Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Semen reactive oxygen species levels are correlated with erectile function among chronic prostatitis/chronic pelvic pain syndrome patients


Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is often associated with erectile dysfunction (ED). However, the underlying pathophysiological mechanisms of ED occurrence are still unclear in patients with CP/CPPS. The aim of the study was to investigate superoxide anion (O2) and total reactive oxygen species (ROS) production in semen of men with category IIIA CP/CPPS and their association with ED. This prospective study included 33 men with category IIIA CP/CPPS. Control group consisted of 13 healthy men. Total ROS and O2 production were assayed by luminol and lucigenin-dependent chemiluminescence (CL) methods, respectively. ED was evaluated using the IIEF-5 questionnaire. Patients with CP/CPPS had significantly higher seminal total ROS and O2 levels than healthy control subjects (2.9 ± 0.5 relative light unit (RLU) vs. 2.4 ± 0.2 RLU, p < 0.001; luminol-dependent CL and 2.5 ± 0.4 RLU vs. 2.3 ± 0.2 RLU, p = 0.02; lucigenin-dependent CL, respectively). Seminal O2 and ROS levels were negatively correlated with IIEF-5 scores (r = −0.556, r = −0.536; p < 0.001, respectively). These results may suggest O2/ROS overproduction could be one of the important mechanisms in the etiology of ED development in CP/CPPS patients.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2


  1. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999;282:236–7.

    CAS  Article  Google Scholar 

  2. Nickel C. Prostatitis syndromes: an update for urologic practice. Can J Urol. 2000;7:1091–8.

    CAS  PubMed  Google Scholar 

  3. Schaeffer AJ. Classification (traditional and National Institutes of Health) and demographics of prostatitis. Urology. 2002;60:5–6.

    Article  Google Scholar 

  4. Schaeffer AJ, Knauss JS, Landis JR, Propert KJ, Alexander RB, Litwin MS, et al. Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: The National Institutes of Health Chronic Prostatitis Cohort Study. J Urol. 2002;168:1048–53.

    Article  Google Scholar 

  5. Li HJ, Kang DY. Prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: a meta-analysis. World J Urol. 2016;34:1009–17.

    Article  Google Scholar 

  6. Shoskes DA, Prots D, Karns J, Horhn J, Shoskes AC. Greater endothelial dysfunction and arterial stiffness in men with chronic prostatitis/chronic pelvic pain syndrome--a possible link to cardiovascular disease. J Urol. 2011;186:907–10.

    Article  Google Scholar 

  7. Li M, Zhuan L, Wang T, Rao K, Yang J, Yang J, et al. Apocynin improves erectile function in diabetic rats through regulation of NADPH oxidase expression. J Sex Med. 2012;9:3041–50.

    CAS  Article  Google Scholar 

  8. Montezano AC, Touyz RM. Reactive oxygen species, vascular Noxs, and hypertension: focus on translational and clinical research. Antioxid Redox Signal. 2014;20:164–82.

    CAS  Article  Google Scholar 

  9. Jeremy JY, Jones RA, Koupparis AJ, Hotston M, Persad R, Angelini GD, et al. Reactive oxygen species and erectile dysfunction: possible role of NADPH oxidase. Int J Impot Res. 2007;19:265–80.

    CAS  Article  Google Scholar 

  10. Castiglione R, Salemi M, Vicari LO, Vicari E. Relationship of semen hyperviscosity with IL-6, TNF-α, IL-10 and ROS production in seminal plasma of infertile patients with prostatitis and prostato-vesiculitis. Andrologia. 2014;46:1148–55.

    CAS  Article  Google Scholar 

  11. Pasqualotto FF, Sharma RK, Potts JM, Nelson DR, Thomas AJ, Agarwal A. Seminal oxidative stress in patients with chronic prostatitis. Urology . 2000;55:881–5.

    CAS  Article  Google Scholar 

  12. Bivalacqua TJ, Armstrong JS, Biggerstaff J, Abdel-Mageed AB, Kadowitz PJ, Hellstrom WJ, et al. Gene transfer of extracellular SOD to the penis reduces O2 •– and improves erectile function in aged rats. Am J Physiol Heart Circ Physiol. 2003;284:1408–21.

    Article  Google Scholar 

  13. Bivalacqua TJ, Usta MF, Kendirci M, Pradhan L, Alvarez X, Champion HC, et al. Superoxide anion production in the rat penis impairs erectile function in diabetes: influence of in vivo extracellular superoxide dismutase gene therapy. J Sex Med. 2005;2:187–97.

    CAS  Article  Google Scholar 

  14. Litwin MS, McNaughton-Collins M, Fowler FJ Jr, Nickel JC, Calhoun EA, Pontari MA, et al. The National Institutes of Health Chronic Prostatitis Symptom Index: development and validation of a new outcome measure. J Urol. 1999;162:369–75.

    CAS  Article  Google Scholar 

  15. Turunc T, Deveci S, Guvel S, Peskircioglu L. The assessment of Turkish validation with 5 question version of International Index of Erectile Function (IIEF-5). Turk J Urol. 2007;33:45–49.

    Google Scholar 

  16. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11:319–26.

    CAS  Article  Google Scholar 

  17. World Health Organization. WHO Laboratory Manual for the Examination and Processing of Human Semen. 5th edn. (WHO Press, Geneva, 2010).

  18. Alkan I, Simşek F, Haklar G, Kervancioğlu E, Ozveri H, Yalçin S, et al. Reactive oxygen species production by the spermatozoa of patients with idiopathic infertility: relationship to seminal plasma antioxidants. J Urol. 1997;157:140–3.

    CAS  Article  Google Scholar 

  19. Sener TE, Yüksel M, Özyılmaz-Yay N, Ercan F, Akbal C, Şimşek F, et al. Apocynin attenuates testicular ischemia-reperfusion injury in rats. J Pediatr Surg. 2015;50:1382–7.

    Article  Google Scholar 

  20. Aitken RJ, Buckingham DW, West KM. Reactive oxygen species and human spermatozoa: analysis of the cellular mechanisms involved in luminol and lucigenin-dependent chemiluminescence. J Cell Physiol. 1992;151:466–77.

    CAS  Article  Google Scholar 

  21. Shahed AR, Shoskes DA. Oxidative stress in prostatic fluid of patients with chronic pelvic pain syndrome: correlation with gram positive bacterial growth and treatment response. J Androl. 2000;21:669–75.

    CAS  PubMed  Google Scholar 

  22. Vicari E. Seminal leukocyte concentration and related specific reactive oxygen species production in patients with male accessory gland infections. Hum Reprod. 1999;14:2025–230.

    CAS  Article  Google Scholar 

  23. Pan F, Qiu XF, Yu W, Zhang QP, Chen Q, Zhang CY, et al. MicroRNA-200a is up-regulated in aged rats with erectile dysfunction and could attenuate endothelial function via SIRT1 inhibition. Asian J Androl. 2016;18:74–79.

    CAS  Article  Google Scholar 

  24. Sumimoto H. Structure, regulation and evolution of Nox-family NADPH oxidases that produce reactive oxygen species. FEBS J. 2008;275:3249–77.

    CAS  Article  Google Scholar 

  25. Selemidis S, Sobey CG, Wingler K, Schmidt HH, Drummond GR. NADPH oxidases in the vasculature: molecular features, roles in disease and pharmacological inhibition. Pharmacol Ther. 2008;120:254–91.

    CAS  Article  Google Scholar 

  26. Kim SC, Kim IK, Seo KK, Baek KJ, Lee MY. Involvement of superoxide radical in the impaired endothelium-dependent relaxation of cavernous smooth muscle in hypercholesterolemic rabbits. Urol Res. 1997;25:341–6.

    CAS  Article  Google Scholar 

  27. Jin L, Burnett AL. NADPH oxidase: recent evidence for its role in erectile dysfunction. Asian J Androl. 2008;10:6–13.

    CAS  Article  Google Scholar 

  28. Pacher P, Beckman JS, Liaudet L. Nitric oxide and peroxynitrite in health and disease. Physiol Rev. 2007;87:315–424.

    CAS  Article  Google Scholar 

  29. Li WJ, Park K, Paick JS, Kim SW. Chronic treatment with an oral rho-kinase inhibitor restores erectile function by suppressing corporal apoptosis in diabetic rats. J Sex Med. 2011;8:400–10.

    CAS  Article  Google Scholar 

  30. Bivalacqua TJ, Champion HC, Usta MF, Cellek S, Chitaley K, Webb RC. RhoA/Rho-kinase suppresses endothelial nitric oxide synthase in the penis: a mechanism for diabetes-associated erectile dysfunction. Proc Natl Acad Sci USA. 2004;101:9121–6.

    CAS  Article  Google Scholar 

  31. Hu Y, Niu X, Wang G, Huang J, Liu M, Peng B. Chronic prostatitis/chronic pelvic pain syndrome impairs erectile function through increased endothelial dysfunction, oxidative stress, apoptosis, and corporal fibrosis in a rat mode. Andrology. 2016;6:1209–16.

    Article  Google Scholar 

  32. Huang TR, Li W, Peng B. Correlation of inflammatory mediators in prostatic secretion with chronic prostatitis and chronic pelvic pain syndrome. Andrologia. 2018; e-pub ahead of print 1 August 2017;

    Article  PubMed  Google Scholar 

  33. Zhao HF, Li X, Jiang XZ. Heat shock protein 9-mediated inflammation reaction in patients with chronic prostatitis with erectile dysfunction. Eur Rev Med Pharmacol Sci. 2016;20:4185–9.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ilter Alkan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Alkan, I., Yüksel, M., Özveri, H. et al. Semen reactive oxygen species levels are correlated with erectile function among chronic prostatitis/chronic pelvic pain syndrome patients. Int J Impot Res 30, 335–341 (2018).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

Further reading


Quick links