&lt;h1 class=&quot;heading-title&quot;&gt;&lt;a title=&quot;Frequent ejaculation associated free radical and lactic acid accumulation cause noninfectious inflammation and muscle dysfunction: a potential mechanism for symptoms in Chronic Prostatitis/Chronic Pelvic Pain Syndrome&quot; href=&quot;https://pubmed.ncbi.nlm.nih.gov/19435656/&quot;&gt;Frequent ejaculation associated free radical and lactic acid accumulation cause noninfectious inflammation and muscle dysfunction: a potential mechanism for symptoms in Chronic Prostatitis/Chronic Pelvic Pain Syndrome&lt;/a&gt;&lt;/h1&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;During male ejaculation, the pelvic muscles undergo coordinated intense contraction to expel the semen out of the male genital tract, a process associated with locally increased levels of lactic acid and free radicals as byproducts. In this regards, repetitive sexual activities with frequent ejaculation would impede the drainage and cause accumulation of these byproducts in the pelvic region, triggering consequent local pathophysiological changes such as edema, venous dilation and muscular malfunction, which further leads to common complaints in Chronic Prostatitis (CP)/Chronic Pelvic Pain Syndromes (CPPS). patients such as lower urinary tract symptoms, pelvic discomfort and pain.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;hr /&gt;
&lt;div class=&quot;article-content-section&quot;&gt;
&lt;h3 id=&quot;references&quot; class=&quot;reg&quot;&gt;References&lt;/h3&gt;
&lt;ol class=&quot;references&quot;&gt;
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&lt;li&gt;Parnham A, Serefoglu EC:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.21037/tau.2016.06.05&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Retrograde ejaculation, painful ejaculation and hematospermia&lt;/a&gt;. Transl Androl Urol. 2016, 592:601.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.21037/tau.2016.06.05&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.21037/tau.2016.06.05&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
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&lt;li&gt;Irwin D, Milsom I, Reilly K, Hunskaar S:&amp;nbsp;&lt;a href=&quot;https://www.eu-openscience.europeanurology.com/article/S1569-9056(06)60543-5/abstract&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Prevalence of lower urinary tract symptoms (Luts) in men: European results from the epic study&lt;/a&gt;. Eur Urol Suppl. 2006, 5:157.&lt;/li&gt;
&lt;li&gt;Barnas J, Parker M, Guhring P, Mulhall JP:&amp;nbsp;&lt;a href=&quot;https://www.sciencedirect.com/science/article/abs/pii/S0302283804005585&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;The utility of tamsulosin in the management of orgasm-associated pain: a pilot analysis&lt;/a&gt;. Eur Urol. 2005, 47:361-5.&lt;/li&gt;
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&lt;li&gt;Matsushita K, Tal R, Mulhall JP:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1111/j.1743-6109.2012.02699.x&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;The evolution of orgasmic pain (dysorgasmia) Following radical prostatectomy&lt;/a&gt;. J Sex Med. 2012, 9:1454-8.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1111/j.1743-6109.2012.02699.x&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1111/j.1743-6109.2012.02699.x&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Kaplan HS:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.4324/9780203727317&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Hormones and sex&lt;/a&gt;. The New Sex Therapy, Active Treatment of Sexual Dysfunctions. Taylor &amp;amp; Francis, New York; 1974. 1:46-61.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.4324/9780203727317&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.4324/9780203727317&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Alwaal A, Breyer BN, Lue TF:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1016/j.fertnstert.2015.08.033&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Normal male sexual function: emphasis on orgasm and ejaculation&lt;/a&gt;. Fertil Steril. 2015, 104:1051-60.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1016/j.fertnstert.2015.08.033&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1016/j.fertnstert.2015.08.033&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Althof SE, McMahon CG:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1016/j.urology.2016.02.018&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Contemporary management of disorders of male orgasm and ejaculation&lt;/a&gt;. Urology. 2016, 6:9-21.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1016/j.urology.2016.02.018&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1016/j.urology.2016.02.018&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
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&lt;li&gt;N&amp;uacute;&amp;ntilde;ez R, Gross GH, Sachs BD:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1002/cne.902470402&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Origin and central projections of rat dorsal penile nerve: Possible direct projection to autonomic and somatic neurons by primary afferents of nonmuscle origin&lt;/a&gt;. J Comp Neurol. 1986, 247:417-29.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1002/cne.902470402&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1002/cne.902470402&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Comarr AE:&amp;nbsp;&lt;a href=&quot;http://www.ncbi.nlm.nih.gov/pubmed/5422714&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Sexual function among patients with spinal cord injury&lt;/a&gt;. Urol Int. 1970, 6:134-68.&lt;/li&gt;
&lt;li&gt;Gerstenberg TC, Levin RJ, Wagner G:&amp;nbsp;&lt;a href=&quot;https://bjui-journals.onlinelibrary.wiley.com/doi/abs/10.1111/j.1464-410X.1990.tb14764.x&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Erection and ejaculation in man. Assessment of the electromyographic activity of the bulbocavernosus and ischiocavernosus muscles&lt;/a&gt;. Br J Urol. 1990, 65:395-402.&lt;/li&gt;
&lt;li&gt;Blanker MH, Bosch JL, Groeneveld FP:&amp;nbsp;&lt;a href=&quot;http://www.ncbi.nlm.nih.gov/pubmed/11306400&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Erectile and ejaculatory dysfunction in a community-based sample of men 50 to 78 years old: prevalence, concern, and relation to sexual activity&lt;/a&gt;. Urology. 2001, 57:763-8.&lt;/li&gt;
&lt;li&gt;Nickel JC, Elhilali M, Vallancien G:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1111/j.1464-410X.2005.05341.x&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Benign prostatic hyperplasia (BPH) and prostatitis: Prevalence of painful ejaculation in men with clinical BPH&lt;/a&gt;. BJU Int. 2005, 95:571-4.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1111/j.1464-410X.2005.05341.x&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1111/j.1464-410X.2005.05341.x&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Litwin MS, McNaughton-Collins M, Fowler FJ:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1016/S0022-5347(05)68562-X&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure&lt;/a&gt;. J Urol. 1999, 162:369-75.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1016/S0022-5347(05)68562-X&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1016/S0022-5347(05)68562-X&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Barnas JL, Pierpaoli S, Ladd P:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1111/j.1464-410X.2004.05009.x&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;The prevalence and nature of orgasmic dysfunction after radical prostatectomy&lt;/a&gt;. BJU Int. 2004, 94:603-5.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1111/j.1464-410X.2004.05009.x&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1111/j.1464-410X.2004.05009.x&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Zaidi S, Gandhi J, Seyam O:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1159/000489429&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Etiology, diagnosis, and management of seminal vesicle stones&lt;/a&gt;. Curr Urol. 2019, 8093:113-20.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1159/000489429&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1159/000489429&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Sundar R, Sundar G:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1136/bcr-2014-207618&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Zinner syndrome: an uncommon cause of painful ejaculation&lt;/a&gt;. BMJ Case Rep. 2015, 2015:1-5.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1136/bcr-2014-207618&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1136/bcr-2014-207618&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Lira Neto FT, Bach PV, Miranda E de P:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.5935/1518-0557.20190075&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Management of ejaculatory duct obstruction by seminal vesiculoscopy: case report and literature review&lt;/a&gt;. JBRA Assist Reprod. 2020, 00:1-5.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.5935/1518-0557.20190075&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.5935/1518-0557.20190075&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Kang PM, Seo WI, Yoon JH, Kim TS, Chung J:&amp;nbsp;&lt;a href=&quot;http://www.ncbi.nlm.nih.gov/pubmed/26387919&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Transutricular seminal vesiculoscopy in the management of symptomatic midline cyst of the prostate&lt;/a&gt;. World J Urol. 2016, 34:985-92.&lt;/li&gt;
&lt;li&gt;Wang H, Ye H, Xu C:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.2164/jandrol.111.013912&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Transurethral seminal vesiculoscopy using a 6F vesiculoscope for ejaculatory duct obstruction: initial experience&lt;/a&gt;. J Androl. 201, 33:637-43.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.2164/jandrol.111.013912&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.2164/jandrol.111.013912&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Robert R, Prat-Pradal D, Labat JJ:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1007/BF01628908&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Anatomic basis of chronic perineal pain: role of the pudendal nerve&lt;/a&gt;. Surg Radiol Anat. 1998, 20:93-8.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1007/BF01628908&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1007/BF01628908&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Shoskes DA, Landis JR, Wang Y, Nickel JC, Zeitlin SI, Nadler R:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1097/01.ju.0000132798.48067.23&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Impact of post-ejaculatory pain in men with category III chronic prostatitis/chronic pelvic pain syndrome&lt;/a&gt;. J Urol. 2004, 172:542-7.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1097/01.ju.0000132798.48067.23&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1097/01.ju.0000132798.48067.23&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Simpson GM, Blair JH, Amuso D:&amp;nbsp;&lt;a href=&quot;https://europepmc.org/article/med/5850736&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Effects of antidepressants on genito-urinary function&lt;/a&gt;. Dis Nerv Syst. 1965, 26:787-789.&lt;/li&gt;
&lt;li&gt;Kraus MB, Wie CS, Gorlin AW, Wisenbaugh ES, Rosenfeld DM:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1002/sm2.93&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Painful ejaculation with cyclobenzaprine: a case report and literature review&lt;/a&gt;. Sex Med. 2015, 3:343-5.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1002/sm2.93&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1002/sm2.93&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Shapiro EI, Silber SJ:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1016/S0015-0282(16)44357-8&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia&lt;/a&gt;. Fertil Steril. 1979, 32:546-50.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1016/S0015-0282(16)44357-8&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1016/S0015-0282(16)44357-8&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Gray M, Zillioux J, Khourdaji I, Smith RP:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.21037/tau.2018.06.20&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Contemporary management of ejaculatory dysfunction&lt;/a&gt;. Transl Androl Urol. 2018, 7:686-702.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.21037/tau.2018.06.20&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.21037/tau.2018.06.20&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Johnson CW, Bingham JB, Goluboff ET, Fisch H:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1111/j.1464-410X.2004.05261.x&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Transurethral resection of the ejaculatory ducts for treating ejaculatory symptoms&lt;/a&gt;. BJU Int. 2005, 95:117-9.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1111/j.1464-410X.2004.05261.x&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1111/j.1464-410X.2004.05261.x&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Barnas J, Parker M, Guhring P, Mulhall JP:&amp;nbsp;&lt;a href=&quot;https://dx.doi.org/10.1016/j.eururo.2004.10.020&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;The utility of tamsulosin in the management of orgasm-associated pain: a pilot analysis&lt;/a&gt;. Eur Urol. 2005, 47:361-5.&amp;nbsp;&lt;span class=&quot;citation-doi&quot;&gt;&lt;a href=&quot;https://dx.doi.org/10.1016/j.eururo.2004.10.020&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;10.1016/j.eururo.2004.10.020&lt;/a&gt;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Jordi PM, Maria-Jos&amp;eacute; AM, Luis-Alfonso MM, Mauro SM:&amp;nbsp;&lt;a href=&quot;https://journals.lww.com/clinicalpain/Abstract/2004/09000/Management_of_Ejaculation_Pain_With_Topiramate__A.14.aspx&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Management of ejaculation pain with topiramate: a case report&lt;/a&gt;. Clin J Pain. 2004, 20:368-369.&lt;/li&gt;
&lt;/ol&gt;
&lt;/div&gt;

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