BPH treatment and sexual function

Start with the facts

Both BPH and problems with sexual function become more and more common as men get older. So it is not surprising that many men with BPH have problems with sexual function as well. These problems include lower sexual desire (libido), ejaculation problems, and erectile dysfunction. It is also well known that some treatments for BPH have an impact on sexual function, so it is important for you and your partner to understand how these treatments can affect your sexual relationship.

Concerns and misunderstanding about sexual function can get in the way of sex — just as much as actual treatment. Be informed about what might happen with treatment and talk about any concerns you have with your doctor ahead of time.

Sexual function after minimally invasive procedures or surgery for BPH

It may take up to a year for sexual function to return to normal after surgery but the good news is that with time, most men will be able to enjoy sex again.2 The effect of BPH surgery on sexual function varies depending on the type of procedure. .2 Minimally invasive procedures such as TUMT and TUNA do not appear to have an effect on a man’s ability to withhold urine during erections.2 During surgical procedures such as TURP and open surgery, the muscle that normally closes off the entrance to the bladder during ejaculation is cut. This can lead to a condition called retrograde ejaculation, or dry climax. This condition is not harmful to your health. It means that during ejaculation, the sperm do not exit through the penis but instead enter the bladder and are flushed out in the urine.2 Although this "dry climax" may feel different, most men find they can enjoy sex as much as they did before surgery.2

Sexual side effects of BPH medication

Selective alpha-blockers work by relaxing the smooth muscle in the prostate and the bladder neck. But they may also relax the muscles in the vas deferens, the part of the male reproductive system that helps propel the sperm out into the urethra and penis.9 This means that ejaculation may occur with little or no semen. As with retrograde ejaculation after surgery, this change in climax is not harmful to your health. Also, this side effect will stop if medication is discontinued. Alpha-blockers do not affect a man’s ability to have erections or achieve orgasm.

The most common side effects of 5-alpha-reductase inhibitors are related to sexual function. The 5-ARIs interfere with the body’s production of dihydrotestosterone, a male hormone. Sexual side effects may include impotence, decreased sexual desire, reduced semen with ejaculation, and other ejaculation problems.5

BPH treatment and diagnosis
For partners who care
Learn about treatment options for BPH

References

Fenter TC, Naslund MJ, Shah MB, et al. The cost of treating the 10 most prevalent diseases in men 50 years of age or older. Am J Manag Care. 2006;12(4 suppl):S90-S98
National Institute of Diabetes and Digestive and Kidney Diseases. Prostate enlargement: benign prostatic hyperplasia. NIH Publication No. 07-3012. June 2006.
Shvartzman P, Borkan JM, Stoliar L, et al. Second-hand prostatism: effects of prostatic symptoms on spouses’ quality of life, daily routines and family relationships. Family Pract. 2001;18:610-613.
American Urological Association. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol. 2003;170:530-547
Nickel JC. Comparison of clinical trials with finasteride and dutasteride. Rev Urol. 2004;6 Suppl 9:S31-9
Benign Prostatic Hyperplasia (BPH): A Patient’s Guide. Available at: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/patient-guides/bph_guide_2003.pdf. Accessed February 4, 2009.
Brawer MK. A multicenter study on the efficacy and safety of interstitial laser coagulation versus α-blockade in subjects with symptomatic benign prostatic hyperplasia: preliminary results. Rev Urol. 2005;7(suppl 9):S29-S33.
Medline Plus Medical Encyclopedia from NIH: Enlarged Prostate. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000381.htm. Accessed March 5, 2009.
Moriyama N, Nasu K, Takeuchi T, et al. Quantification and distribution of a1-adrenoceptor subtype mRNAs in human vas deferens: comparison with those of epididymal and pelvic portions. Br J Pharmacol. 1997;122:1009-1014.
Kuritzky L. A primary care physician’s perspective on benign prostatic hyperplasia. Rev Urol. 2003;5(suppl 5):S42-S48.
Wolters R, et al: Lower urinary tract symptoms: social influence is more important than symptoms in seeking medical care. BJU Int. 2002;90:655–661.
Rosen RC, Giuliano F, Cason CC. Sexual dysfunction and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Eur Urol 2005;47:824–837.
Ponholzer A, Madersbacher S. Lower urinary tract symptoms and erectile dysfunction; Links for diagnosis, management and treatment. Int J Impot Res. 2007;19:544-550.
National Institute on Aging: Talking With Your Doctor. Available at: http://www.nia.nih.gov/HealthInformation/Publications/TalkingWithYourDoctor/. Accessed March 5, 2009.
de Mey C, Michel MC, McEwen J, Moreland T. A double-blind comparison of terazosin and tamsulosin on their differential effects on ambulatory blood pressure and nocturnal orthostatic stress testing. Eur Urol. 1998;33(5):481-8.
http://www.dictionary.com
Atlas of Human Anatomy, Frank H. Netter, MD, Ciba-Geigy Corporation, Summit, NJ, 1989.

Talking to your doctor

It may help you to fill out the American Urological Association BPH Symptom Score Questionnaire.

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