Sexual Dysfunction in benign prostatic hyperplasia (BPH) twice as high as physicians estimate

May 11 2004

The incidence of sexual dysfunction in patients suffering from Benign Prostatic Hyperplasia (BPH) -- or enlarged prostate -- is nearly twice as high as treating physicians believe shows a new survey from the American Foundation for Urologic Diseases (AFUD) presented today at the American Urological Association annual meeting.

Given that certain treatments can cause or worsen sexual dysfunction, including Erectile Dysfunction (ED) and Ejaculatory Dysfunction (EjD), the study authors encourage broader educational initiatives about the prevalence, impact and management of BPH- and treatment-related sexual side effects to ensure that patients' sexual health concerns are adequately addressed.

"The findings underscore a critical disparity between the incidence of sexual dysfunction in BPH patients and the perception of the medical community regarding its importance," says Allen Seftel, MD, Professor of Urology & Reproductive Biology, Case-Western Reserve University School of Medicine in Cleveland, OH.

"Sexual dysfunction resulting from enlarged prostate or its treatment can negatively impact a patient's quality-of-life, self-esteem and relationships, so it's important that these concerns not be underestimated(3)."

Discounting Sexual Dysfunction in BPH In the survey of 1,275 urologists and primary-care physicians (PCPs), respondents indicated that they believed that approximately 25% of patients experienced sexual dysfunction, while MSAM-7, a major epidemiological study of nearly 14,000 men published in 2003, places the incidence at 50% -- twice as high as physician perception. Surprisingly, urologists, who were shown by the survey to treat BPH twice as frequently as PCPs, were more likely to underestimate the incidence of sexual dysfunction associated with BPH (19% of their patient population for urologists vs. 27% for PCPs) or BPH medication (19% for urologists vs. 24% for PCPs).

However, urologists were more cognizant that certain treatments cause particular sexual side effects. Urologists estimated that 28% of patients using some alpha-blockers -- which work by relaxing the muscles in and around the prostate -- experienced difficulties with ejaculation versus 16% of patients using 5-alpha reductase inhibitors (5-ARIs) -- which work by shrinking the prostate.

PCPs did not perceive significant differences in specific sexual side effects between alpha-blockers and 5-ARIs(1). "Certain alpha-blockers are associated with higher rates of EjD than 5-ARIs while 5-ARIs are more likely to cause or complicate ED," explains Dr. Seftel. "It's important that physicians be highly aware of the extent of the connection between BPH and sexual function and the tendency for certain medications to complicate these problems(2)." BPH affects more than eight million men in the U.S.

More than half of all men over age 60 have the condition -- and after age 80, men have an 80% chance of developing the condition. Left untreated, the symptoms may progress, leading to serious health problems including urinary tract infections, bladder and kidney damage, bladder stones, incontinence and acute urinary retention.

Lower urinary tract symptoms related to enlarged prostate are also strongly correlated to sexual problems, including Erectile Dysfunction (ED) and Ejaculatory Dysfunction (EjD). In fact, lower urinary tract symptoms are a risk factor for ED independent of other conditions associated with ED, such as diabetes, hypertension, cardiac disease and hyperlipidemia.

Men with severe urinary symptoms report 50% less sexual activity and 33% reduction in overall sexual satisfaction compared to men without severe lower urinary tract symptoms. "We've seen in our practices that the majority of men over age 50 consider an active sex life important," adds Dr. Seftel. "Since men with BPH symptoms are already at risk for compromised sexual function, it makes sense to consider sexual side effects when treating urinary symptoms of BPH." http://www.sanofi-synthelabo.com/