Dr. Simon Rattenbury, UK


Innehållet på den här sidan är en sammanställning från olika inlägg gjorda av Dr. Rattenbury, UK på en mailing list tillhörande The British Prostatitis Support Association (BPSA) http://www.bps-assoc.org.uk. Dr. Rattenbury är själv drabbad av kronisk prostatit och under rubriken Diet m.m. framgår hur han bl.a. genom att anpassa sin kost försöker få en så bra livskvalitet som möjligt.

Dr. Rattenbury (microbiologist) works in concert with a number of urologists and clinicians in London and see patients from all over the UK and the world. 

Presentation av Dr. Rattenbury http://www.andrologysolutions.co.uk/?page_id=11 

Email: srattenbury@yahoo.ie 



  Male Sub-Fertility Issues

  Surgery, nutrition Observera!


  Myofascial Pain

  Microbial investigation

  Reactive arthritis

  UTI/Urinary Tract Infection

  Om mediciner m.m.




  Just some basics




Prostatitis is an inflammation of the prostate gland, which forms part of the reproductive system this, is just a little background (don't worry to much about this) however, local structures such as nerves, muscles & blood vessels may have an impact on this condition. It is very difficult for a clinician to make a firm diagnosis such as "abacterial" "CPPS" etc without doing some investigations even then it is difficult!

The prostate is a gland situated underneath the bladder (the bladder neck) and is perforated by the first portion of the urethra. The two ejaculatory ducts enter the upper part of the prostate from behind, travel through the gland and open into the urethra on a small protuberance (3-4 mm) of the urethral mucosa called the verumontanum ("veru"). The veru is critical because of the convergence of several other structures. Between the two openings of the ejaculatory ducts, we find the opening of the utricle; The appearance of the utricle can vary widely from a tiny dimple in the veru to a long narrow duct extending deep into the prostatic tissue parallel to the ejaculatory ducts in the midline. In some individuals, this duct obliterates forming a cyst in the prostate, not rarely the cause of symptoms identical to those of "chronic prostatitis".

The prostatic acini produce a fluid that, at orgasm, is expelled from the acini by contraction of the prostatic smooth muscle tissue surrounding these acini. The composition of the prostatic fluid is vital for the well being of the spermatic cells outside the body and severe alteration, like in certain forms of chronic prostatitis, can degrade fertility.

The aetiology of prostatitis is poorly understood, we know that it may be caused by infections such as Chlamydia, Mycoplasma, ureaplasma and a range of other microbes however; Prostatitis can be caused by stone formation, reflux of urine, autoimmune disease, (molecular mimicry) inflammation of the nerves supplying that area, pelvic floor tension etc. Symptoms. The range of symptom's are varied and any combination can occur. Urinary tract infections are not very common in men due to the length of the urethra therefore; urinary symptoms should in my opinion be investigated more fully than just a urine test, which more often than not comes back from the laboratory as negative. Men rarely get urinary tract infections unless there is some underlying pathology.

These symptoms are not in order of frequency but are most that have been described to me over the years:

  Occasional vague discomfort in the testicles, urethra, lower abdomen, and back.

  Getting up at night and having a wee more than a couple of times.

  Problems starting or finishing a wee.

  Pain or stinging during a wee.

  Discharge from the penis (seen as pus or stains in the underpants).

  Pain/aching in the low abdominal area.

  Pain/aching in the testicles.

  Pain/aching in the area between the anus and scrotum.

  Pain/aching in the lower back area.

  Pain/aching down the front or sides of the leg's.

  Pain/aching during ejaculation.

  Blood in the semen.

  Patients might refer to sitting on a golf ball.

  Pain/aching after driving or sitting for a time.

  Can't sit in a meeting without worrying about having to wee.

  Lack of Libido.

  Fertility issues.

  Pain or discomfort on ejaculation is quite common & is due to the prostate contracting which expresses prostatic fluid

into the ejaculatory ducts, in doing so the prostate becomes inflamed (similar to pressing a spot). Many men describe

that they stop having sex due to prostate pain and the constant aching post ejaculation.

  Quite a few men say that prostatic massage helps with symptoms, this at first seems a little confusing when you

consider that the massage has a similar effect to the ejaculation during sexual activity, however the massage is very

vigorous and if performed properly the massage will extend all over the prostate gland expressing a great deal of its

contents also during this process any micro-abscess or blockage present may burst or dislodged reducing the     inflammation.

  Some prostate are cold and boggy just as you would fined with a swollen lump, so that when you press on it it leaves   

an indentation. On the other hand they can be hot and swollen and sometimes I can almost feel the colour of the prostate "RED"!

  I have found that ~ 35% of men with fertility issues that I see have an inflammed prostate, however I have

had prostatitis since I was 27 (now 47) & I have four children with no problems!


The aetiology of prostatitis is poorly understood. In my opinion prostatitis can be caused by a whole host of possibilities e.g.

  Infection (in 20+ years I have seen many and mostly they have been treated successfully).

  Doble J Urol. 1989 Feb; 141(2): 332-3) actually states that Chlamydia can not be ruled out as a cause?

  Mycoplasma, ureaplasma and a range of other microbes.


  Stone formation

  Crystal formation

  Reflux of urine. It is known that urine can reflux into the prostate, therefore waste products from the urine may be

deposited within the gland: theory is that the reflux of urine into prostatic ducts causes prostatic inflammation via high

concentrations of purine and pyrimidine (uric acid) base-containing metabolites in prostatic secretions. In some cases

the use of allopurinol (has side effects) for treatment of chronic prostatitis has been used in theory lowering prostatic

levels of uric acid and improving symptoms. However there has not been enough research.

  Autoimmune conditions, Molecular mimicry.

  Inflammation of the nerves supplying that area, pelvic floor tension etc.

  BPH & other oncogenic processes.


Semen; is basically composed three parts; the fluid that supports the spermatozoa (sperm); 65% from the seminal vesicles, 30 to 35% from the prostate and 5% from the vasa. Semen contains citric acid, free amino acids, fructose, enzymes, phosphorylcholine, prostaglandin, potassium, and zinc. The amount of ejaculate you produce can vary, from just a few drops to about a teaspoon full (2 to 6 mL). However, this may depend on sexual activity however, small volumes may be due to reflux of semen up into the bladder (bladder neck problems can cause this for example). When semen  is produced it becomes "clumpy" like a blood clot this is quite normal. The colour does vary slightly; white/grey to cream/yellowish however, pus & blood cells can change the colour. 

What I would suggest depends on age, medical history etc but if you are worried have a prostate investigation & a sperm test, also if you don't plan on having children for some time you can always freeze & store the semen. My youngest patient was 13 he was sexually active; many of the patients I see are in their 20's through to 80+, so its not an "old mans" illness.

As a microbiologist I do not condone the misuse of antibiotics and I agree that treatment after treatment is probably not required. It is important to obtain some good microbiology first before starting any treatment (not in acute P) Antibiotics should be limited to one big hit (six weeks to obtain a sufficiently high concentration) then stop unless there clinical evidence of sepsis. Therapeutic massage works for some patients but not all, however it has to be performed on a regular basis, also good nutrition and fluid intake are equally important. Quite a few men say that prostatic massage helps with symptoms, this at first seems a little confusing when you consider that the massage has a similar effect to the ejaculation during sexual activity, however the massage is very vigorous and if performed properly the massage will extend all over the prostate gland expressing a great deal of its contents also during this process any micro-abscess or blockage present may burst or dislodged reducing the inflammation.

The problem with many drugs is that they do not acheive adequate levels within the prostate for many reasons e.g. lipid solubility, degree of ionization, degree of protein binding and the size and shape of the molecule. Therefore drugs are unable to cross the electrically charged lipid membrane of the prostate epithelium to reach therapeutic levels within the prostatic acini.

As I have said many times on the BPSA (Brittish Prostatitis Support Association) site, prostatitis is a complex issue in that other clinical manifestations have to be excluded or at the very least recognised, as someone posted recently Chronic pelvic pain syndrome is a "syndrome" which maybe be stating the obvious but CPPS may have nothing to do with prostatitis. I feel it is this type of issue that medicine does not address, once the urologist in his or her mind has ruled out prostatitis (how!) and perhaps they have performed  some other investigations they are at a loss, therefore the next port of call is the use of mood controlling medication. I look after many patients, from politicians, sportsman, actors, musicians, so called celebrities etc, all of who thought they were unique and worried sick because "men don't talk".

Prostatitis is a real "PAIN", I have had prostatitis since I was 27 (now 50), it was bad for about a year then it went for a while then I have "blips" every now and then! Mine is true prostatitis in that I have WBC in my prostate & urine and is not chronic pelvic pain syndrome (at least not yet) but I also have ankylosing spondylitis, which can produce pelvic pain & can confuse the condition. The pain from prostatitis is similar to the worst type of period pain that lot's of women get each month but with prostatitis it may last weeks, months or in some cases years.The duration of the illness varies from person to person; this is obviously dependant on the stage of the disease, antibiotic or other therapy. 

But generally speaking I always tell all my patients "once a member of the prostate club always a member". But that's not to say that you will always have the symptoms, however you my have episodes throughout your life (as I do).

My point is that prostatitis (P) and CPPS (Chronic Pelvic Pain Syndrome) are different. However in my view P may cause CPPS but I am unsure that the converse is true having seen many thousands of men in 20+ years. P may be the trigger for a host of autoimmune conditions (as seen with STI's also). In my simple mind prostatitis is not just microbial in nature but may be caused by a number of other triggers all of which I have explained on the BPSA site.

The Stanford protocol is for pain management after the diagnosis of P has been excluded. I have my reservations concerning the Stanford protocol based on patients that have spent a great deal of time and money for very little in the way of "cure". I have seen many men from all over the world who in total distress who have tried treatments from all over the globe, most of which have just been money making!


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Surgery, nutrition


Keep away from surgery, change your diet to that of a healthy heart protocol. Talk to your partner, keep having sex. I know this sounds silly but try and lead a normal life (I also have prostatitis), try and have sex if not then have lot's of naughty cuddles talk about it with your partner, tell her the pain is like a very bad period etc, the adage of a healthy heart equates also.

To a healthy prostate if the basics of nutrition & exercise are followed: 
  A diet which is low in salt and saturated fats such as a Mediterranean diet, oily fish for the Omega 3 group of fatty acids, olive oil, garlic, broccoli, avocados, fresh fruit and a varity of vegetables, seeds are good for trace elements such as zinc.

  A diet for a health heart equates to a health prostate. 

  What ever happens do not stop drinking water. Two litres of water, more if you exercise, a few glasses of good red wine occasionally has also been found to be beneficial.


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Male Sub-Fertility Issues

Normally, after a careful history, physical examination & possibly bloods for genetic or biochemical markers the males role in a couple with infertility; put simply is to produce a semen sample, if this sample is deemed satisfactory by their consultant then that is normally the end of the males participation, this in itself can be very frustrating to the man especially when at the end of each monthly cycle a pregnancy does not occur. However, semen is a complex of secretions produced by the sexual accessory tissues (glands), which include the prostate, seminal vesicles, epididymis, vas deferens, ampullae, Cowper's gland, and glands of Littre Therefore, if any of these structures are inflamed or infected then, this will reduce the quality of the semen produced & potentially affect fertility.

Infection or inflammation of the accessory glands (MAGI) such as the prostate and seminal vesicles occurs twice as often in the male partner of infertile couples than in fertile men and it is thought that MAGI could affect male fertility by decreasing the sperm count, morphology, motility and accessory gland function (decreased levels of zinc, acid phosphatase, fructose). Leukocytes are the main source of reactive oxygen species (free radicals), which can decrease sperm function (acrosome reaction and zona-binding). MAGI is associated with an increased prevalence of sperm antibodies and chronic infection could lead to ductal stenosis and subclinical orchitis.

Damage to the DNA bonding of sperm (DNA fragmentation) may also be influenced by the above factors; levels of fragmentation above 30% are consistent with multiple miscarriages and or reduced fertility. There are a number of different microbes associated with prostatitis and reduced fertility such as Mycoplasma/Ureaplasma, Chlamydia, gonorrhoea etc.

Basically semen; is composed three parts; the fluid that supports the spermatozoa (sperm); 65% from the seminal vesicles, 30 to 35% from the prostate and 5% from the vasa. The amount of ejaculate you produce can vary, from just a few drops to about a teaspoon full (2 to 6 mL). However, this may depend on sexual activity, small volumes may be due to reflux of semen up into the bladder (bladder neck problems can cause this for example) The colour does vary slightly; white/grey to cream/yellowish however, pus & blood cells can change the colour. It is important to remember that a semen analysis only gives the basic data and certainly, microbial culture results should be treated with caution in the absence of other supporting evidence.

Seminal fluid contains citric acid, free amino acids, fructose, enzymes, phosphorylcholine, prostaglandin, potassium, and zinc. Fructose is primarily an energy source for sperm & there are other components that cause the semen to become "clumpy" like a blood clot when first produced, this is quite normal. Fluid from the prostate is very complex and basically affects the acid/alkaline balance (pH) activates the head of the sperm, causes the semen to liquefy, a prostaglandin that has immuno-modulating affect within the vagina (vaginal immune system).

Constituents of Prostatic Fluid:

Polyamines (spermine)

Prostatic Acid Phosphatase

Plasminogen Activator

Prostatic-Specific Antigen (PSA)

Seminal Neutral Protease (seminin)


Proteolytic enzymes

Kallikrein-2 (hK2) and prostate-specific antigen (PSA).

Cholesterol, Lipids

Zinc (prostatic antibacterial factor)

Lactate Dehydrogenase


Prostatic Products - Actions

Zinc Antibacterial Factor

Citrate as a buffer or chelator of cations

Sperm Transport (anion citrate)


Cell Proliferation  Odour of Semen

Cholesterol, Lipids

Sperm Protection

Plasminogen Activator

Semen Liquefaction


Semen Liquefaction

Inflammation of the prostate is very common and it has been reported that as many as one in two men will have prostate disease at some point in their lives  (Stamey et al), its not just an old mans disease inflammation is seen in sexually active men both young and mature. However, not all men will have symptoms or at least they may not recognise or attribute them or they may confuse them with other conditions such as "flu" "tiredness" "dribbling", often on taking a medical history the patient may describe vague pains in the testicles or post ejaculation discomfort at sometime, sports injury or a past history of a sexually transmitted infection such as NSU (non specific urethritis).

Of course there are a group of men that have what I term as "silent" inflammation with no apparent symptoms and would not normally be aware of an issue until they are screened as part of a fertility work up or it flares up in later life! I have found that ~ 35% of men with fertility issues that I see have an inflamed prostate.

Inflammation/Infections of the prostate can cause swelling and blockage of the ejaculatory duct as this duct passes through the prostate gland. Blockage in this region will prevent sperm from being ejaculated. Occasionally, a man may have a congenital abnormality (a problem they have been born with) in which or 'cysts' in the prostate gland have formed. By pressing on the ejaculatory ducts, these cysts can also cause blockage of sperm at this level. Blockage of the seminal vesicles can reduce the amount of fructose present, which is vital as an energy source for the sperm.

What Other Effects Can The Inflammation Have:

Spermatozoa are 'foreign' to the body that produces them because they contain only half the normal number of chromosomes. Sperm, or sperm products, which come into contact with blood, are therefore capable of initiating an immune reaction with production of anti-sperm antibodies. For this reason, spermatogenesis normally takes place behind an immunological barrier' in the testes. However, damage caused by infection, trauma or sperm or sperm components leaking across the barrier can stimulate antibody production. Antibodies may then enter the seminal fluid and 'attack' the sperm. Viewed under the microscope, antisperm antibodies are seen to cause agglutination of the sperm and to seriously reduce motility, thereby causing infertility. Once the immune system has been sensitised to sperm, it is extremely difficult to reverse the process. However, by the use of high doses corticosteroids, the amount of antibodies may be reduced and fertility temporarily restored but not without possible major consequences for the male, these should be discussed with the consultant.

Inflammation can induce reactive oxygen species (ROS) which effect sperm function and fertility; Sperm are particularly sensitive to damage by reactive oxygen compounds (ROS) because of the high content of polyunsaturated fatty acids contained in the sperm membrane, they can induce damage by peroxidation of sperm lipid membranes and creation of toxic fatty acid peroxides. Sperm axonemes also appear to be the targets of ROS-induced sperm damage, which include hydroxyl radical (OH), superoxide anion (O2) and hydrogen peroxide (H2O2). These are generated cells of the immune system such as leukocytes (white blood cells/pus), however the news is not all bad the body does have mechanisms to counteract the potentially harmful effects of ROS including the enzymes superoxide dismutase (SOD), glutathione peroxidase, and catalase.

A number of studies have demonstrated an increase in ROS in the semen of men with idiopathic sub-fertility with the effect of reducing sperm-egg fusion in light of these studies, several investigators have attempted to introduce compounds such pentoxifylline into the semen that detoxify or scavenge these ROS.


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The pudendal nerve transmits sensations from the external genitals, the lower rectum, and the perineum (the bit between the testicles and anus). Neuropathy is disease of or damage to nerves (this damage may be due to viral, autoimmune disease, tissue damage, diabetes or multiple sclerosis or other such trauma (sports injury). Pudendal neuropathy can cause symptoms in any of these areas. Some folk have mostly rectal pain, sometimes with passing faeces & others have mostly pain in the perineum or genitals. The symptoms may include shooting, twisting or burning pain, pins and needles, numbness or hypersensitivity. The symptoms are sometimes exacerbated by sitting, and are better by either standing or lying down. 


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Myofascial pain

Anm. Myofascial Pain innebär smärta, som utgår från muskelvävnad och muskelbindvävshinna. 

These are some of the factors that are implicated in Myofascial Pain. What explanation/rational is there for prostatitis vis trigger point release? What explanation/rational is there for prostatitis vis trigger point release. These factors can cause trigger points:

  Sudden trauma to musculoskeletal tissues (muscles, ligaments, tendons, bursae).

  Injury to intervertebral discs.

  Generalize fatigue (fibromyalgia is a perpetuating factor of MPS, perhaps chronic fatigue syndrome may produce
     trigger points as well).

  Repetative motions; Excessive exercise; Muscle strain due to over activity.

  Systemic conditions (eg, gall bladder inflammation, heart attack, appendicitis, stomach irritation).

  Lack of activity (eg, a broken arm in a sling).

  Nutritional deficiencies.

  Hormonal changes (eg, trigger point development during PMS or menopause).

  Nervous tension or stress.

  Chilling of areas of the body (eg, sitting under an air conditioning duct; sleeping in front of an air conditioner).


In other words the protocol may work for CPPS, but is that the same as prostatitis? I am just a little confused as there are so many elements that need addressing.


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Microbial investigation

Firstly, men don't get UTI's unless there is some underlying pathology. Urines are examined in different ways in different labs, most do not have the expertise, they don't know what to look for or how. In each urine I am looking for different things but they need to be concentrated etc.

Normal dip screening tests for urinary tract infections are rubbish for identifying infections of the prostate, I have a set protocol in my lab for dealing with such samples.

As far as I know, I am the only microbiologist in UK who does both the massage, microscopy and the microbiology.

This is for an evaluation. Well normally I take a full clinical history.
The procedure is as follows, two urine samples, then a pros massage, then a swab and last of all a third urine. All the samples are concentrated. I look at them under a microscope then they are cultured for 5 days looking for a wide range of microbes including yeasts, mycoplasma, ureaplasma also some moleculare work as well.

I have discussed the microbial investigation of prostatitis many times on this site and stressed the importance of not only having "good" microbiology but also, expert interpretation of the microscopy of the various samples produced. However, within the NHS this type of investigation is poorly understood and the methods used in these laboratories do not reflect the requirements of such specimens. This service "The Stamey Localisation Method" is available privately and I have been providing it for about 20+ years.

I really find it  fascinating that a clinician can make the statement of non bacterial prostatitis without doing the microbiology, most NHS lab's are not set up for this type of investigation. The main reason is that a "urine" sample will not provide the correct information nor is it the correct sample. Basically.......a rubbish sample .........rubbish result.

One of my main problems when investigating prostatitis is that most chap's have had multiple courses of short term antibiotics which, makes the microbiology very difficult, however the investigation is not just about the microbiology but also the microscopy, the cells, crystals etc present.

In my time, these are some of the organisms that we can culture & have isolated from patients (as not all bacteria can be isolated by conventional means): Haemophilus spp, Streptococci spp including pneumoniae & milleri, Ureaplasma, Mycoplasma, corynebacteria, staphylococci, anaerobes from a prostatic abscess, Various coliforms. I have also, seen yeasts, fungi & parasites mostly from immunocompromised patients. With new molecular technology being developed "nucleic acid amplification" microbiology is undergoing a revolution & the aetiology of many disease states maybe unravelled. It is interesting that there are so many experts in medicine who are not microbiologists that can categorically describe that prostatitis is not due to infection, when there are a whole host of microbes that they don't even look for e.g. Viruses, Mycoplasma spp, Ureaplasma spp etc.

The problem really is that Gp's (& other medics) do not recognise the onset or symptoms of prostatitis and just end up giving multiple courses of smarties.and what a surprise abacterial prostatitis. I need to see the patient at the start. I had a patient recently with Haemophilus para influenzae not many Dr's or labs would recognise the significance of that and he was told he had "abacterial P". What about organisms that are difficult to grow such as mycoplasma and ureaplasma & others, what about STI's, what about viruses etc.

But its not just about microbes, its about making a diagnosis. The number of men I have seen over the years who once you tell them that their prostates are inflamed, what the condition is, what happens next etc etc when for years they have been told its all in their head!

Of course there are those chap's with whom I don't find anything and of course my heart sinks but in most cases it helps just talking the issues through.


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Reactive arthritis

It is quite possible that prostatitis can induce reactive arthritis. Some people may have a genetic predisposition and therefore a higher risk of developing reactive syndrome (as I am). Just as we inherit our hair colour and blood type from our parents, we also inherit our tissue type. The tissue typing system is the Human Lymphocyte Antigen (HLA) system. One of the tissue types, HLA-B27, is found in only a small percentage of the broad population. Approximately 10% of the Caucasian population has HLA-B27; it is even more rare to find HLA-B27 in people of African descent.  This tissue type seems to increase a person's risk of developing reactive arthritis after a bacterial infection, and may also increase the risk that reactive arthritis will not quickly resolve. Approximately 50% of reactive arthritis patients are HLA-B27 positive.


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UTI/Urinary Tract Infection

Men don't get UTI's unless there is some underlying pathology. By underlying pathology I mean:

  1. Prostatitis

  2. Bladder neck issues such a narrowing.

  3. Urethral stenosis

  4. STI

  5. Autoimmune disorders

  6. Stones

  7. Crystals

  8. Nervous control

  9. Bladder tension

  10. Tumour

  11. Previous systemic infections

  12. etc etc

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Om mediciner m.m.

Finasteride belongs to a group of drugs known as 5-alpha reductase inhibitors, it works by blocking the action of 5-alpha reductase, which reduces levels of di-hydro-testosterone DHT. Consequently, use of Finasteride has been shown to decrease the size of the male prostate. However, one of the side effects can be poor erectile function.

Quercetin should have no effect on your erection, in fact it can be found in a number of foods such as apples and onions, as I tell all my patients diet is very important of dealing with prostatitis. 

Many of the supplements that you buy are found naturally in all food groups however, we do not always eat all the food groups therefore, some increase of these elements is required by taking supplements. Omega 3 is example, we do not eat enough oliy fish in our diets so extra should be taken in the form of fish body oil supplement.


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Testosterone is an androgenic hormone primarily responsible for normal growth and development of male sex and reproductive organs, including the penis, testicles, scrotum, prostate, and seminal vesicles. It facilitates the development of secondary male sex characteristics such as musculature; bone mass, fat distribution, hair patterns, laryngeal enlargement, and vocal chord thickening. Additionally, normal testosterone levels maintain energy level, healthy mood, fertility, and sexual desire.

The testes produce testosterone regulated by a complex chain of signals that begins in the brain. The hypothalamus secretes gonadotropin-releasing hormone (GnRH) to the pituitary gland in carefully timed pulses (bursts), which triggers the secretion of leutenizing hormone (LH) from the pituitary gland. Leutenizing hormone stimulates the Leydig cells of the testes to produce testosterone. Normally, the testes produce 4–7 milligrams (mg) of testosterone daily. Please remember that this is a complex process that involves other hormones such as inhibin etc.

Testosterone production declines with age, however deficiency may result from disease or damage to the hypothalamus, pituitary gland, or testicles that inhibits hormone secretion and testosterone production, and is also known as hypogonadism. Depending on age, insufficient testosterone production can lead to abnormalities in muscle and bone development, underdeveloped genitalia, and reduced libido.

Testosterone levels (function) can be affected as follows:

-  Being Overweight, hypertention, excess alcohol consumption, Chemotherapy.

-  Damage occurring during surgery involving the pituitary gland, hypothalamus, or testes.

-  Glandular malformation, Head trauma that affects the hypothalamus.

-  Infection, Isolated LH deficiency (e.g., fertile eunuch syndrome) Radiation.

-  Testicular trauma, Tumors of the pituitary gland, hypothalamus, or testicles.

You will see many treatments advertised on the web but before embarking on any treatment please consult your clinician and discuss in detail the symptoms if necessary ask for a referal to an endocrinologist.

Use or misuse of steroids can have serious side effects however proper use under medical supervision can be benifical


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There can be many reasons why our erections don't always feel as they should and in some cases an erection just don't happen for physical reasons, or chaps just lack libido but still get erections and to a greater or lesser extent the erection works. I agree you should always have a chat with your GP and explain ALL that's going on in your life etc including any symptoms you have.

There are medical conditions:
1. Diabetics
2. Hormones
3. Being very overweight
4. Heart conditions
5. Certain drugs (Beta blockers for example) Alcohol, cocaine
6. Depression
7. High blood pressure etc

I see patients with acute / chronic pain from prostatitis, they may get discomfort or pain during or after ejaculation and of course they don't feel very sexy or they feel they might pass it on to their partner (bugs).


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First of all this is not an old mans illness, my youngest patient was thirteen, the average age of the patients I see is mid 30's. Secondly, it affects both men and women, obviously females do not have a prostate but the effects on a relationship can be enormous. One of the most important factors on the road of understanding the condition is talking about it and with someone who understands the condition. (Women also suffer with a pelvic pain syndrome).

Many of the men I see feel that they are the only one with this affliction and in some cases that they may pass it on to their partners (STI's not included) and in some way they are dirty. One in two men will suffer with prostatic disease!

There is no clinical evidence to show that having your prostate removed or a TURP will stop the pelvic pain, however a total prostotectomy is a major undertaking with many risks. I know this sounds silly but try and have a normal life, don't cut yourself off, keep having sex (or just cuddles), only make a few lifestyle changes......if you drink try different types of alcohol (only Whisky makes my prostate worse). Make sure you have a good diet, moderate exercise.

The problem as I see it is that too many Drs choose the diagnosis of P without doing in depth investigations (as much as you can), then treat with antibiotics, if the symptoms do not resolve after multiple courses then it must be one of the others e.g. CPPS, abacterial P, non inflammatory etc etc.

The microbial flora of the genitourinary tract is rich yes, there are specific pathogens such as Chlamydia, GC, HSV, HPV but with due regard to other microbes who is the bad guy and who is just passing by! Therefore expert microbiology work is required.

Antibiotics do penetrate the prostate, some at high concentration but it all depends on three main factors of the antibiotic. The major factors determining the diffusion and concentration of antimicrobial agents in prostatic fluid and tissue are the lipid solubility, dissociation constant (pKa) and protein binding. The normal pH of human prostatic fluid is 6.5–6.7, it increases in chronic prostatitis, ranging from 7.0 to 8.3. A greater concentration of antimicrobial agents in the prostatic fluid occurs in the presence of a pH gradient across the membrane separating plasma from prostatic fluid.

Metronidazole penetrates the prostate well, however in my experience of anaerobes in the prostate, I would expect a walled off area like a sack or small abscess. Massage may work well in these circumstances.

My point is pelvic pain may be caused by P along with a host of other conditions such as nerve or muscle damage, but why should pain in the pelvis cause P the prostate may not be involved at all!

The worst offenders take swabs, semen samples, MSU and end up with rubbish microbiology (obviously this is a sweeping statement), they then get these chaps back time after time to treat what are probably regional flora. 50% of all Chlamydial infections in men have no symptoms, (80% in women) this may be a trigger for autoimmune disease but then there are a host of other microbes such as mycoplasma and ureaplasma spp which may act as a trigger.

Then we have those men who are HLA-B25 or HLA-B51 positive these chaps may be more prone to "autoimmune type" P, the trigger may be any of the above, however so may stomach bugs such as Campylobacter, Proteus or Klebsiella spp, these can manifest in spondylitis or spondyloarthropathyr. Then theres Reiters syndrome and spondyloarthropathy etc.

Most of my patients have prostates full of white blood cells and debris, which does not always mean infection but it does mean inflammation. In some men over a period of time the prostate blocks and becomes inflammed once more, however I have a few patients whom I saw early in the disease process that have responded well to the massage and have made a dramatic recovery.

Yes, massage may have an effect on the local muscles but it does not account for men who have UTI, urethral discharge, auoimmune issues, crystals, stones etc.

The "Stanford protocol" may well be the treatment for certain aspects of the pathology.


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Just some basics

What you describe is very common and unfortunately a rather large number of my patients are treated in this appalling manor. Firstly, is to discuss the use of long term antibiotics which in the case of prostatitis are not warranted unless proven scientifically even then specific regimens are applied generally 6-12 weeks and then stop NO MORE recurrent infections are rare unless there is an abscess or walled off region sometimes a fistula can form between structures and infections can track between the two but this is quite rare. With regard to amitriptyline this type of drug at best should be used in the short term as a temporary measure dealing with pain or disturbed sleep patterns. (Excluding mental ill health).

Inflammation of the prostate may have a number of causes e.g. stones, crystals, reflux of urine, infection, autoimmune disorders, then there is pelvic floor pain which may be due to prostatitis or changes to the pudenal  nerve, muscle tension, alignment of the pelvic floor etc etc.

Yeasts can cause a very itchy rectum, perineum, penis as well as a number of other pathologies, however one of the most common causes of an itchy rectum/perineum is a parasite known as a pin worm which is very infectious and common in children, this won’t cause serious illness but is very itchy, I know as I’ve had it. Then there are other microbes such as bacteria (staph and streps) however, chemicals and allergies can cause similar symptoms.

I have had prostatitis since I was 27 and now in my 50’s so I know what you are going through but it is so important to have a sex life once again I get all my patients to keep ejaculating as I am sure they will testify at first it takes time to over come the pain but it does reduce with time plus it is so important to share you thoughts with your partner as relationships are not just about your sexual satisfaction but all the other things such as cuddling, kissing etc etc it makes you both feel good, obviously this is ok when you are in a relationship but with time and a building self-confidence it can happen.

Basics such as good nutrition, reduction in fat’s, salt and sugar, good hydration, fish body oils, drink good quality wine if that’s your thing, exercise, yoga, sex, try to reduce stress and talk. Treatments can vary from Prostate massage, trigger point therapy, pelvic floor alignment etc

Best wishes



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"Smärttillstånd" jämförbart med smärtor vid kronisk prostatit/CPPS!

Bild hämtad från föreläsning om sjukdomen av Prof. J Curtis Nickel, Kanada.


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