Anderson Rodney U, Wise David, Sawyer Timothy, Chan Christine A
Department of Urology, Stanford University School of Medicine, Stanford, California, USA.
J Urol. 2006 Oct;176(4 Pt 1):1534-8; discussion 1538-9. doi: 10.1016/j.juro.2006.06.010.
The impact of chronic pelvic pain syndrome on sexual function in men is underestimated. We quantified sexual dysfunction (ejaculatory pain, decreased libido, erectile dysfunction and ejaculatory difficulties) in men with chronic pelvic pain syndrome and assessed the effects of pelvic muscle trigger point release concomitant with paradoxical relaxation training.
We treated 146 men with a mean age of 42 years who had had refractory chronic pelvic pain syndrome for at least 1 month with trigger point release/paradoxical relaxation training to release trigger points in the pelvic floor musculature. The Pelvic Pain Symptom Survey and National Institutes of Health-Chronic Prostatitis Symptom Index were used to document the severity/frequency of pain, urinary and sexual symptoms. A global response assessment was done to record patient perceptions of overall therapeutic effects at an average 5-month followup.
At baseline 133 men (92%) had sexual dysfunction, including ejaculatory pain in 56%, decreased libido in 66%, and erectile and ejaculatory dysfunction in 31%. After trigger point release/paradoxical relaxation training specific Pelvic Pain Symptom Survey sexual symptoms improved an average of 77% to 87% in responders, that is greater than 50% improvement. Overall a global response assessment of markedly or moderately improved, indicating clinical success, was reported by 70% of patients who had a significant decrease of 9 (35%) and 7 points (26%) on the National Institutes of Health-Chronic Prostatitis Symptom Index (p < 0.001). Pelvic Pain Symptom Survey sexual scores improved 43% with a markedly improved global response assessment (p < 0.001) but only 10% with moderate improvement (p = 0.96).
Sexual dysfunction is common in men with refractory chronic pelvic pain syndrome but it is unexpected in the mid fifth decade of life. Application of the trigger point release/paradoxical relaxation training protocol was associated with significant improvement in pelvic pain, urinary symptoms, libido, ejaculatory pain, and erectile and ejaculatory dysfunction.
慢性盆腔疼痛综合征对男性性功能的影响被低估了。我们对患有慢性盆腔疼痛综合征的男性的性功能障碍（射精疼痛、性欲减退、勃起功能障碍和射精困难）进行了量化，并评估了盆底肌触发点释放联合矛盾放松训练的效果。
我们治疗了146名平均年龄42岁、患有难治性慢性盆腔疼痛综合征至少1个月的男性，采用触发点释放/矛盾放松训练来松解盆底肌肉组织中的触发点。使用盆腔疼痛症状调查和美国国立卫生研究院慢性前列腺炎症状指数来记录疼痛、泌尿和性症状的严重程度/频率。在平均5个月的随访时进行整体反应评估，以记录患者对总体治疗效果的看法。
基线时，133名男性（92%）存在性功能障碍，其中56%有射精疼痛，66%性欲减退，31%有勃起和射精功能障碍。在触发点释放/矛盾放松训练后，有反应者（即改善超过50%）的特定盆腔疼痛症状调查性症状平均改善了77%至87%。总体而言，70%的患者报告整体反应评估为明显或中度改善，表明临床成功，这些患者在美国国立卫生研究院慢性前列腺炎症状指数上显著下降了9分（35%）和7分（26%）（p<0.001）。盆腔疼痛症状调查性评分在整体反应评估明显改善时提高了43%（p<0.001），但在中度改善时仅提高了10%（p = 0.96）。
性功能障碍在患有难治性慢性盆腔疼痛综合征的男性中很常见，但在五十多岁时出现则出乎意料。应用触发点释放/矛盾放松训练方案与盆腔疼痛、泌尿症状、性欲、射精疼痛以及勃起和射精功能障碍的显著改善相关。
