Enlarged Prostate and Sexual Dysfunction

Benign prostate hyperplasia (BPH) is a common condition seen in middle-aged and elderly men. This enlargement of the prostate gland causes many problems like impeding the flow of urine, causing bleeding during urination, causing kidney damage as well as affecting a man's sexual life.

Yes. Multiple studies have shown that BPH and sexual dysfunction are inter-related. BPH is a stronger predictor of sexual dysfunction compared to diabetes, heart disease or hypertension. In fact, erectile function has been shown to deteriorate in tandem with worsening symptoms of BPH.

How does BPH cause worsening of sexual function?

Because of the failure of relaxation of the smooth muscle. The relaxation of the smooth muscle in the erectile tissue of the penis is needed for engorgement of the penis with blood. Similarly, relaxation of the smooth muscle in the prostate and bladder neck is needed for urine to pass out of the bladder through the penis. When there is failure of relaxation of the smooth muscle in the penis, this leads to erection difficulties; while in the prostate and bladder neck, urination difficulties occur.

Medication prescribed by doctors fall into 2 groups - alpha blockers (terazosin, doxazosin, alfuzosin, tamsulosin and silodosin) and 5alpha reductase inhibitors (finasteride and dutasteride). However, even though they improve symptoms of BPH, they have varying negative effects on sexual function eg. detrimental effects in ejaculation, decrease in sexual desire and erectile dysfunction.

If erectile dysfunction occurs as a result of BPH treatment, phosphodiestaerase-5 inhibitor medications like vardenafil, tadalafil and sildenafil can be used. However, the side effect is, there is higher risk of drop in blood pressure when taken together with alpha blockers.

(Source: Problems of a large prostate, StarFit4Life, 24 June 2012)

Is there a safer solution?