The reader didn’t mention it, but the discomfort would also probably have been associated with difficulty and/or frequency when passing urine. Not all symptoms occur in every case. The start of his condition coincided with a stressful job demanding long hours in the office and a three-hour commute, beginning at 5.15am. The sedentary life that resulted from this lifestyle had caused his weight to increase by almost two stone. His self-prescribed treatment — self-prescribed because none of that offered by doctors over the past two years had helped — was to lose 6lb in weight and to increase his intake of broccoli and berries.

Prostatitis is a term that strictly means the inflammation of the prostate, although this is not always demonstrable, and is picked up either from the girlfriend or the bladder. It is one of the subjects that medical writers approach with trepidation. The subject is so contentious that whatever they write will produce angry correspondence from experts (most of whose opinions will differ), disgruntled patients who are still suffering and alternative practitioners. Unsurprisingly, our reader writes that he has been unable to obtain clear answers to his questions, either in this country or the United States. One American source suggested that the symptoms could follow too much sitting when tense.

Dr Eric Dunlop, my mentor at the Royal London Hospital, has heavily influenced my opinions about prostatitis. He was the man who overcame widespread professional ridicule by battling to gain acceptance of his research that chlamydial infections were important and were the cause of pelvic inflammatory disease. His work and persistence has saved the fertility of countless women.

Another of Dr Dunlop’s causes was to achieve more precision about the diagnosis of prostatitis. He was sceptical about the diagnosis in most of the cases of prostatitis that were presented to him, unless its bacterial origins were obvious. In many of the cases that he saw, he suspected that the prostate was healthy and that the trouble lay elsewhere. Bacterial prostatitis can be acute or chronic. Both types may be difficult to eradicate with antibiotics and often need exceptionally long courses of these.

Another of the Dunlop teachings was that, even if the bacteria was sensitive to a specific antibiotic, it didn’t necessarily follow that it could penetrate prostatic tissue easily. The antibiotic needed to be chosen with care. The organisms involved include chlamydia as well as those that haunt the urinary tract. These include E.coli, proteus and klebsiella. Often the presence of bacteria can be established only by prostatic massage and analysis of the prostatic fluid, or by the analysis of urine taken before and after prostatic massage.

The controversy surrounding prostatitis centres on those patients who have such symptoms as low back ache, pain in the thighs and genital pains, but are without evidence of a bacterial infection. These cases are sometimes diagnosed as prostatodynia, a pseudoclassical term that means no more than a painful prostate.

Two cases that are typical of the many that had been incorrectly diagnosed as non-bacterial prostatitis were those of the machinery manufacturer and the travel courier. Both had had months, if not years, of treatment after some very uncomfortable investigation.

The manufacturer travelled north about once a month to supervise the running of the equipment that his factory had installed. These visits were followed by pain in his lower back, worse after sex, that radiated to his perineum, inner thigh and genitalia. He was convinced that his girlfriend up north had something nasty. Dr Dunlop and I were equally convinced that she hadn’t. An MRI scan of his back showed a disc lesion that was pressing on his spinal cord at a level that would account for his pain. Disc pain is often made worse by sex and by long car drives, hence its association with the journeys north by the manufacturer. Intervention by the orthopaedic surgeons enabled him to continue to visit his friend, and to keep his factory’s machinery working.

The courier developed his “prostatic” symptoms every time he took a party overseas. He too had a clearly demonstratable disc lesion. Once he had been told to leave the carrying of heavy cases to others, he lost his symptoms of “prostatitis”.

It is not surprising that a popular American textbook not only recommends long courses of the appropriate antibiotics for bacterial prostatitis but also muscle relaxants, anti-inflammatory drugs and tranquillisers for those in whom there is little evidence of infection.

Incidentally, the reader is on the right track. His spine will be helped by weight loss, and as a precautionary measure tomatoes, berries and pomegranate juice are excellent for prostate health.

For more information, contact the Prostate Research Campaign on 020-8877 5840 or www.prostate-research.org.uk.

A saxophonist has burning pains around his mouth and tightness in his lips. His tongue and gums seem to be in perfect order. The pain is spasmodic, but complete relief, when it comes, lasts for only two or three hours. Another reader has tingling and numbness in her fingers and toes. Both wonder about the possible causes.

Tingling of the fingers and toes, sometimes associated with either numbness or extreme sensitivity, is known as acroparaesthesia. Aberrant and painful skin sensations can be a symptom of trouble with a single nerve, or polyneuropathy, when many different ones are affected.

As there are so many causes of polyneuritis, these symptoms always need investigation. When both upper and lower limbs are affected, as in the reader’s case, the feet are usually involved before the hands. The symptoms tend to start in the fingers and toes and work upwards.

The nerve supply to the area around the lips and cheeks is from different branches of the fifth cranial nerve, the trigeminal nerve. As no simple reason has been found for the saxophonist’s trouble, he too should discuss with his own doctor the possibility of seeing a neurologist.

An occasional cause of numbness around the mouth is hyperventilation. This affects musicians, and anyone who breathes rapidly when excited or tense. Even the phlegmatic, once stimulated by the atmosphere and animation of a good party, may hyperventilate. A drinks party can leave guests with perioral paraesthesia, a slight feeling of numbness around the mouth.

ASK DR STUTTAFORD

Send your questions to drstuttaford@thetimes.co.uk or to times2, The Times, 1 Pennington Street, London E98 1TT. Please include the following: the symptoms (and how long they have been present), the person’s age, sex and marital status. Dr Stuttaford’s replies cannot apply to individual cases but should be taken in a general context. Readers are always advised to consult their GP, as only he/she will be fully conversant with the background. We regret that Dr Stuttaford cannot enter into personal correspondence.

Medical forum online: click here to send an e-mail to Dr Stuttaford for his online medical forum. The topic this week is foot and ankle injuries