A physical exam is not usually enough to make the diagnosis. But, often it reveals that the anal sphincter, prostate, and groin muscles are tight.
A diagnosis of nonbacterial prostatitis usually is made after repeated unsuccessful attempts to treat what is presumed to be bacterial prostatitis. Although microscopic examination of prostate massage specimens may show increased numbers of white blood cells, ultimately, no definite source of infection can be identified. Urine and prostatic fluid routinely fail to show the presence of any infecting organisms. Often the diagnosis is made only after various unsuccessful drug treatments, numerous doctors' visits and considerable expense.
Occasionally, doctors will diagnose patients whose nonbacterial prostatitis develops from a lack of sexual activity. This so-called "congestive prostatitis" is thought to be the result of a lack of ejaculation. When semen stays too long in the prostate and causes inflammation.
A converse diagnosis of "exhaustive prostatitis" or "overuse prostatitis" may be made in men whose nonbacterial protatitis symptoms appear to be caused by excessive ejaculation. In both cases, a sexual history is essential to accurate diagnosis, and modification of sexual activity usually is prescribed.