Benign Prostatic Hyperplasia
Can benign prostatic hyperplasia affect sexual life?
Benign prostatic hyperplasia (BPH) and sexual dysfunction (SD) are highly prevalent conditions, frequently coexisting in the same aging male group. This association can be partly explained by the high prevalence of comorbidities (e.g., hypertension, dyslipidemia, diabetes) in older men, often suffering from BPH, which are risk factors for erectile dysfunction (ED). On the other hand, BPH seems to impact sexual function both directly and indirectly negatively.
Lower urinary tract symptoms and sexual dysfunction
The clinical expression of BPH are lower urinary tract symptoms (LUTS) - such as peeing with a weak stream and difficulty with bladder emptying - which can occur with varying degrees of severity. In recent years, a common pathophysiology has been hypothesized to explain the frequent association between LUTS and SDs, regardless of shared risk factors, although a specific causal relationship has not yet been defined. While the direct mechanism through the LUTS is only speculated, it is widely accepted that both conservative and surgical procedures for BPH may cause SDs. However, as mentioned, SDs are often pre-existing to treatment for BPH and therefore should be adequately assessed to avoid mistakenly considering them complications of therapy.
BPH medications and sexual side effects
Ejaculatory dysfunction is among the main adverse events of some drugs for BPH. Originally, abnormal ejaculation was thought to be retrograde, but more recent data demonstrate that it is due to a decrease or absence of seminal fluid. Decreased libido and ED are other common complications associated with certain classes of drugs for BPH, which have an antiandrogenic effect.
Several sexual side effects, including erectile, ejaculatory, and orgasmic dysfunction were described with the majority of surgical procedures for BPH. Ejaculatory dysfunction represents the most commonly reported sexual adverse event. It is primarily due to a disruption of the sphincter mechanism that prevents retrograde ejaculation. The correlation between BPH surgery and the onset of ED is less clear. Thermal injury to the adjacent cavernous nerves and blood vessels and the inadvertent violation of the prostatic capsule during surgery were proposed factors contributing to postoperative ED.
It is essential to highlight that some studies showed no change or even a possible improvement of sexual function following the surgical treatment of BPH. Besides, in the last few years, there has been a growing interest in developing minimally invasive surgical procedures to achieve similar symptomatic improvement while maintaining sexual function. Most of these techniques, however, are still under investigation.
Sexual health remains a pivotal component of overall QoL in most men, regardless of age. For that reason, every man needs to weigh his benefits of reducing LUTS against risk of sexual adverse events following BPH treatment. Any questions or concerns should be discussed with the doctor during medical counseling.
Celeste Manfredi 1, Javier Romero Otero 2,3
1 Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
2 Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
3 Unit of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, SpainHFTHQ 21-10
Gravas S, et al. EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS). Edn. presented at the EAU Annual Congress Milan 2021. 978-94-92671-13-4. Publisher: EAU Guidelines Office. Place published: Arnhem, The Netherlands
McVary K. Lower urinary tract symptoms and sexual dysfunction: epidemiology and pathophysiology. BJU Int. 2006 Apr;97 Suppl 2:23-8; discussion 44-5
Gacci M, et al. Impact of medical treatments for male lower urinary tract symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review and meta-analysis. J Sex Med, 2014. 11: 1554
Becher EF, et al. Surgical Procedures for BPH/LUTS: Impact on Male Sexual Health. Sex Med Rev. 2014 Jan;2(1):47-55
Soans J, et al. Can surgical treatment for benign prostatic hyperplasia improve sexual function? A systematic review. Aging Male. 2019 Apr 6:1-10
Borchert A, et al. A Review of Male Sexual Health and Dysfunction Following Surgical Treatment for Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms. Curr Urol Rep. 2018 Jun 19;19(8):66
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