Does ejaculation help in treating acute prostatitis?

Ejaculation in the Treatment of Acute Prostatitis

Ejaculation is not recommended as a treatment for acute bacterial prostatitis and may potentially worsen the condition by increasing inflammation and pain. 1, 2

Diagnostic Considerations for Acute Bacterial Prostatitis

Acute bacterial prostatitis (ABP) is characterized by:

• Pelvic pain
• Urinary symptoms (dysuria, frequency, retention)
• Systemic symptoms (fever, chills, malaise)
• Tender, enlarged prostate on digital rectal examination

The European Association of Urology (EAU) guidelines strongly recommend against prostatic massage in acute bacterial prostatitis 1, which suggests that mechanical stimulation of the prostate (including that which occurs during ejaculation) should be avoided during the acute inflammatory phase.

Recommended Diagnostic Approach:

• Midstream urine dipstick to check nitrite and leukocytes
• Midstream urine culture to guide antibiotic selection
• Blood culture and complete blood count
• Transrectal ultrasound in selected cases to rule out prostatic abscess 1

Treatment Recommendations

First-line Treatment:

• Appropriate antibiotic therapy based on culture results
• For acute infections: 2-4 weeks of antibiotics even when symptoms improve early 2
• Fluoroquinolones (e.g., ciprofloxacin 500mg twice daily) are often first-line due to good prostatic penetration 2
• Alternative options when fluoroquinolones are contraindicated: trimethoprim-sulfamethoxazole or doxycycline 2

Supportive Measures:

• Alpha-blockers for urinary symptoms
• Anti-inflammatory agents for pain relief
• Adequate hydration
• Bladder drainage if urinary retention occurs 3

Why Ejaculation is Not Recommended

1. Potential to Worsen Inflammation: Ejaculation involves contraction of the prostate and surrounding muscles, which may increase inflammation and pain in an already inflamed prostate gland 3

2. Risk of Spreading Infection: There is a theoretical risk of spreading bacteria from the prostate to other parts of the genitourinary tract during ejaculation

3. Lack of Evidence: There is no evidence in current guidelines supporting ejaculation as a therapeutic intervention for acute bacterial prostatitis 1, 2

4. Contradicts Rest Recommendation: The general recommendation for acute inflammatory conditions is to rest the affected organ/tissue

Monitoring and Follow-up

• Clinical reassessment after 2 weeks to evaluate symptom improvement
• Follow-up urine culture at the end of treatment to confirm eradication
• Repeat measurement of PSA 3 months after resolution if it was elevated during infection 2

Special Considerations

• Patients with severe symptoms, inability to urinate, systemic illness, or risk factors for antibiotic resistance may require hospitalization and IV antibiotics 3
• Prostatic abscess should be ruled out in patients who fail to respond to appropriate antibiotic therapy 1
• Treatment failure may result from inadequate antibiotic selection, insufficient treatment duration, or overlooked complications 2

While ejaculation has been discussed as potentially beneficial in some chronic prostatitis conditions to help drain the prostate ducts, it is specifically not recommended in acute bacterial prostatitis due to the risk of exacerbating inflammation and spreading infection.