The Impact and Management of Sexual Dysfunction Secondary to Pharmacological Therapy of Benign Prostatic Hyperplasia

Jason Gandhi; Steven J. Weissbart; Noel L. Smith; Steven A. Kaplan; Gautam Dagur; Anna Zumbo; Gargi Joshi; Sardar Ali Khan


Transl Androl Urol. 2017;6(2):295-304. 

In This Article


Before the pharmacological therapy for BPH is initiated, it is crucial that the physician discusses potential side effects with the patient so they can comprehend the risks. In some cases, patients may prefer to continue treatment with ABs or 5ARIs regardless of experiencing the sexual side effects. Other options available would be either to decrease the dosage of medication, decrease the frequency, or terminate the treatment completely and instead opt for surgery. Based on the patient's presentation of LUTS and possible sexual dysfunction, the physician may evaluate an alternative class of BPH therapy drugs. The effect of AB on libido and erectile function is similar to that of a placebo, while having different effects on ejaculation. 5ARIs produce sexual side effects and increased risk for ED, EjD, and decreased libido compared to a placebo. Combination therapy with AB and 5ARI triples the risk for EjD incidence compared to that of AB or 5ARI used individually. The phosphodiesterase-5 inhibitor tadalafil is presently a new treatment alternative to other established drugs for LUTS, such as the aforementioned ABs or 5ARIs. However, it is not just an alternative, since sexual adverse events associated with ABs and 5ARIs are avoided; tadalafil is the only drug that can treat both ED and LUTS simultaneously. Nevertheless, objective improvement on LUTS has been met with controversy. Further studies are imperative in gauging the long-term the role of combined therapy of phosphodiesterase-5 inhibitors and ABs or 5-ARIs in the management LUTS/BPH.[59]