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Many men, of all ages, have a problem with prostate pain. This pain often is worst at the moment of ejaculation. First  there is some some good news: This problem doesn't mean you have to give up sex, and even if the underlying cause of the pain is bacterial prostatitis, it isn't something you can give to your sex partner. 

Prostate pain is not in and of itself a sure sign of prostate cancer; more often the problem is that the central nervous system has somehow come to associate pain with orgasm. This is a condition known as allodynia. 

Allodynia isn't necessarily related to damage in prostate tissue. The trigger for allodynia can be injury, such as bouncing up and down on a bicycle seat, or exposure to toxins, or needing to "hold it in" either during sex or urination. Some men avoid ejaculation as a martial arts discipline. If they aren't doing this under the direction of a very knowledgeable martial arts master, they can generate chronic prostate pain. Other men develop prostate problems because they don't urinate often enough. Men in professions as varied as trucker, doctor, and elementary school teacher can develop this prostate problem because they don't go to the bathroom often enough. Unfortunately, there is also some bad news: This problem can be very difficult to treat.

There are more things you can do when the problem first starts that you can't do if you haven't done anything about it in months or years. Here are the places to start.

  • Antibiotic treatment (this is something you have to get from a doctor, because choosing the wrong antibiotic can actually make the problem worse) often relieves pain if the antibiotic is started within a few weeks to a few months after the pain starts. Even after the bacteria are wiped out in the prostate, however, they can linger in the bowel. To avoid reinfection, be careful with hygiene after defecation, wiping backward from the anus, not in the direction of the penis, making sure you are clean before you leave the toilet.
  • Aspirin and NSAIDs help, but they are usually are not enough,.
  • Some men get great results from herbal products, such as Cernilton, bee pollen extract, beta-sitosterol, saw palmetto extract, or a combination of all of these. They may not be all that helps, however. Medication may give even more relief.
  • Doctors often prescribe alpha-blockers or muscle relaxants for this problem. The longer a man has had prostate pain, the less these medications can relieve it.
  • Tricyclic antidepressants, a class of drugs no longer used to treat depression in most of the world, can relieve chronic pain caused by changes in the central nervous system. The challenge in using these medications, which are very inexpensive, is that they cause sleepiness. They are needed at bedtime, but a man has to get around to having sex while he is still awake.
  • Montelukast (Singulair), a drug that is more often used to treat asthma, sometimes relieves prostate pain. It modifies white blood cells so that they don't produce inflammatory hormones.
  • Pentosanpolysulfate (Elmiron) is a medication that is approved for treating interstitial cystitis/painful bladder syndrome/bladder pain syndrome (IC/PBS/BPS). It also helps in prostate pain. It works by changing the structure of the lining of the prostate.
  • Muscle relaxants are sometimes prescribed to treat muscle spasms that don't occur in the prostate, but are felt in the prostate. There are newer medications that don't cause drowsiness and aren't addictive.
There is a lot a urologist can do to help men with painful prostate problems that doesn't involve surgery. 
Be careful even with surgery that doesn't involve removal of the prostate, however, because it can cause a particularly troublesome complication called retrograde ejaculation. In this condition, semen travels up rather than out. It is possible for a man to have intense orgasms even with this condition, but it is not "normal" sexual intercourse for most men.

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