Question

I'm 29 years old and for the last 4 years I have been seeing a urologist and he always finds a hard spot on my prostate. He performed a biopsy and it was negative but my symptoms keep getting worse. I get lower back pain, painful ejaculations, and have completly lost my sexual desire and my erections. All my doctor does is treat me with antbiotics and I'm desperate and need someone else's opinion. Can someone please help me because I have already lost my wife because of my sexual problems. I would really appreciate it.
Thank you.

Louis

Answer

Louis presents with painful ejaculation, difficulty maintaining erections, low back pain, and loss of libido with a history of firmness in the area of the prostate that is biopsy negative for cancer. His symptoms persist in spite of multiple courses of antibiotics. What's wrong?

This history and the physical findings are quite suggestive of chronic prostatitis. I refer you to my prior remarks on prostatitis:

http://www.canfp.org/artman/publish/article_779.shtml

In the face of the failure of antibiotics to resolve the symptoms (assuming the ones that were used are known to develop effective levels of medication in the prostate tissue) I would switch to a long term (many months) use of anti-inflammatories coupled with sitz baths at least twice a day, good fluid intake to keep the urine dilute, and abstinence from any caffeine-containing substances. All these symptoms will resolve in time with appropriate treatment.

Gregory Polito, MD

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