Do prostate infections (prostatitis) cause sexual side effects?

Do Prostate Infections Cause Sexual Side Effects?

Yes, prostate infections (prostatitis) definitively cause sexual side effects, including erectile dysfunction, ejaculatory pain, premature ejaculation, and reduced libido, with sexual dysfunction being a core symptom of chronic prostatitis/chronic pelvic pain syndrome. 1, 2

Types of Sexual Dysfunction in Prostatitis

Erectile Dysfunction

• Men with chronic bacterial prostatitis and chronic pelvic pain syndrome experience erectile dysfunction as a prominent symptom, with the dysfunction correlating directly with increasing symptom severity scores. 1, 3
• The mechanism appears to be multifactorial: pain during or after ejaculation, perineal and penile discomfort, and overall impaired quality of life all contribute to erectile difficulties. 3
• Erectile dysfunction in prostatitis patients is strongly associated with negative impacts on quality of life, creating a bidirectional relationship where pain worsens sexual function and sexual dysfunction further degrades quality of life. 3

Ejaculatory Dysfunction

• Ejaculatory pain is a hallmark symptom of chronic prostatitis/chronic pelvic pain syndrome, described as discomfort or pain during or after ejaculation. 4, 2, 3
• Premature ejaculation occurs with increased frequency in men with chronic prostatitis compared to the general population. 2
• Ejaculatory dysfunction adds to the number of positive symptom phenotypes and correlates with higher overall symptom burden. 1

Reduced Sexual Desire

• Diminished libido is frequently reported in chronic prostatitis/chronic pelvic pain syndrome, particularly when pain is the dominant symptom. 4, 2
• Pain is likely the most significant factor relating to sexual dysfunction in men with chronic prostatitis, as any type of pain during sexual activity predictably reduces desire and participation. 3

Clinical Presentation Patterns

Acute Bacterial Prostatitis

• Severe genitourinary pain involving the perineum, suprapubic area, lower back, rectum, testicles, or penile tip characterizes acute bacterial prostatitis and directly interferes with sexual function during the acute illness. 4
• Sexual activity should be avoided during active acute prostatitis until infection is fully treated to prevent ongoing transmission and allow healing. 4

Chronic Bacterial Prostatitis

• Persistent or intermittent pelvic pain involving the perineum, suprapubic area, testicles, or penile tip occurs alongside voiding disturbances (frequency, urgency, dysuria). 4
• Sexual dysfunction manifests as dyspareunia (painful intercourse) and reduced libido in addition to erectile and ejaculatory problems. 4

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)

• Pain lasting ≥3 months without documented bacterial infection defines CP/CPPS, with pain typically worsening during urination or ejaculation. 4
• Many patients describe "pressure" or "discomfort" rather than overt pain, which can lead to underreporting if not specifically queried. 4
• Significant sexual dysfunction—including dyspareunia, reduced libido, erectile dysfunction, and ejaculatory pain—is frequently reported and may be the presenting complaint. 4, 2

Impact on Fertility

• Patients with chronic bacterial prostatitis and chronic pelvic pain syndrome demonstrate impaired sperm parameters in multiple studies. 1
• In chronic bacterial prostatitis, approximately half of patients show significant bacteriospermia, though the deleterious effects on sperm quality remain debatable. 1
• Anti-inflammatory treatment may have a positive impact on sperm parameters, though high-quality interventional studies are lacking. 1

Treatment Implications for Sexual Function

Alpha-Blocker Therapy

• Alpha-blockers (tamsulosin, alfuzosin, doxazosin, terazosin) are first-line treatment for chronic prostatitis/chronic pelvic pain syndrome and have been associated with improvement in sexual dysfunction following treatment. 5, 6
• Common caveat: Tamsulosin carries a higher risk of ejaculatory dysfunction (retrograde ejaculation) compared to other alpha-blockers, which may paradoxically worsen sexual side effects in some patients. 5

Antibiotic Therapy

• For bacterial prostatitis, appropriate antibiotic therapy targeting the causative organism is essential, with fluoroquinolones (ciprofloxacin 500-750 mg twice daily for 2-4 weeks) as first-line when local resistance is <10%. 7
• In men under 35 years with risk factors for sexually transmitted infections, adding doxycycline 100 mg twice daily for 7 days to cover Chlamydia trachomatis and Mycoplasma species is recommended. 7
• Sexual partners should be evaluated and treated to prevent reinfection, which can perpetuate symptoms and sexual dysfunction. 4, 5

Key Clinical Pitfalls

• Patients may be reluctant to initiate discussion about sexual dysfunction, so clinicians must specifically ask about erectile function, ejaculatory pain, premature ejaculation, and libido changes. 8
• Vigorous prostatic massage or aggressive digital rectal examination must be avoided in acute bacterial prostatitis due to risk of bacteremia and sepsis. 4, 5
• Sexual activity—especially unprotected intercourse—raises the risk of bacterial prostatitis by facilitating transmission of sexually transmitted pathogens; consistent condom use is highly effective at lowering this risk. 4
• Stopping antibiotics prematurely can lead to chronic bacterial prostatitis with persistent sexual dysfunction; complete the full 2-4 week course for acute prostatitis and 4-12 weeks for chronic bacterial prostatitis. 4, 7

Distinguishing Bacterial from Non-Bacterial Causes

• The Meares-Stamey 4-glass test (or simplified 2-specimen variant) is the gold standard for diagnosing chronic bacterial prostatitis, requiring a 10-fold higher bacterial count in expressed prostatic secretions compared to midstream urine. 8, 4, 7
• Chronic prostatitis/chronic pelvic pain syndrome is not frequently caused by a culturable infectious agent and requires multimodal management focused on symptom relief (alpha-blockers, anti-inflammatories) rather than prolonged antimicrobials. 8, 4, 5
• Testing for atypical pathogens (Chlamydia trachomatis, Mycoplasma species) is necessary when standard cultures are negative but symptoms persist, as these require specific antimicrobial therapy. 4, 7, 5