At one time, the relationship between BPH and erectile dysfunction was believed to be based solely on age: Older men are also more likely to have other risk factors for erectile dysfunction, including high blood pressure, diabetes, and cardiovascular disease, or to have undergone a procedure for prostate cancer. However, several studies have indicated that BPH and the lower urinary tract symptoms that accompany it are associated with an increased incidence of erectile dysfunction.
One of the most important studies that looked at the relationship between an enlarged prostate and erectile dysfunction the Male Cologne Survey, in which 4, men aged 30 to 80 were questioned about their sexual activities and related factors. The researchers discovered a high percentage of men who had lower urinary tract symptoms due to BPH also had erectile dysfunction: The percentage of men without urinary symptoms who had erectile dysfunction was much lower in each age group.
More evidence of a link between BPH and lower urinary tract symptoms and erectile dysfunction come Prostate related sexual problems two other large studies. Investigators found that men with severe urinary symptoms were about twice as likely to experience erectile dysfunction.
In the Multinational Survey of the Aging Male MSAM-7a survey or more than 14, men ages 50 to 80 years, the high prevalence of BPH associated with lower urinary tract symptoms in aging men was confirmed. Most of the men surveyed had urinary tract symptoms ranging from mild to severe, with about one-third of them in the moderate-to-severe range.
Overall, the increased risk of erectile dysfunction among men who have BPH with associated lower urinary tract symptoms is twofold to fold. Having an enlarged prostate alone does not cause erectile "Prostate related sexual problems." However, scientists are still uncertain why BPH and its lower urinary tract symptoms are associated with erectile dysfunction.
One idea concerns the sympathetic nervous system, which studies show is hyperactive in animals and men with BPH-associated Prostate related sexual problems tract symptoms. Nerve fibers in the sympathetic nervous system transmit signals that have an impact on stress and stress-related symptoms.
An increase in these signals may lead to overactivity in the sympathetic nervous system, which is associated with erectile problems. An enlarged prostate can be treated with either medications or a variety of medical procedures, including surgery, and some of these options can potentially be a cause of erectile dysfunction.
Alpha-blockers are used to relax the muscles where the bladder narrows toward the urethra, improve blood flow, and reduce blood pressure.
Drugs in this category include alfuzosin Uroxatraldoxazosin Carduraprazosin Minipresstamsulosin Flomaxand terazosin Hytrin. Alpha-blockers generally are not one of the causes of erectile dysfunction. In fact, some studies suggest use of alpha-blockers may actually improve erectile function.
Some men had erectile dysfunction and others did not. At the end of the trial, the men who had erectile dysfunction had improved urinary tract symptoms and erectile function, while the men who did not have erectile dysfunction experienced even better improvement in urinary symptoms. In yet one more study of Prostate related sexual problems and erectile dysfunction, a total of 1, men average age, 57 years who had urinary tract symptoms were evaluated.
Of this group, men were taking alpha-blockers. The researchers found a decreased risk of sexual dysfunction among the men taking alpha-blockers. They also reported that the improvement in sexual function correlated with the improvement in urinary tract symptoms more strongly among men who were using alpha-blockers.
In a week study, a total of men who had benign prostatic with lower urinary tract symptoms were given tamsulosin.
Although the incidence of erectile dysfunction was small, it was not negligible and was more apt to occur in men who had a smaller prostate and fewer lower urinary tract symptoms. The 5-alpha reductase inhibitor drugs work by shrinking the size of the prostate. The two main drugs in this category are dutasteride Avodart and finasteride Proscar. Men who take these drugs typically do not notice any improvement in BPH symptoms for several months, so the impact of side effects also occurs later.
A literature review published in the Journal of Sexual Medicine reported that sexual side effects were found in 2. They attributed the development of erectile dysfunction to a decrease in nitric oxide activity related to a decline in dihydrotestosterone DHT levels.
On April 11,the Food and Drug Administration FDA announced that because research suggested use of finasteride was linked to various sexual side effects, manufacturers of finasteride 5 mg Proscar and finasteride 1 mg Propeciafor hair loss had to add warnings to their labels. The new changes were in addition to another modification made inwhen makers of finasteride added a warning that the drug might cause erectile dysfunction after men stopped using it.
Subsequent to the FDA announcement, a study from George Washington University reported in July that finasteride caused sexual side effects, including erectile dysfunction, changes in genital sensation, and quality of ejaculate. Anticholinergics block the action of acetylcholine, a chemical that sends messages to Prostate related sexual problems bladder that trigger contractions, which can make you want to urinate even when your bladder is full.
Thus anticholinergics can delay the urge to urinate. Drugs in this category include darifenacin Enablexfesoterodine Toviazoxybutynin Ditropanand tolterodine Detrol.
Use of anticholinergics increases the risk of erectile dysfunction, as reported by the Merck Manual and several other sources, including a study published in the International Journal of Impotence Researchalthough no statistics are provided. In addition to drugs, some other BPH treatments can impact erectile function.
One of the long-term complications of transurethral resection of the prostate TURP is erectile dysfunction, which reportedly occurs in less than 5 percent of men. Cornell A transurethral incision of the prostate TUIPin which an electrical current or laser beam is used "Prostate related sexual problems" treat the prostate tissue, also reportedly is a cause of erectile dysfunction in 4 to 25 percent of men.
One study found no change in erectile function after low-energy TUMT, while another reported an Another way an enlarged prostate and erectile dysfunction are linked is the effect of an ED drug tadalafil; Cialis on BPH.
Among the many studies leading up to the approval was one presented at the Annual Scientific Meeting of the American Urological Association in Chicago. Researchers reported on men who had had BPH symptoms for at least six months and who were given either 20 mg of tadalafil once daily or a placebo for Prostate related sexual problems months. At the end of the study period, the men who had taken tadalafil experienced an improvement in Prostate related sexual problems flow, peak flow, bladder capacity, and the ability to empty their bladder.
The researchers also noted that by the end of the study, the proportion of men with urethral obstruction increased in the placebo group and declined in the tadalafil group. The men were randomly assigned to receive once daily treatment with placebo or tadalafil 2. At the end of the study, men who had taken tadalafil had an improved urinary flow compared with those in the placebo group, with the most improvements seen in the men who took the highest dose of tadalafil.
The results of these studies suggest that erectile dysfunction drugs may be beneficial in treating BPH symptoms. Prostate related sexual problems for this benefit are not clear, but experts have some theories.
For example, the bladder muscles and prostate both have high activity levels of phosphodiesterase 5 PDE-5which is the enzyme erectile dysfunction drugs block.
When erectile dysfunction drugs relax the arteries and allow blood to flow into the "Prostate related sexual problems," they may also cause small blood vessels in the prostate and bladder to open up, which could improve urinary symptoms. Another possibility is that in older men who have lower urinary tract symptoms, the nerve signals to the brain, prostate, and bladder may not operate properly. Drugs for erectile dysfunction may block those signals and thus improve BPH symptoms.