The Effects of Medical Treatments Used for Benign Prostatic Hyperplasia on Ejaculation

In men, significant lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) requiring treatment increase with aging. Though declining with aging, many individuals in this population sustain their sexual activities. Many drugs commonly used to treat LUTS may have significant adverse effects on sexual functions including ejaculatory function. Among alpha 1 adrenergic receptor (alpha 1-AR) blockers, the most commonly used drugs for treatment of BPH, silodosin and tamsulosin have been associated significantly with ejaculatory dysfunction. Silodosin and tamsulosin lead to ejaculatory problems respectively 32.5 (p<0.0001) and 8.6 times (p=0.006) higher than placebo does. Other drugs in this class such as terazosin, alfuzosin and doxazosin have minimal effects on ejaculation. There seems to be a positive association between development of ejaculatory dysfunction and therapeutic efficacy of the a1-AR blockers. In addition to alterations in libido and penile erection, 5-alpha reductase inhibitors (5ARI) can cause ejaculatory dysfunction. The rate of abnormal ejaculation with finasteride and dutasteride is similar and three times more than placebo (p<0.0001). Abnormal ejaculation is more common with combination therapy of alpha 1-AR blockers and 5ARI than treatment with the individual class of these drugs. In conclusion, treatment with alpha 1-AR blockers, 5ARI or combination of both can cause ejaculatory dysfunction with varying degrees. As this may have a significant impact on quality of life, individuals for whom medical treatment are planned to relieve LUTS due to BPH should be informed and counseled for drug choice.