‘As men grow older they believe they still have abundant sexual energy, but they are being fooled by the signals they are receiving because these are being sent to them only by an irritated, worn-out prostate,’ is how the Italian poet, philosopher, essayist and philosopher of science Guido Ceronetti characterized one of the problems of men suffering from inflammation of the prostate. Prostatitis is very common, more so in its chronic than in its acute form. Acute inflammation of the prostate is generally caused by a bacterium that penetrates the prostate from the urinary tract. This can happen easily since the prostate with its many drainage routes is directly linked to the urethra. Prostatitis is not always the result of a urinary tract infection — micro-organisms can also infect the prostate via the blood. Then there are venereal diseases, euphemistically called sexually transmitted diseases, which may lead to inflammations. In the past the main culprit was the clap, a gonoccochal infection; nowadays it is mostly chlamydia trachomatis. An added problem is that many women carry this micro-organism without being aware of it and so form a source of infection.
In cases of acute prostatitis the patient is unwell, has a high temperature and, because of swelling, urinating is painful and sometimes completely impossible. Treatment with an antibiotic that penetrates the prostate effectively can prevent the condition from worsening. In the worst-case scenario an abcess develops, which has to be drained by a urologist, usually through the rectum. With a chronic prostate infection things go on simmering: medication brings temporary relief, but after a while the symptoms return. Back pain, pain in the area between the scrotum and the anus (the feeling of sitting on a hot chestnut), a burning feeling when urinating, a frequent urge to urinate: these symptoms can drive sufferers to distraction. Sometimes the symptoms spill over into the patient’s sexual functioning: there is a loss of sexual appetite, ejaculation becomes painful and in the worst case the man becomes impotent. Chronic prostate inflammation is sometimes the result of an inadequately treated acute inflammation. The bacteria hide in out-of — the-way corners and hence do not show up in urine cultures. A cure becomes difficult. In some cases stones, or accumulations of calcium, form in the prostate. Very occasionally long-term treatment with an antibiotic brings relief, but mostly it remains an ongoing problem.
Many men with prostatitis change doctors or ask for a second opinion, possibly because advice quite frequently differs widely: one doctor recommends hot baths, another cold ones, one urges less sex, the other. . . etc. That is understandable when one knows that the ailment does not follow a fixed pattern: sometimes the patient feels better after an ejaculation, sometimes even worse. What we do know is that alcohol never helps.