Enlarged Prostate and Negative Impacts on Sexual Health

Benign prostatic hyperplasia (BPH), commonly known as an enlarged prostate, is a condition that affects many men as they age. While BPH doesn’t cause erectile dysfunction directly, both increase with age and the two are somewhat linked. Some BPH treatments can also be the culprit for sexual side effects.

This blog post explores the common sexual side effects of BPH medication and surgical therapy as well as other ways the disease can impact sexual function. It also outlines ways to manage BPH symptoms without negative impacts on sexual health. It’s important to talk with your doctor to discuss BPH symptoms and treatment options to find a therapy that is right for you.

With BPH, the prostate is enlarged, which can lead to various urinary symptoms due to the pressure it exerts on the urethra. Common symptoms of BPH include the frequent urgent need to urinate, nocturia (nighttime urination), bladder damage, urinary tract infections, blood in the urine, incontinence and more. Other symptoms include a weak urine stream and incomplete bladder emptying, which can both cause discomfort. These symptoms can also cause anxiety and embarrassment, which can affect libido or sexual desire as well as decrease confidence and enjoyment in sexual activities. Hormonal changes that occur with aging and BPH can also play a role in reducing libido. (1)

Sexual Side Effects of BPH Medications

There are a few main categories of medications that have historically been used to treat BPH symptoms. Though these medications can be somewhat successful in providing symptom relief for some patients, they are also associated with a number of sexual side effects, including:

• Erectile dysfunction (ED): ED is one of the most common sexual issues associated with medications to treat BPH symptoms, including alpha-blockers and 5-ARIs.
• Decreased libido: Some BPH medications – namely 5-ARIs – work by reducing testosterone levels in the blood. This can cause decreased libido.
• Low sperm count: BPH medication therapy can affect sperm production and ejaculation. Some men may experience a decrease in sperm count, which can impact fertility. This is particularly relevant for men who are still in their reproductive years and are concerned about their ability to father children.
• Retrograde ejaculation: Retrograde ejaculation occurs when semen enters the bladder instead of exiting through the penis during orgasm. This condition can be a side effect of certain BPH medications, particularly alpha-blockers. While retrograde ejaculation is not harmful, it can be distressing for men who experience it.

Patients prescribed BPH medications need to take them daily for the rest of their lives and frequently have multiple prescriptions to treat BPH symptoms, leading to stacking of numerous medications. Facing these side effects, along with difficulty maintaining proper medication adherence, patients have increasingly struggled to find true relief from BPH symptoms with medication.

Sexual Side Effects of TURP

While the transurethral resection of the prostate (TURP) surgical procedure has been the gold standard in BPH treatments, it is an invasive surgery and there are significant risks involved including sexual side effects, incontinence, bleeding, and a much longer recovery time.

Managing BPH While Preserving Sexual Function

Today, there are a number of minimally invasive surgical therapy (MIST) treatment options available to treat BPH. One of the newest options, the Optilume BPH catheter system, combines mechanical dilation with concurrent localized delivery of paclitaxel for treating BPH. Mechanical dilation with a double-lobe balloon technology achieves an anterior commissurotomy (split) releasing the constricting lateral lobes, while the delivery of paclitaxel prevents re-fusion of the lobes during healing, keeping the prostate open, restoring the flow of urine and relieving bothersome BPH symptoms. With this procedure, there is no cutting, heating, burning, lasering, steaming or implantations. It’s also FDA approved and two main clinical trials with five- and two-year positive outcomes have demonstrated safety and efficacy, including:

• Highest average peak urinary flow rate (Qmax) at two years reported in randomized MIST trials for BPH to date. At 19mL/second, Qmax more than doubled (113%) with Optilume BPH vs. baseline. This is a critical metric to show improvement.

• Significant, immediate symptomatic and functional improvements, including a 53% improvement in International Prostate Symptom Score (IPSS) (at two years vs. baseline).
• Post-void residual decreased by 20% at two years vs. baseline.
• Durability of improvements were shown through five years follow-up.
• There was no impact to erectile and ejaculatory function scores from baseline through follow-up.

If you are experiencing symptoms of BPH and are concerned about your diagnosis, treatment options and its impact on your sexual health, find a urologist near you to schedule a consultation to find a treatment option that is right for you. Be sure to voice your concerns about preserving sexual function when talking with your doctor. To learn more about the Optilume BPH catheter system and find a provider, visit Laborie.com/find-a-provider.