The risks of putting it off: experts discussed the link between prostatitis and men’s sexual and reproductive health

More than 59% of men with chronic prostatitis and chronic pelvic pain syndrome experience sexual dysfunction^[1]. Yet men undergo reproductive health screening nearly 36% less often than women. Why is it important not to delay diagnosis and treatment, and can a single approach be effective for every patient? Experts discussed these questions at two satellite symposia supported by Petrovax Pharm during the 26th Congress of the Russian Society of Urologists, held in Kazan on September 10–13.

In Russia, 8–35% of men aged 20–40 experience symptoms of prostatitis, including pain and urinary symptoms, sexual problems, anxiety and reduced quality of life^[2].

Dmitry Pushkar, Academician of the Russian Academy of Sciences and Chief Urologist of the Russian Ministry of Health, highlighted the link between inflammation in the prostate and male reproductive tract and sexual dysfunction. He emphasized the importance of early treatment, before the changes become irreversible. In this context, he noted the potential of enzyme therapy.

This association is supported by clinical data. A meta-analysis involving 20,127 men with chronic prostatitis/chronic pelvic pain syndrome found that 59% experienced sexual dysfunction, 34% had erectile dysfunction and 35% had premature ejaculation^[1].

Several interconnected processes can contribute to prostatitis becoming chronic. Persistent inflammation triggers the remodeling of connective tissue in the prostate and the development of fibrosis. When bacteria are involved, they can form biofilms, becoming less accessible to antibiotics^{[3], [4]}. This explains why antibiotic therapy alone may be insufficient for chronic prostatitis.

Adding bovhyaluronidase azoximer (Longidaza^®) to antibiotic therapy was associated with greater reductions in signs of inflammation and bacterial colonization: complete disappearance of neutrophils was observed in 41% of patients versus 7.2%, and complete elimination of bacterial colonies in 42% versus 12% in the antibiotic monotherapy group^[5]. Recurrence rates at six months were 11% versus 41%, and at 12 months, 38% versus 90%, respectively^[5].

The link between benign prostatic hyperplasia (BPH) and male sexuality is supported by findings from the Integrated Assessment of Male Sexuality Questionnaire, presented at the congress by Mikhail Kogan, Doctor of Medical Sciences, Professor and Head of the Department of Urology and Human Reproductive Health at Rostov State Medical University. According to his data, hyposexuality occurs in 23.2% of healthy men, compared with 34–35% of men with BPH, depending on the region. Hypersexuality is also more common among men with BPH, at 25.5–32% versus 14%. Normosexuality is considerably less common in men with BPH: 33–40.5% of respondents, compared with 62.8% in the healthy group.

Chronic inflammation of the prostate therefore has implications beyond pain and urinary symptoms. Its manifestations can affect a man’s sexual function, quality of life and reproductive health. Experts at the congress emphasized the need for timely diagnosis and a multimodal approach that takes into account the mechanisms of disease in each patient and targets different aspects of the pathological process.

References

¹ Alshahrani, S.; Fathi, B.A.; Abouelgreed, T.A.; El-Metwally, A. Prevalence of Sexual Dysfunction with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): An Updated Systematic Review and Meta-Analysis. Medicina 2025, 61, 1110. doi:10.3390/medicina61061110

² Kyzlasov P.S., Abuev G.G., Mustafaev A.T. Evaluation of the efficacy and safety of Adenoprosin^® in patients with category IIIA chronic prostatitis. Experimental and Clinical Urology. 2023. (In Russian)

³ Mazzoli S. (2009) Biofilm and bacterial microorganisms in genito-urinary infections [in Italian]. Infez Med 17 (suppl 3): 3–9.

⁴ Garcia-Castillo M.