Prostatitis, an umbrella term for several conditions that cause prostate inflammation and swelling, affects at least one in four men with prostates at some point in their lives. Although prostate health is often discussed as a concern for older people, prostatitis is especially common among young people—and it can seriously disrupt their sex lives.
While symptoms vary significantly, prostatitis often causes a dull, throbbing pain throughout the penis, testicles, and lower torso. It also makes people feel like they constantly need to pee, but they either can't or find it painful. This discomfort can cut into people's ability to get or stay aroused. People with prostatitis often find ejaculation painful. They may also come more rapidly, or experience a drop in sex drive and erectile function.
Medical experts know shockingly little about the most common, serious form of the condition, chronic prostatitis, which affects at least 10 percent of people with prostates. Chronic prostatitis doesn’t respond to antibiotics, like some other forms of prostatitis do, and it causes recurrent symptoms that last anywhere between a few months and a lifetime.
Experts believe there are multiple potential causes of chronic prostatitis, including autoimmune diseases, genetic predispositions, nerve or muscle damage near the prostate, and hormonal imbalances. However, even specialists can rarely identify the specific cause of any given case of chronic prostatitis. Instead, modern treatment focuses on figuring out what might trigger a patient’s symptoms and suggesting lifestyle tweaks and medications to mitigate them.
But chronic prostatitis symptoms may change over time, and many medical care providers aren’t up to date on treatments for chronic prostatitis. Patients with prostatitis often get long, ineffective courses of antibiotics and are then left to find their own ways to live with their symptoms. Even when people with prostatitis do find well-informed specialists, there’s not much information out there on how to account for their symptoms during sex.
Researchers have called for further study into the management of sexual effects of chronic prostatitis. However, firsthand accounts of life—and sex—with the condition are still rare. To address this gap, VICE spoke to David Lonergan, who developed chronic prostatitis in his mid 30s, and his wife, Dana Schrager, about the role the condition has played in their particular relationship and sex life.
This interview has been edited for length and clarity.
David Lonergan: In 2014, I started feeling wild sensations throughout my pelvic area. At first, there was a slight burning in my rectum whenever I was sitting. Then the pain took on a sharp quality, and spread throughout my pelvis. Eventually, I felt like there were hundreds of razor blades cutting into the inside of my entire urethra. On a scale of 1 to 10, I’d put the pain at 11.
I didn’t suspect this pain had anything to do with my prostate because the pain wasn’t solely focused there. It was confusing. And I worried that if I went to a doctor to address the pain, they’d tell me I’d need to take time off of work, which I didn’t feel like I could do because I was the primary earner in our household. I was also a very stereotypical man in terms of avoiding medical care. I decided I was just going to ignore the pain and push through.
Dana Schrager: David told me what he was feeling from the start. We did go online to try to figure out what was causing his pain, but we couldn’t find anything.
David: My symptoms got so bad that I couldn’t pee. The constant feeling of having to go, but not being able to was the straw that broke my back. I couldn’t live like that. I finally took time off work to go to a doctor.
I saw multiple urologists, and they all said, “It’s prostatitis. Have some antibiotics.” I asked what prostatitis was, and they said, “It’s an inflamed prostate.” I asked what caused it, and they said, “There are many reasons.” I asked why my prostate was inflamed, and they said that they could do some tests, but they might not figure it out, and treatment was trial-and-error. I went on antibiotics for 12 straight months, but they didn’t help. It was clear I had chronic prostatitis, but after I found that out, the information just stopped. There was nothing to guide me.
Our sex life wasn’t in a great place before all of this—we were both dealing with some mental health issues. But we were still having sex occasionally. Then my symptoms started to make sex—especially ejaculation—excruciatingly painful. Early on, I felt like the pleasure of an orgasm, and the sense of pressure relief that accompanied them, was worth the hours of pain I felt afterward. But as the pain got worse, I decided that it wasn’t, and I stopped initiating sex.
Dana: I was dealing with undiagnosed depression, my hormones were out of balance, and I wasn’t using additional lubrication during sex. When we did have sex, it felt like David’s penis was coated in sandpaper. My depression made it hard to communicate, my sex drive was low, and I was afraid of that pain. So I didn’t initiate sex, either.
But watching the person I love live in such pain and knowing urologists seemed to have nothing to offer us was difficult. I was seeing a therapist, and during one session, I told her about what David was going through. She told me about a men’s health clinic in our area. I told David about it and he agreed to give it a shot, because, at that point, we’d try anything.
David: The clinic referred me to pelvic physiotherapy, and that care provider referred me to a nurse practitioner who specializes in prostatitis.
That practitioner held my hand through the process of identifying things that seem to trigger my symptoms. I kept a graph recording all my activities and my pain levels every day. For example, if I had a beer one evening, I could see my pain spike an hour later. Then he helped me figure out lifestyle changes to address each of my triggers. I had to change my diet entirely—which was a good thing, because I ate terribly.
I had to go in for regular prostate massages to drain the excess fluids that created pressure in my prostate, and through that pressure many of my symptoms. Some people massage their own prostates at home, but I didn’t want to do something wrong and make it worse, so I did it in a clinical setting with a nurse who could, at the same time, examine my prostate and prostatic fluids.
Dana: It was a relief to know that, OK, this is something that we can control now.
David: There was one issue with my treatment, though: My care provider told me I should ejaculate regularly to exercise my prostate and to release built-up fluids. [Editor’s note: Although a fair number of care providers subscribe to this approach, there is no firm medical consensus on the role of ejaculation in treating prostatitis symptoms.]
He also told me that, while both masturbation and sex would help, sex would be better because the movements involved in intercourse, like deep thrusting, are better for stimulating the prostate, and orgasms associated with sex are usually larger, and relieve more pressure.
I was scared to masturbate or have sex because of the pain I knew I’d feel afterwards. I figured that if I was going to do this, I wanted to have sex instead of masturbate, in order to apparently do more for my prostate. But because we were both dealing with pain and mental health issues, neither of us was excited to have sex. Especially because there was no foreplay or romance involved in this kind of sex. We were getting a job done.
Dana: Yeah, sex became this medicalized thing. That took all the joy out of it.
David: It’s like eating food with no flavor. It’s just calories.
Dana: I knew that sex would be medically helpful for David, but I still didn’t feel much desire. That made intimacy even more difficult for me. After sex, you’re not happy. You’re just done. Who wants that? Neither of us really wanted to have that kind of sex. Also, I knew that sex still hurt David—and I didn’t want sex to hurt the person I love. Chronic pain is a real mindfuck.
David: During my early treatment, we had sex maybe two or three times over one year, when we wanted to see if we could make it work. But we weren’t enjoying it—we either just stopped, or finished and put it off again for a long time after.
Because sex wasn’t working for us, I opted to masturbate once a day, just in order to ejaculate. I was warned not to masturbate twice in a row, either because I was horny or to try to get out more prostatic fluid, because I’d just aggravate my prostate. [Editor's note: Most medical resources only note that people with prostatitis don’t need to avoid sex, since it typically won’t make the overall condition worse. However, they also acknowledge that intercourse may lead to pain.] I did try to masturbate twice in a day anyway at one point, but the second time was a huge mistake in terms of my pain levels.
At one point, I said that if we weren’t able to have sex, that was OK, but I wanted to consider seeing a sex worker to deal with my prostate issues. That did not go over well.
Dana: I felt anger and frustration, and a sense of having failed as David’s partner. It was an extremely challenging time in our relationship. But David’s always been very committed to telling me what he’s thinking and feeling. That helped me understand where he was coming from. It helped both of us to not give up on this relationship. Still, throughout this time, we’d developed one giant, shared ball of anxiety around sex.
David: Over three years of treatment, my pain went from a constant 10 or 11 to a steady and manageable 2. I only have to go in for prostate massages every six months now, and over the last six months—for the first time since all of this has started—I haven’t worried about randomly triggering my symptoms. I also did a lot of mindfulness work, which helped me to wipe the slate clean of this medical baggage around sex and re-approach it with less anxiety and fear.
Dana: We were both going to therapy, individually and as a couple. That really helped us work through all of our anxieties about sex. I also found effective treatment for my mental health issues and hormonal changes, including medications, and started using lubrication during sex.
Things didn’t get magically better all at once, like they do in the movies. We had to work really hard to process these experiences, move past this medicalization of our sex life, and get to a new happy place. But in the end we did. It was worth it.
David: We got to a point where we were able to have sex just because we wanted to again—not because either of us felt like we needed to for my health. We’re just there for intimacy again. We still don’t have sex all the time, but when we do it’s not freighted now.
Dana: It’s a joyful thing again—an intimate thing that helps to connect us.
David: If I masturbate or have sex now, I may still feel some pain afterwards, but if I take a hot bath or put a heating blanket on my abdomen right afterwards, I’m either going to avoid that pain or minimize it. So, I just do that automatically after sex. I don’t think about my prostate at all anymore either before, during, or after sex—which is a big change and a relief.
Prostatitis symptoms can change over time. So, if my symptoms get bad again, well… [Laughs] We’ll cross that bridge when we get there. But I think we’ll both handle it differently.
Dana: Our relationship, our mental health, and our perspectives on sex are in such a better place now than they were when this all started. I think we’d be much better equipped to deal with it.