory processes in the prostate, the prostoroma removes the prerequisites for such complications (or manifestations) of prostatitis, as a reduction in sexual desire and premature ejaculation. However, these drugs are deprived of all the negative properties inherent in the above methods of treatment.

All 28 patients complained of loss of interest in sex, easing of erection, accelerated ejaculation. We did not attempt to express this indicator (PE) in units of time, based on scores in which the patient subjectively assessed his condition. All men linked their disease with chronic prostatitis, noting a significant deterioration in sexual function during the exacerbation and for several weeks after antibiotic therapy.

The parameters of the hemogram and the analysis of three portions of urine were within the norm both at admission and at the end of treatment; latent leukocyturia was also not determined. In the secretion of the prostate, the initially moderate number of leukocytes (10-25) was determined in 17 patients, in the remaining 11 patients the number of leukocytes exceeded 25 in the field of vision. In all cases a reduced amount of lecithin grains was determined. Growth of microflora was not obtained in any case. Using the method of PCR diagnostics, mycoplasma was detected in 2 patients, in 1 - ureaplasma. No patient had a normal spermogram: a decrease in volume was observed in 28 (100%), a decrease in the viscosity of ejaculate in 26 (92.9%), asthenozoospermia was found in 15 (53.6%), oligospermia in 8 (28.6 %), and 12 (42.9%) - hypozoospermia.

The arterial pressure was moderately elevated (140/100 mm Hg) in 6 patients, the rest had normotonia.

Thus, in all 28 patients at the time of enrollment, there was a CAP complicated by sexual dysfunction. Given the absence of growth of pathogenic microorganisms in the exprimates of the gonads, and also the normal hemogram, we found the appointment of antibiotics not shown and confined to phytotherapy by a prostanorm in combination with Phyto-novo-sedom according to the above scheme.

At the control examination after 4 weeks 27 patients marked a significant improvement; 1 patient, a student, discontinued therapy, as the course of treatment fell on the session, and the onset of increased libido distracted him from his studies. In 22 patients (81.5%), the secret of the prostate was sanitized, the others had a significant improvement; the average number of leukocytes was 8.1 cells in the field of view. The saturation of the smear with lecithin grains increased in 25 patients, in 3 this index did not change. Spermogram parameters were also improved: the number of patients with astenozoospermia decreased 3-fold, with oligo- and hypozoospermia 2-fold. The volume of ejaculate increased 2.3 times on average.

Almost all parameters received a significant improvement, except for the quality of orgasm - the positive dynamics in this parameter on average appeared to our patients less expressive. In no case was there any significant side effect (except for the student's excessive effectiveness). There was no negative effect of drugs on hemodynamics: neither in patients with initial normotonia, nor in patients with initial hypertension had an increase in blood pressure. In contrast, among 6 patients with hypertension, 4 had a drop in arterial pressure by an average of 12.4 mm Hg. Art.

Since a subjective method of assessing the sexual function of men was used, 14 regular sexual partners of the patients were also interviewed for greater reliability. Women were asked to assess the sex life on the same scale scale before and after treatment. It should be noted that initially the ladies looked at the sexual life more pessimistically than their partners, but the results they rated higher.

Thus, all women were satisfied with the results of treatment of their sexual partners, and even more satisfied than the patients themselves. At the time of the referral to the doctor, all 14 women regarded the sexual life with the patient as "bad", did not feel the desire for intimacy, the sexual act took place in a nervous situation, and sexual satisfaction was not received. A month later, 13 (92.9%) of the wives of patients noted improvement, 9 of them (69.2%) rated the result as a "significant improvement". One of the women interviewed seemed unconvincing, although her husband was pleased with them.

Thus, the use of phytopreparations by prostanorm and Phyto Novened is highly effective as a monotherapy of patients for chronic prostatitis, complicated by sexual dysfunction. Preparations do not cause complications and adverse reactions, have a beneficial effect on the patient's overall somatic state, on the course of the inflammatory process in the prostate and on all components of the sexual act.

Modern scientific achievements leave no doubt that ejaculation is a neurobiological phenomenon. The process of ejaculation is regulated by the brain through neurotransmitters, the leading ones being serotonin, dopamine and oxytocin. Serotonin and oxytocin are produced by neurons of the brain. A brain cell in response to a stimulus must be excited rapidly and repeatedly. The first to respond to the signal sodium channels (sodium enters the cell), almost immediately followed by potassium channels (potassium leaves the cell, ensuring its inhibition and preparing for the arrival of a new pulse). But already in the middle of the rise of the potential, calcium channels are included, which provide entry into the calcium cell and activation of all functional processes of the cell. Without calcium, the neuron does not function: it does not produce serotonin, oxytocin, etc. Does not transmit impulses.

The production of neurotransmitters, as well as other neuron functions, can be disrupted by the dysfunction of the brain-specific protein S 100, which plays a key role in the neuron ion-exchange processes. S 100 is an antigen, therefore, the appearance of antibodies to it in the CSF causes an intensified stimulation of the synthesis of this protein, restores the function of the neuron, removes foci of stagnant excitation / inhibition, normalizes the production of neurotransmitters. The appointment of the drug tenotene, which is an affinity purified antibodies to the brain-specific protein S 100. 1 tablet 2-3 times a day for 6-8 weeks sublingually allows to achieve a stable anxiolytic, antidepressant, stress-protective, anti-asthenic effect. In this case, tenoten does not cause sedative, muscle relaxant and anticholinergic action. Carrying out of complex treatment with tenotene in combination with local low-intensity laser therapy for patients with chronic prostatitis complicated by ejaculation disorders allows to prolong the sexual intercourse to an acceptable duration, to remove the patient's anxiety about this and significantly improve the quality of his life.