Chronic prostatitis and sexual disorders

Chronic prostatitis and sexual disorders:

The structure of sexual pathology in patients with chronic prostatitis depends on many factors and is characterized by isolated damage to the ejaculatory component, which clinically manifested accelerated ejaculation (47%), painful ejaculation (52%) and smoothed (with altered color) orgasm (20%). The basis of most cases of erectile disorder are changes in mental and neuro-component copulative cycle. As the main complaint is erectile dysfunction is present in chronic prostatitis in 30% of cases. At the core lies the fear and anxiety about their condition, the fear of possible consequences. In 19 century domestic psychiatrists Kovalevsky and Popov introduced the concept of "neurasthenia psihotravmaticheskaya recover from." It creates a vicious circle - the fear of the patient for a particular authority is reflected in the functions of the latter, and the growing functional disorders have been reinforced by fear. The special features of patients with long-term ongoing chronic prostatitis include hypochondriac willingness and commit the slightest sensation in the genital organs. The presence of patients with anxious depression, obsessive show (ie, dominant in the consciousness and uncontrollable) mind disturbing the contents of his men, and therefore human inferiority of the incurable disease and futility of treatment, the imminent loss of family welfare. The same anxiety and fear with their condition and determine any actions of almost every step of the patients whose behavior is classified as "care in the disease with a separation from reality." For this category of patients tend to self-diagnose and self-healing. In the clinical picture of anxious depression are typical for these patients, sleep disorders and appetite, marked autonomic symptoms - sweating, lability of the pulse. Sexual disorders - decreased libido (40%), decrease in frequency and severity of spontaneous erections (15%), the weakening of adequate erections (30%), the inevitable manifestation of affective disorders. Psychotic burdened detected in approximately 75% of patients with chronic prostatitis. In 60,2% of patients with psychotic prior aggravated sexual dysfunctions, while 17,8% of patients psychoneurological symptoms occur after prolonged and ineffective treatment of the underlying disease, and makes certain specific sexual disorders clinic.
Erectile violations found at the chronic prostatitis should be considered in the structure of asthenic, anxious, hypochondriacal, astenoipohondricheskogo, astenodepressivnogo syndromes and purely hypochondriacal and depressive state. Typically, these states do not require a special correction by psychotropic drugs. Adequate is raising conducting interviews, the appointment of biogenic stimulants, adaptogens, the course of therapy with the use of Yohimbine. Good clinical effect is observed when using acupuncture. Aseptic prostatitis often has a psychosomatic basis. He and occurs more frequently in people with certain types of character because of "personality disorders and emotional stress and is highly resistant to therapy.
Often, analyzing the premorbid characteristics of patients, we can note the presence of cyclothymia, accentual character of residual-organic CNS lesions, postkontuzionny syndrome, which in turn may cause sexual disorders. In the history of these patients affective fluctuations preceded clinical manifestations of prostatitis.
The analysis described the group of patients suggests that long-term course of chronic prostatitis, confirmed by objective data, inevitably leads to the appearance, but over time, even predominance, neuropsychiatric symptoms with accentuation of urination disorders, sexual disorders, ie, there is somatopsihicheskaya orientation of the pathogenesis of the disease . Masked depression with prevalence of sexual dysfunctions are accompanied by complaints of accelerating or decelerating ejaculation combined with the weakening of erection, at least to reduce sexual desire and intensity of orgasmic sensations. Sexual disorders, as noted by the patients, a very complicated intra-family relationships, often becoming the cause of quarrels and even divorce. The examination along with somatovegetativnymi disorders characteristic of the depressive phase, to identify signs of congestion in the prostate.
Sexual disorders in masked depression also occur periodically (often seasonal), have the daily fluctuations of intensity are closely related to somatovegetativnymi disorders, relatively resistant to the stimulant, treatment of male sex hormones, psychotherapy and vice versa, there is a clear positive response to treatment with antidepressants. Disorders often disappear spontaneously. Subject sexual pathology is often heard in the statements of patients with neurosis-like form of depression, indirectly caused by various chronic forms prostatopaty.
Along with depressive and astenonevroticheskimi states to erectile disorder causes a syndrome of anxious expectation of failure that occurs after one or several unsuccessful attempts at intercourse. The clinical picture phobic options, among other intrusive phenomena are observed, obsessive doubts, misgivings, fears, desires and actions associated with sexuality, such as unfounded fear of failure during intercourse (koitofobiya), fear of inevitable consequences of masturbation (onanofobiya), incurable genital disorders, venereal disease, etc. Also a great difficulty for the differential diagnosis of psychosomatic disorders copulative cycle are those mild depression for tsiklotimicheskomu type, which were accompanied by anxiety concentrating on conventional operations actually become breeding grounds for psychogenic potency disorders by type of neurosis expectations . Such sexual disorders are prone to splitting off its endogenous bases and further development of pure neurotic mechanisms. In regard to the sexual neurotic syndromes can be divided into two groups - with the primary (ie direct) defeated the sexual sphere, and with secondary involvement of the sphere in the picture of neurosis. According to the literature core syndromes of the first group observed in approximately 23% of men seeking medical help, and syndromes of the second group - in 7% of surveyed. Thus, the primary sexological syndromes in patients with chronic prostatitis occur more than 3 times more often secondary. On the relative frequency of the main forms of classification NK Lipgart in the second group received the following distribution: astenonevroticheskie forms - 75,6%, anxious-phobic forms - 19,5%, hysterical forms - 4,9%. However, in the first group of anxious-phobic (61.1%) forms greatly outnumber astenonevroticheskimi (38,9%) with complete absence of primary sexological violations hysterical type. These data demonstrate the need for more actively identify and assess changes in mental status in patients with chronic prostatitis. Timely and directed correction of mental disorders in chronic prostatitis prevents the development of a more flagrant violations of the psyche and allows the successful treatment of somatic pain. In the complex treatment of chronic prostatitis should include the participation of specialist neuropsychiatrist, especially in cases of so-called difficult patients. Violation of sexual function in chronic prostatitis is accompanied by dysfunction of the autonomic nervous system. In connection with the imbalance of sympathetic and parasympathetic nervous system and inhibition of spinal erection centers, some patients note the weakening and even disappearance of the spontaneous (morning) erections. In some patients there is staining of orgasm, from the dull or painful, to anorgasmia. Chronic prostatitis can act as a predisposing factor in the development of sexual disorders, provoking ( "trigger") and worse (secondary to sexual dysfunction) factors. Thus, a direct correlation relationship between chronic prostatitis and erectile disorders have been identified. Damage erectile component copulative cycle in chronic prostatitis is not over, and in some cases even less pronounced than in chronic somatic diseases at other sites. However, the localization of the pathological process and its clinical manifestations, determines the number of violations of the sexual sphere predominantly on the psychosomatic principle.
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