Adverse Impact of Sexual Dysfunction in Chronic Prostatitis/Chronic Pelvic Pain Syndrome

doi:10.1016/j.urology.2007.08.043

Urology

Volume 71, Issue 1, January 2008, Pages 79-84

https://doi.org/10.1016/j.urology.2007.08.043 Get rights and content

Objectives

To examine the prevalence, characteristics, and impact of sexual dysfunction in our primary care referral population.

Methods

Participants seeking treatment for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) were recruited from general urology clinics. The subjects completed the National Institutes of Health-Chronic Prostatitis Symptom Index, International Index of Erectile Function-5, and selected questions from the University of Washington Symptom Score. Additional information on demographics and medical and treatment history were also obtained. Sexual dysfunction was defined as self-reported erectile dysfunction (ED) or ejaculatory difficulty, or both.

Results

Of 296 participants with CP/CPPS, 214 (72.3%) reported sexual dysfunction. The National Institutes of Health-Chronic Prostatitis Symptom Index total score averaged 22.5 ± 6.9 for participants with sexual dysfunction compared with 20.4 ± 7.8 for participants who did not report sexual dysfunction (P = 0.03). Of the 214 participants with sexual dysfunction, 54 (25.0%) complained of ED only, 71 (33.4%) complained of ejaculatory difficulties only, and 89 (41.6%) complained of both ED and ejaculatory difficulties. Men reporting both ED and ejaculatory difficulty reported worse CP/CPPS symptoms (analysis of variance, P = 0.042) and worse quality of life (analysis of variance, P = 0.006) than men without sexual dysfunction.

Conclusions

Sexual dysfunction was reported by almost three quarters of patients with CP/CPPS. Patients with CP/CPPS and sexual dysfunction experienced substantially worse symptoms, particularly worse quality of life, than other patients with CP/CPPS. Sexual dysfunction merits consideration as an important aspect of CP/CPPS and a potential outcome measure.

Section snippets

Participants and Clinical Evaluation

The participants were recruited from the general urology clinics in Penang, Malaysia from February 1, 2004 to October 10, 2005, after the men provided informed consent according to the protocols approved by the Joint School of Pharmaceutical Sciences, University of Science Malaysia-Penang Hospital and University of Washington institutional review boards. The evaluation followed a standardized clinical and microbiologic protocol. All met the National Institutes of Health CP/CPPS definition.¹ In

Participants

Of the 389 patients with CP/CPPS screened, 296 enrolled, representing a 76% response rate. The participants were an average of 41.4 ± 10.6 years old (range 20 to 69), had a mean symptom duration of 2.0 ± 2.8 years (range 3 months to 23 years), and a mean NIH-CPSI total score of 21.9 ± 7.2 (range 0 to 41; Table 2). Most were employed (86%), were married or living with a partner (74%), and had received at least one previous treatment for CP/CPPS symptoms (69%).

Prevalence and Impact of Sexual Dysfunction

Of the 296 participants, 214 (72.3%)

Comment

Self-reported sexual dysfunction occurred in almost three quarters of our 296 participants with CP/CPPS. Among the 214 men with sexual dysfunction, 54 (25.0%) complained of ED only, 71 (33.4%) of ejaculatory difficulties only, and 89 (41.6%) of both ED and ejaculatory difficulties. A multinational study evaluated ED in random samples of 600 men from each of multiple countries using a standardized questionnaire.¹⁵ Age-adjusted rates of moderate or severe ED were 22% in Malaysia, 34% in Japan,

Conclusions

Sexual dysfunction was self-reported by almost three quarters of our population of 296 men with CP/CPPS. Patients with sexual dysfunction were more likely to report the combination of ED and ejaculatory difficulties (41.6%) than ejaculatory difficulties only (33.4%) or ED only (25.0%). Sexual dysfunction, especially the combination of ED and ejaculatory difficulties, was associated with substantial reductions in QOL (P = 0.006) and worse CP/CPPS symptoms (P = 0.042). These findings suggest that

Acknowledgment

To the consultant urologists and primary care physicians in the northern Malaysian states who referred patients for this study, especially Drs. Christopher Chee, Hin Wai Yap, Wooi Long Choong, Timothy Khor, Chu Leong Teh, and Murali Mohan, with great appreciation for their support; and to Kok Heng Heng, Siew Kin Yang, Colina Wong, Mai Chuan Heng, Beng Sim Lee, Nohana Arif, and Ms. Pushpa for their assistance in data acquisition and clinical work.

References (26)

P.Y. Cheah et al.
Terazosin therapy for chronic prostatitis/chronic pelvic pain syndrome: a randomized, placebo controlled trial
J Urol
(2003)
J.N. Krieger et al.
Chronic pelvic pains represent the most prominent urogenital symptoms of “chronic prostatitis”
Urology
(1996)
P.Y. Cheah et al.
Terazosin therapy for chronic prostatitis/chronic pelvic pain syndrome: a randomized, placebo controlled trial
J Urol
(2003)
J.C. Nickel et al.
Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial
Urology
(2003)
A.J. Schaeffer et al.
Demographic and clinical characteristics of men with chronic prostatitis: the National Institutes of Health Chronic Prostatitis Cohort Study
J Urol
(2002)
P.Y. Cheah et al.
Chronic prostatitis: symptom survey with follow-up clinical evaluation
Urology
(2003)
R.C. Rosen et al.
The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction
Urology
(1997)
A. Nicolosi et al.
Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction
Urology
(2003)
R.U. Anderson et al.
Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training
J Urol
(2006)
D.A. Shoskes et al.
CPCRN Study Group: Impact of post-ejaculatory pain in men with category III chronic prostatitis/chronic pelvic pain syndrome (CPPS)
J Urol
(2004)

M.S. Litwin

A review of the development and validation of the National Institutes of Health Chronic Prostatitis Symptom Index

Urology

(2002)

S. Lee et al.

Demographic and clinical characteristics of chronic prostatitis: prospective comparison of the University of Sciences Malaysia cohort with the U.S. National Institute of Health cohort

J Urol

(2007)

A.J. Schaeffer et al.

Demographic and clinical characteristics of men with chronic prostatitis: the National Institutes of Health Chronic Prostatitis Cohort Study

J Urol

(2002)

Cited by (76)

Predictors of Male Sexual Dysfunction in Urologic Chronic Pelvic Pain Syndrome (UCPPS), Other Chronic Pain Syndromes, and Healthy Controls in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network
2022, Journal of Sexual Medicine
Citation Excerpt :
Sexual dysfunction (SD), including erectile dysfunction (ED), ejaculatory disorders, and suppressed libido, is prevalent among patients with UCPPS and is associated with a diminished quality of life (QoL).3–7 Several mechanisms have been proposed including the influence of associated psychological conditions, endothelial dysfunction, and the destructive effects of the inflammatory response.3,8–12 The current literature is limited by small sample sizes, inconsistent objective evaluations, and lack of control groups.2
Sexual dysfunction (SD), including erectile (ED) and ejaculatory dysfunction, is associated with diminished quality of life (QoL) in men with UCPPS (chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and/or interstitial cystitis/bladder pain syndrome (IC/BPS)).
We sought to compare SD among male patients with UCPPS, other chronic pain conditions (positive controls, PC), and healthy controls (HC) without chronic pain, and to evaluate the association of comorbidities, psychosocial factors, and urologic factors of SD in all 3 groups.
Baseline data from male UCPPS participants, PC (irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia) and HC enrolled in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network Epidemiology and Phenotyping Study were included in the analysis. Sexual function was assessed using the International Index of Erectile Function-Erectile Function Domain (IIEFEF) and Ejaculatory Function Scale (EFS). Male ED was defined as a composite IIEF-EF score <21. Higher EFS score indicated worse sexual dysfunction; no threshold to define SD was identified for the EFS. Multivariable logistic and linear regression was used to investigate associations of comorbidities, psychosocial factors, and urologic factors with ED and ejaculatory, respectively.
Comorbidities, genital pain, and psychosocial factors are associated with SD across the study population and male patients with UCPPS had a high prevalence of ED and greater ejaculatory dysfunction.
There were 191 males with UCPPS; 44 PC; and 182 HC. Males with UCPPS had worse SD compared to PC and HC including lower mean IIEF-EF scores, greater degree of ejaculatory dysfunction, and lower quality of sexual relationships. Among all 3 cohorts, depression, stress, and pain were associated with ED in univariable and multivariable analysis, as was diabetes mellitus. Pain in the genitalia, severity of urinary symptoms, depression, stress, and history of childhood sexual trauma were associated with ejaculatory dysfunction in univariable and multivariable analysis.
A multidisciplinary approach that addresses the identified risk factors for SD may improve overall QoL in males with UCPPS.
Our study is strengthened by its use of validated, patient-reported questionnaires and inclusion of healthy and positive controls. Our understanding of the role of IC in this study is limited because only 1 patient in the study had IC/BPS as a sole diagnosis.
When compared to healthy controls and patients with other chronic pain conditions, males with UCPPS experience higher degrees of SD, including erectile and ejaculatory dysfunction.
Loh-Doyle JC, Stephens-Shields AJ, Rolston R, et al. Predictors of Male Sexual Dysfunction in Urologic Chronic Pelvic Pain Syndrome (UCPPS), Other Chronic Pain Syndromes, and Healthy Controls in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. J Sex Med 2022;19:1804–1812.
Clinical Phenotyping and Multimodal Treatment of Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome From the Middle East and North Africa: Determining Treatment Outcomes and Predictors of Clinical Improvement
2022, Urology
To evaluate the effectiveness of UPOINT based multimodal treatment on patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and determine factors that could be associated with clinical improvement.
A retrospective study was conducted in Doha, Qatar including patients with CP/CPPS from the Middle East and North Africa. The UPOINT phenotyping system was used to classify patients and guide their multimodal therapy. NIH-CPSI scores were computed initially and after 3 months of treatment, and predictors of clinical improvement were assessed.
The total NIH-CPSI improved significantly with a mean reduction of 8.21 after 3 months of treatment (P < .001). 66.2% of patients had a clinical improvement demonstrated as a total NIH-CPSI score reduction by at least 6 points after 3 months of treatment. No significant association was found between clinical improvement, and extent of pain (ORa = 1.198, 95% CI 0.392-3.662, P = .751), initial total NIH-CPSI (ORa = 0.983, 95% CI 0.886-1.089, P = .738), number of positive UPOINT domains (ORa = 0.871, 95% CI 0.451-1.681, P = .681), and number of prescribed therapies (ORa = 1.118, 95% CI 0.699-1.789, P = .641).
UPOINT phenotyping and directed therapy is associated with an important improvement in the CP/CPPS. Therapeutic response does not appear to related to age or ethnicity. Clinical improvement is also not predicted by initial extent and severity of the disease, whether relating to NIH-CPSI or the number of positive UPOINT phenotypes, neither to the number of therapies involved in the multimodal treatment strategy.
The impact of nonmotor symptom burden on sexual function
2022, International Review of Neurobiology
Citation Excerpt :
Chronic pelvic pain has been linked to SD in men (Lee et al., 2008). Of the participants of this particular study, 48.3% reported erectile dysfunction, which was linked with severity of pain in these patients (Lee et al., 2008). SD is also associated with urinary dysfunction (Vela-Desojo et al., 2020).
Sexual dysfunction (SD) is defined as a combination of reduction in libido, and problems with a person's ability to have sex. It is a frequent but neglected and poorly recognized nonmotor symptom (NMS) in Parkinson's disease (PD) which correlates with reduced quality of life (QoL). Hypersexuality forms another spectrum of SD and is an impulse control disorder (ICD) of behavior, which also affects the sexual desires of people with Parkinson's (PwP) and impacts their partner, family, and QoL. NMS occur in various forms and represents a range of symptoms, from cognitive dysfunction to pain and SD, and this chapter explores the relationship of comorbid NMS with SD and also how NMS, motor symptoms, and hypersexuality experienced by patients may impact sexual function in people with Parkinson's (PwP).
“The Overactive Pelvic Floor (OPF) and Sexual Dysfunction” Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response
2021, Sexual Medicine Reviews
Overactive pelvic floor (OPF) muscles are defined as muscles that do not relax, or may even contract, when relaxation is needed, for example, during micturition or defecation. Conditions associated with OPF are multifactorial and include multiple possible etiologies and symptom complexes. The complex interplay between biological and psychosocial elements can lead to the persistence of OPF symptoms along with psychological and emotional distress.
(1) To review and contextualize, from a pathophysiologic perspective, the evidence for OPF, (2) to provide an overview of common clinical presentations and comorbidities of OPF, and (3) to discuss the effect of OPF on sexual function in men and women.
Review of the updated literature on the pathophysiology of OPF was carried out. OPF-associated conditions were overviewed, with special emphasis on the impact on sexual function in men and women.
Individuals with suspected OPF often present with a combination of gastrointestinal, gynecological, musculoskeletal, sexual, and urological comorbidities, mostly accompanied by psychoemotional distress. In both women and men, sexual function is significantly impaired by OPF and genitopelvic pain penetration disorders are often the primary manifestation of this condition. Women with OPF report less sexual desire, arousal, and satisfaction; more difficulty reaching orgasm; lower frequencies of intercourse; more negative attitudes toward sexuality; and more sexual distress than women without sexual pain. The most frequently reported sexual dysfunctions in men with OPF include erectile dysfunction, premature ejaculation, and ejaculatory pain.
The complex pathophysiology of OPF involving multisystemic comorbidities and psychosocial factors emphasize the importance of a biopsychosocial assessment for guiding effective and personalized management.
Padoa A, McLean L, Morin M, et al. “The Overactive Pelvic Floor (OPF) and Sexual Dysfunction” Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response. Sex Med 2021;9:64–75.
THE ACUPUNCTURE IN CHRONIC PROSTATITIS/ CHRONIC PELVIC PAIN, RETROSPECTIVE COMPARATIVE STUDY
2023, Community Practitioner
Chronic prostatitis/chronic pelvic pain syndrome
2023, Urologie

View all citing articles on Scopus

: This study was funded in part by the U.S. National Institutes of Health, Bethesda, Maryland, grants DK065266 and DK38955.

View full text

Prostatic diseasesAdverse Impact of Sexual Dysfunction in Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Objectives

Methods

Results

Conclusions

Section snippets

Participants and Clinical Evaluation

Participants

Prevalence and Impact of Sexual Dysfunction

Comment

Conclusions

Acknowledgment

J Urol

Urology

J Urol

Urology

J Urol

Urology

Urology

Urology

J Urol

J Urol

Urology

J Urol

J Urol

Prostatic diseases
Adverse Impact of Sexual Dysfunction in Chronic Prostatitis/Chronic Pelvic Pain Syndrome