An in-depth review of sexual function and BPH, including the effect of BPH treatments
by Neal Shore, MD
Medical science has yet to find an exact cause-and-effect relationship between enlarged
prostate (BPH) and sexual dysfunction. But
a 2003 study1 shows a significantly higher risk of sexual dysfunction
among men with BPH than those without BPH and even greater risk among those men
with more severe BPH symptoms. For these reasons, a patient and physician should
discuss sexual function. Even though some men (and physicians) are hesitant to discuss
sexual function, an open discussion is the best way to make a wise and informed
treatment choice. Some men who are treated for BPH may actually experience an improvement
in sexual function.
The prostate plays a role in sexual
function, producing 85%-90% of the fluid volume produced during ejaculation. Because
the complex physiological mechanism involved in erection and ejaculation is not
fully understood, scientists cannot yet explain why an enlarging prostate gland
can impact sexual function. However, we know that worries about sexual function
can impact a man’s sexual health and that the risk of sexual dysfunction in
men increases with age.
Men affected by sexual dysfunction will report one or more of the following symptoms:
- Erectile dysfunction: difficulties achieving and/or maintaining an erection
- Ejaculation dysfunction: reduced volume, absence of ejaculation, or pain and/or
discomfort during ejaculation
- Decreased libido: reduced interest in sexual activity
- Reduced overall satisfaction with sexual activity
Studies indicate that men with BPH who have normal sexual function are often concerned
about how BPH treatment will affect their sexual function. In fact, sexual function
is the critical issue for some men in their decision-making. For most men, sexual
function remains stable following BPH treatment, with smaller numbers reporting
either negative or positive changes.2
Sex and Medications for BPH
When watchful waiting is not an option, drug therapy is often the first treatment
physicians suggest. However, patients with BPH
may be so anxious about finding relief from their lower urinary tract symptoms that
they don’t inquire about the impact that these medications may have on their
sexual function. All BPH medications carry some risk of impact on sexual function.
- Alpha-blockers (Cardura® or doxazosin mesylate; Flomax®
or tamsulosin hydrochloride; Hytrin® or terazosin hydrochloride;
Minipress® or prazosin hydrochloride; and Uroxatral®
or alfuzosin hydrochloride) may be prescribed by a physician. These drugs may potentially
decrease ejaculatory function, erectile function, libido, and overall sexual satisfaction.
Users must also be cautious when taking alpha-blockers with drugs like Viagra®or
sildenafil citrate because the combination can occasionally produce dangerous drops
in blood pressure.
- Alpha-reductase inhibitors (Proscar® or finasteride; and Avodart®
or dutasteride) may also be prescribed by physicians for relief of BPH symptoms.
These medications also have the potential to decrease ejaculatory function, erectile
function, libido, and overall sexual satisfaction.
- Herbal remedies, such as saw palmetto, are derived from phyto-estrogen plants, which
are the same plants used to create herbal remedies for treating women’s menopausal
symptoms. They are sold over-the-counter. While some men find these supplements
relieve urinary symptoms, they can also decrease libido and, in rare cases, cause
impotence. Herbal supplements are not
regulated by the Food and Drug Administration, which means it is impossible to know
the precise ingredients and quantities contained in any supplement.
Any impact that BPH medications have on sexual function will typically end when
a man stops taking the drug. Some men treated with drugs are satisfied with the
improvement in their voiding function and consider the sexual side effects tolerable.
For others, the sexual side effects are bothersome enough that they stop taking
the medication and seek an alternative treatment.
Sex and Office-Based Minimally Invasive Treatments (MITs) for BPH
There are different kinds of office-based minimally
invasive treatments for BPH and most
are performed in the doctor’s office. An example of an MIT is the
Prolieve Thermodilatation® System (www.prolieve.com), which is performed in your doctor's
office and requires no anesthesia or incision. The treatment takes about 45 minutes.
By using heat to shrink the size of the prostate,
MITs often produce symptom relief. Most MITs have virtually no impact on libido
or erectile function. In a minority of cases, men report initial discomfort during
sexual activity, but this usually disappears rapidly. Some men report retrograde
ejaculation or dry climax, which means that semen empties into the bladder during
sex rather than exiting the penis. Interestingly, some recent studies suggest sexual
function may actually improve following MIT therapy.3
Sex and Surgery for BPH
None of the various surgical procedures for BPH
have an impact on libido. However, each surgical procedure carries a high risk of
ejaculatory dysfunction and a low risk of erectile dysfunction:
- Open prostatectomy patients have a 95%-100% chance for retrograde ejaculation (dry
climax).
- Transurethral resection of the prostate
(TURP) patients have a 95% incidence of retrograde ejaculation.
- Transurethral incision of the prostate (TUIP) patients have a lower incidence of
ejaculatory dysfunction, but the side effect can still occur.
- Laser surgery Greenlight PV®,
Holmium Laser Treatment) patients have an increased risk of retrograde ejaculation.
For men who consider ejaculation an important component of sexual activity, changes
in ejaculatory function can diminish their overall sexual satisfaction. In addition,
surgical patients have between a 2%-10% chance (depending upon the procedure) of
developing some erectile dysfunction following surgery. However, complete surgical
recovery can take as long as a year, and some adverse changes in sexual function
may disappear over that time.
Treatment Options for Sexual Dysfunction
It is important to remember that there are safe and effective treatments for sexual
dysfunction, including:
- PD5 inhibitors (i.e., Viagra®or sildenafil citrate, Levitra®or
vardenafil HCI, Cialis®or tadalafil)
- Testosterone supplements
- Penile injection therapy
- Urethral suppositories
- Vacuum erectile devices
- Penile implants
Speaking with a knowledgeable physician is the first step in getting treatment for
sexual dysfunction.
Finding Help
No man need assume that sexual dysfunction is a necessary part of aging. Furthermore,
no man need assume that successful treatment of his
BPH must always result in loss of erectile or ejaculatory function.
A knowledgeable physician can help a patient make the right treatment decision –
either watchful waiting, medication, surgery, or an office-based minimally invasive
treatment.
Disclaimer: This material is provided for information purposes only and is not a substitute for a consultation. You should talk with a urologist regarding your specific symptoms or medical condition.
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