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:
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.
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.
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
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:
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.
It is important to remember that there are safe and effective treatments for sexual dysfunction, including:
Speaking with a knowledgeable physician is the first in getting treatment for sexual dysfunction.
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.