ReviewSexual Dysfunction and Lower Urinary Tract Symptoms (LUTS) Associated with Benign Prostatic Hyperplasia (BPH)
Introduction
Until recently, it was widely assumed that symptoms of male sexual dysfunction, including erectile dysfunction (ED; persistent inability to achieve and maintain an erection sufficient for satisfactory sexual performance [1]), ejaculatory dysfunction (EjD; any disturbance in the male ejaculatory reflex, including loss of ejaculation, ejaculation with a decreased amount of semen, premature ejaculation, delayed ejaculation, and retrograde ejaculation [2]), and hypoactive desire (HD; loss of desire or decreased desire) were a natural consequence of the aging process. As a result, many older men did not seek help for their sexual problems and healthcare providers frequently failed to ask their patients about their sexual concerns. Recent studies have shown that a decrease in sexual function and sexual activity is not an inevitable consequence of aging. Furthermore, effective and well-tolerated treatments (e.g., phosphodiesterase type 5 inhibitors for the treatment of ED) are available for managing many of these conditions.
Various studies have assessed the prevalence of different types of male sexual dysfunction, often using varying definitions for the condition being assessed. The results of a large-scale, population-based study of men aged 40 to 70 years, the Massachusetts Male Aging Study (MMAS), demonstrated that ED had a high prevalence (52%), with nearly 35% of the men reporting moderate-to-severe ED [3]. The prevalence of complete ED was age-dependent, increasing from 5% for men aged 40 years to 15% for those aged 70 years. However, ED was also significantly associated with various age-independent predictor variables [3]. Based on MMAS data, it has been estimated that the worldwide prevalence of ED will be 322 million men in 2025 [4]. Other study results indicated that older individuals retain significant interest in sexuality and that a large proportion of older men and women remain sexually active [5], [6]. Furthermore, sexuality is a factor that correlates with individuals’ perception of their well-being and quality of life [7]. With the development of new measures for assessing sexual function and new medications for the treatment of ED, regular discussions between healthcare providers and patients on sexual problems can lead to effective management strategies and improvements in patient quality of life.
Lower urinary tract symptoms (LUTS; urinary frequency, urgency, decreased urine flow rates, nocturia) are common problems in aging individuals. Benign prostatic hyperplasia (BPH) is the primary cause of LUTS in men aged 50 years and older. The presence of histological BPH at autopsy is approximately 8% in men aged 31 to 40 years, 50% in those aged 51 to 60 years, 70% in those aged 61 to 70 years, and 90% in those aged 81 to 90 years [8]. Unfortunately, the MMAS did not evaluate LUTS as a possible predictor variable for ED. Thus, although both male sexual dysfunction and LUTS were known to be age-dependent, the exact relationship between these 2 conditions remained unclear. However, more recent large-scale epidemiological studies with different population samples and various measurement approaches have demonstrated consistent and compelling evidence of a relationship between LUTS and sexual dysfunction in aging men that is independent of the effects of age or other comorbidities. These studies, including the Multinational Survey of the Aging Male (MSAM-7) [6], and new pathophysiological insights have provided valuable information on the relationship between LUTS and sexual dysfunction in aging men. Moreover, these advances have resulted in new approaches to the evaluation of these disorders and the selection of treatment options. The present review article provides an overview of current knowledge on the relationship between male sexual dysfunction and LUTS, with a particular focus on LUTS associated with BPH, as well as medical treatment options for symptomatic BPH and their effects on sexual function.
Section snippets
General population studies
Data from the National Health and Social Life Survey (NHSLS), a population-based representative sample of US adults aged 18 to 59 years, demonstrated a high prevalence of sexual dysfunction in men (31%) and women (43%) [9]. Increasing age in men was associated with significantly higher prevalence rates of ED and HD. The results of the NHSLS also indicated that LUTS was a significant predictor for ED [9]. A study of 2476 Spanish men aged 25 to 70 years indicated that the prevalence of ED was 12%
Therapy for LUTS associated with BPH
The main goals of therapy in men with LUTS associated with BPH are to alleviate the bothersomeness of LUTS and to improve patient quality of life. Because of the significant association between LUTS/BPH and domains of sexual dysfunction in men, an assessment of sexual function is recommended in the evaluation of all men with LUTS associated with BPH, and the effects of BPH treatments on sexual function should be carefully considered by both the patient and the clinician.
Instruments for assessing male sexual function
Patient self-assessment questionnaires are extremely useful in assessing sexual function in a clinical setting. Validated questionnaires used in the assessment of male sexual function include the International Index of Erectile Function (IIEF; 15 items; 5 domains of male sexual function: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction [97], the Brief Sexual Function Inventory (11 items that focus on sexual drive, erection, ejaculation,
Conclusions and future directions
Research during the past decade has firmly established that ED and EjD are highly prevalent conditions in aging men, particularly those with LUTS associated with BPH. Furthermore, the results of recent large-scale studies have demonstrated that LUTS associated with BPH is an independent risk factor for male sexual dysfunction. Interestingly, LUTS is also an independent predictor of sexual dysfunction in women [16]. Although the underlying mechanisms responsible for the relationship between LUTS
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