The Association Between Varicocele, Premature Ejaculation and Prostatitis Symptoms: Possible Mechanisms

Abstract

Introduction.No study has ever systematically evaluated the impact of varicocele on sexual function. Aim. Two cross-sectional studies were performed in patients attending an andrology unit either for male sexual dysfunction (study 1) or couple infertility (study 2). In study 1, we evaluated the impact of varicocele on sexual function. In study 2, we retrospectively evaluated a possible association between varicocele and prostatitis signs and symptoms. Methods. Study 1 refers to a consecutive series of 2,448 (mean age 52.0 Ϯ 12.9 years) subjects. Study 2 consists of a consecutive series of 139 male subjects (mean age 37.3 Ϯ 6.3). Main Outcome Measures. In study 1, varicocele was clinically classified into three grades according to Dubin criteria. Different hormonal parameters were also evaluated. All the patients of study 2 underwent simultaneous scrotal and transrectal color-Doppler ultrasonography (CDU) along with seminal characteristics and interleukin-8, a surrogate marker of prostatitis. Results. After adjusting for age, subjects with severe varicocele (N = 284, 11.6%; Dubin grade 2 and 3) showed a reduction of testicular volume (P < 0.01), higher luteinizing hormone (LH) (P < 0.05), follicle stimulating hormone (FSH) (P < 0.0001) and prolactin (P < 0.05) levels, and also an enlarged or tender prostate at digito-rectal examination (P < 0.05). Premature ejaculation was the only sexual symptoms significantly associated with varicocele (29.2% vs. 24.9% in subjects with or without varicocele, respectively; P < 0.05). In study 2, subjects with severe echographicdefined varicocele (basal venous reflux increasing or not after Valsalva's maneuver; N = 28, 20.1%) showed CDU features of prostatitis and higher seminal inteleukin-8 levels. The presence of any degree of varicocele (N = 40, 28.8%) was also associated with prostatitis symptoms, as measured by the National Institutes of Health Chronic Prostatitis Symptom Index scoring (P < 0.05), and in particular with the pain domain (P < 0.05). Conclusions. In conclusion, signs and symptoms of prostatitis are more common in varicocele patients, who more often complain of premature ejaculation. Lotti F, Corona G, Mancini M, Biagini C, Colpi GM, Innocenti SD, Filimberti E, Gacci M, Krausz C, Sforza A, Forti G, Mannucci E, and Maggi M. The association between varicocele, premature ejaculation and prostatitis symptoms: Possible mechanisms. J Sex Med 2009;6:2878-2887.

Seminal, ultrasound and psychobiological parameters correlate with metabolic syndrome in male members of infertile couples

“…HDL: high density lipoprotein, BP: blood pressure, FSH: follicle stimulating hormone, LH: luteinizing hormone, PRL: prolactin, TSH: thyroid stimulating hormone, Tp: therapy. Echographic defined severe varicocoele = basal venous reflux increasing after Valsalva's manoeuvre at sonography (according to Isidori & Lenzi, 2008;Lotti et al, 2009).…”

“…b Clinical varicocoele: any degree of varicocoele (Grade 1-3) according to Dubin & Amelar classification (Dubin & Amelar, 1970). c CDU defined severe varicocoele = basal venous reflux increasing after Valsalva's manoeuvre at CDU (according to Isidori & Lenzi, 2008;Lotti et al, 2009). A statistical analysis comparing patients with and without MetS has been performed.…”

Pharmacology for the Treatment of Premature Ejaculation

“…Evidence has been provided for an association between hyperthyroidism and acquired PE in a few patients; nevertheless, the data linking thyroid hormones and ejaculatory dysfunction is inconsistent (for review, see Althof et al, 2010). Prostatic inflammation/chronic prostatitis might be involved in some cases (Lotti et al, 2009). Considering the role of the prostate in the ejaculatory mechanism, a direct influence of the local inflammation in the pathogenesis of some cases of acquired PE seems likely (for review, see Althof et al, 2010).…”

421 Prevalence of Prostatitis-Like Symptoms in Outpatients With Four Premature Ejaculation Syndromes: A Study in 438 Men Complaining of Ejaculating Prematurely

“…The LPE and NVPE group had higher prevalence PLS and had a higher NIH-CPSI score compared with the control group, which is probably due to the particular sexual behavior of boys. On the other hand, CP may act as a risk factor or could be the cause of the onset of PE before the beginning of sexual life, but without any clinical symptoms, at least in some subjects [26]. Bacterial inflammation may become chronic, sub-clinical, and cause permanent rapid ejaculation based on an organic condition [6].…”