SEXUAL FUNCTION AND BPH

An In-Depth Review of Sexual Function and BPH,
Including the Effect of BPH Treatments

by Neal Shore , MD, Myrtle Beach , SC

Medical science has yet to find an exact cause-and-effect relationship between enlarged prostate (BPH) and sexual dysfunction. But a 2003 study 1 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.

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 (cannot obtain an erection). 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®® System 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 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.