Impotence or erectile dysfunction is reported in CPPS, but information on prevalence is highly variable, although rates are higher than in controls, especially in young CPPS sufferers. It is most likely caused by underlying testosterone deficiency, diabetes and obesity and/or stress/fear induced reactions. See discussion on testosterone, nocturia and sleep for causes of testosterone deficiency in CPPS.
Erection is a complex "neurovascular" event "modulated by psychological and hormonal factors" leading to increased blood flow into and decreased flow out of the penis (so called tumescence). Murine (rats and mice) studies indicate that selenium, vitamin E and vitamin C insufficiency may be involved.(1)
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, erektion
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(1) Priviero FBM, Leite R, Webb RC, Teixeira CE. Neurphysiological basis of penile erection. Acta Pharmacol Sin 28(6):751-755, 2007 (this is a concise review).
Saturday, August 29, 2009
Sexual health in CPPS
There are a lot of sexual problems associated with CPPS, which is one cause why Freudians have had a field day with CPPS (and other urogenital disorders). Careful anamnesis will show that sexual problems evolve slowly over many years in CPPS sufferers. And it is when those interfere too much in normal life that they are brought to the doctor’s attention. Due to this there is an obvious possibility of many a CPPS sufferer consulting a psychiatrist (or "sexologists") rather than a urologist.
Problems are those mentioned below and also: penis / glans pain / discomfort (not associated with urination); penile numbness / insensitivity to "friction" (obviously more noticeable in non-circumcised men); and, discoloration (bluish-whitish-pinkish mottled hue) of glans.
Sufferers have less sexual interest and erectile function(1-2). This is hardly surprising and a well described and known fact as it is both part of the pathology and of sickness behavior (the bodily reactions to pain, illness and infection which cause androgen down-regulation, impaired spermatogenesis, depression etc). The only interesting fact in the study by Aubin et al. (one of many on the subject) is the usage of an adapted form of the BSFQ (brief sexual functioning questionnaire), that, while highly subjective, is useful indicating CPPS sexual symptom severity. About 36% of the CPPS subjects had never had epi- or post-coital pain. 51% occasionally and 13 often or always. The rest of the study was pretty oxymoronic, such as proving that age and disease activity was significant for pain, sexual function and satisfaction… duh! (apologies for this rant).
In a german study of chronic pelvic pain (LUTS) about 30-40% up to 40 years old were affected of loss of libido and erectile dysfunction, and about 50-65% between 40 and 60 years, compared to about 5.5% and 9% respectively in controls. Above 60 years of age the differences vaned. The study also showed that premature ejaculation (defined as before or at the beginning of intercourse or without erection), was noticeably more common in all age groups. 4-10 times more common than in controls.(3)
Marital relations are normal, except in a few cases where it may precipitate a separation (4) (most likely do the mood swings affect an already compromised relationship).
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, sexuell hälsa
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(1) Aubin S, Berger RE, Heiman JR, Ciol MA. The association between sexual function, pain and psychological adaption of men diagnosed with CPPS type III. J Sex Med 5:657-667, 2008.
(2) Davis SNP,Binik YM, Carrier S. Sexual dysfunction and pelvic pain in men: a male sexual pain disorder?. J Sex Marit Ther 35(3):182-205, 2009.
(3) Beutel ME, Weidner W, Brähler E. Der chronishe Beckenschmerz und seine Komorbidität. Der Urologe [A] 43:261-267, 2004. [Chronic pelvic pain and its comorbidity. In german.]
(4) Mehik A, Hellström P, Sarpola A, Lukkarinen O, Järvelin MR. Fears, sexual disturbances and personality features in men with prostatitis: a population-based cross-sectional study in Finland. BJU Int 88(1):35-38, 2001.
Problems are those mentioned below and also: penis / glans pain / discomfort (not associated with urination); penile numbness / insensitivity to "friction" (obviously more noticeable in non-circumcised men); and, discoloration (bluish-whitish-pinkish mottled hue) of glans.
Sufferers have less sexual interest and erectile function(1-2). This is hardly surprising and a well described and known fact as it is both part of the pathology and of sickness behavior (the bodily reactions to pain, illness and infection which cause androgen down-regulation, impaired spermatogenesis, depression etc). The only interesting fact in the study by Aubin et al. (one of many on the subject) is the usage of an adapted form of the BSFQ (brief sexual functioning questionnaire), that, while highly subjective, is useful indicating CPPS sexual symptom severity. About 36% of the CPPS subjects had never had epi- or post-coital pain. 51% occasionally and 13 often or always. The rest of the study was pretty oxymoronic, such as proving that age and disease activity was significant for pain, sexual function and satisfaction… duh! (apologies for this rant).
In a german study of chronic pelvic pain (LUTS) about 30-40% up to 40 years old were affected of loss of libido and erectile dysfunction, and about 50-65% between 40 and 60 years, compared to about 5.5% and 9% respectively in controls. Above 60 years of age the differences vaned. The study also showed that premature ejaculation (defined as before or at the beginning of intercourse or without erection), was noticeably more common in all age groups. 4-10 times more common than in controls.(3)
Marital relations are normal, except in a few cases where it may precipitate a separation (4) (most likely do the mood swings affect an already compromised relationship).
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, sexuell hälsa
__________________________________
(1) Aubin S, Berger RE, Heiman JR, Ciol MA. The association between sexual function, pain and psychological adaption of men diagnosed with CPPS type III. J Sex Med 5:657-667, 2008.
(2) Davis SNP,Binik YM, Carrier S. Sexual dysfunction and pelvic pain in men: a male sexual pain disorder?. J Sex Marit Ther 35(3):182-205, 2009.
(3) Beutel ME, Weidner W, Brähler E. Der chronishe Beckenschmerz und seine Komorbidität. Der Urologe [A] 43:261-267, 2004. [Chronic pelvic pain and its comorbidity. In german.]
(4) Mehik A, Hellström P, Sarpola A, Lukkarinen O, Järvelin MR. Fears, sexual disturbances and personality features in men with prostatitis: a population-based cross-sectional study in Finland. BJU Int 88(1):35-38, 2001.
Micturition-concluding thought
Micturition troubles are a strong cause of worsened quality of life (QoL). There is no good explanation for those in CPPS, but the fact that many of the "irritants" affect vasopressin regulation and the pituitary is an indication of cause. Especially nocturia is very troublesome as it deeply affects daily life for persons with family and work. Improving nocturia by dietary changes and maybe additional small doses of vasopressin analogues would probably lead to much improved QoL for the average CPPS sufferer.
Wednesday, June 10, 2009
Pelvic tenderness
A study has shown that men with CPPS have more tenderness in the pelvic-pubic area. Internal and external "tender points" were examined.(1) How the tender points were selected and/or identified was not clear. The tender points bore no correlation to the fibromyalgia tender points.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, tender points
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(1) Berger RE, Ciol MA, Rothman I, Turner JA. Pelvic tenderness is not limited to the prostate in CPPS… comparison of men with and without CPPS. BMC Urol 7:17-24, 2007.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, tender points
________________
(1) Berger RE, Ciol MA, Rothman I, Turner JA. Pelvic tenderness is not limited to the prostate in CPPS… comparison of men with and without CPPS. BMC Urol 7:17-24, 2007.
Tuesday, June 9, 2009
Urinary nitrites
Urinary nitrites are higher in patients with enuresis (1) indicating a connection between nitric oxide (NO) regulation and enuresis ("over-active bladder"). "NO plays an important role in the micturition process and disorders [IC, cystitits, enuresis] of the lower urinary tract."(2) Some IC patients show significant improvement with decreasing bladder NO.(3)
Nitric oxide (NO) has been shown to be significantly higher in the prostatic urethra of NIH-IIIa patients, but not in NIH-IIIb patients.(4)
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb
_________________
(1) Al-Waili NS Increased urinary nitrite excretion in primary enuresis: effects of indomethacin treatment on urinary and serum osmolality and electrolytes, urinary volumes and nitrite excretion. BJU Int 90:294-301, 2002.
(2) Ho MH, Bhatia NN, Khorram O. Physiologic role of nitric oxide and nitric oxide synthase in female lower urinary tract. Curr Opin Obstet Gynecol 16(5):423-429, 2004.
(3) Hosseini A, Ehren I, Wiklund NP. Nitric oxide as an objective marker for evaluation of treatment response in patients with classic interstitial cystitis. J Urol 172(6 Pt 1):2261-2265, 2004.
(4) Hosseini A, Herulf M, Ehren I. Measurement of nitric oxide may differentiate between inflammatory and non-inflammatory prostatitis. Scand J Urol Nephrol 40(2):125-130, 2006.
Nitric oxide (NO) has been shown to be significantly higher in the prostatic urethra of NIH-IIIa patients, but not in NIH-IIIb patients.(4)
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb
_________________
(1) Al-Waili NS Increased urinary nitrite excretion in primary enuresis: effects of indomethacin treatment on urinary and serum osmolality and electrolytes, urinary volumes and nitrite excretion. BJU Int 90:294-301, 2002.
(2) Ho MH, Bhatia NN, Khorram O. Physiologic role of nitric oxide and nitric oxide synthase in female lower urinary tract. Curr Opin Obstet Gynecol 16(5):423-429, 2004.
(3) Hosseini A, Ehren I, Wiklund NP. Nitric oxide as an objective marker for evaluation of treatment response in patients with classic interstitial cystitis. J Urol 172(6 Pt 1):2261-2265, 2004.
(4) Hosseini A, Herulf M, Ehren I. Measurement of nitric oxide may differentiate between inflammatory and non-inflammatory prostatitis. Scand J Urol Nephrol 40(2):125-130, 2006.
Monday, June 8, 2009
Bladder lining findings
Many CPPS sufferers react with pain/discomfort on potassium instillations (a potassium ion containing fluid is injected into the bladder) in a manner similar to IC patients, but the so called potassium sensitivity test is not wholly reliable as both false negatives and positives are common. It is believed that the potassium sensitivity is caused by impaired “barrier function” of the bladder urothelium to irritants or cytotoxic substances in the urinary fluid. It is assumed that potassium influx into nerve and muscular cells causes abnormal nerve firing and muscular relaxation.
Sulfated polysaccharides, like heparin, are thought to lower adherence to the bladder and urethral etc mucosal wall, which would also improve urine flow dynamics. If adherence increases bacteria, molecules etc can attach to the surface, as well as flow become more turbulent.
Other research has shown that instillation with resinifera-toxin modulates nerve firing in such a way as to (permanently?) alleviate bladder related symptoms. See additional discussion under treatment.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, urinblåsa
Sulfated polysaccharides, like heparin, are thought to lower adherence to the bladder and urethral etc mucosal wall, which would also improve urine flow dynamics. If adherence increases bacteria, molecules etc can attach to the surface, as well as flow become more turbulent.
Other research has shown that instillation with resinifera-toxin modulates nerve firing in such a way as to (permanently?) alleviate bladder related symptoms. See additional discussion under treatment.
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, urinblåsa
The female prostate
As mentioned in passing in an earlier post some women have a vestigial prostate (and some men a vestigial uterus: the utriculum). The organ is more known as Skene's or the paraurethral gland. Oddly enough it is semifunctional in some cases and may eject a fluid and be stimulated. A popular overview was recently published in the may 30 issue of New Scientist.
Andra bloggar om prostata
Andra bloggar om prostata
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