BPH/LUTS significantly affect sexual health, and each intervention carries varying risks of sexual dysfunction, requiring specific tailored treatment plans and a multidisciplinary approach to management.
Key Findings
Results
A significant association exists between BPH, LUTS, and sexual dysfunction, with ED, ejaculatory dysfunction, and hypogonadism being common complications.
The association between BPH, LUTS, and sexual dysfunction is described as 'significant' based on a comprehensive literature review.
Sexual dysfunction manifestations include erectile dysfunction (ED), reduced sexual desire, hormonal imbalances, and ejaculatory dysfunction.
Hypogonadism is identified as a common complication alongside ED and ejaculatory dysfunction.
The report was based on guidelines from the International Consultation on Sexual Medicine (ICSM 2024) with recommendations graded using the GRADE system.
Results
Multiple treatment modalities for BPH/LUTS are recommended, each carrying varying risks of sexual dysfunction.
Recommended treatments include lifestyle modifications, medical therapies, minimally invasive surgical therapies, prostate artery embolization, and surgeries.
Surgical options specifically identified include Transurethral resection of the prostate (TURP), HoLEP, and Aquablation.
Each intervention carries varying risks of sexual dysfunction, requiring specific tailored treatment plans.
The varying risk profiles across interventions necessitate individualized treatment planning rather than a one-size-fits-all approach.
Background
BPH is characterized as an age-related condition with emerging evidence highlighting its relationship to both urinary and sexual health outcomes.
BPH is described as an 'age-related condition affecting many men.'
The relationship between BPH, LUTS, and sexual dysfunction is described as 'emerging evidence' that highlights a 'strong relationship.'
The condition warrants 'a comprehensive approach to diagnosis and management' based on the breadth of associated sexual health effects.
Sexual effects encompass both functional domains (erectile function, ejaculatory function) and hormonal domains (sexual desire, hormonal imbalances).
Conclusions
A multidisciplinary approach to managing BPH/LUTS-associated sexual dysfunction is emphasized as necessary.
The paper emphasizes 'the need for a multidisciplinary approach to management' of BPH/LUTS sexual health impacts.
Enhanced education for patients and their partners is recommended as a means to 'improve quality of life and coping mechanisms.'
Partner involvement is specifically highlighted as a component of patient education and support.
The multidisciplinary recommendation reflects the breadth of domains affected, spanning urology, sexual medicine, and endocrinology.
Conclusions
Future research priorities include refining diagnostic criteria and developing treatments that minimize sexual side effects of BPH/LUTS interventions.
The paper calls for future research to 'refine diagnostic criteria' for BPH/LUTS-associated sexual dysfunction.
Development of treatments that 'minimize sexual side effects' is identified as a key research priority.
The recommendations were graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
The literature review was conducted in accordance with International Consultation on Sexual Medicine guidelines.
What This Means
This research summarizes recommendations from a major international expert consultation (ICSM 2024) on the relationship between prostate enlargement (benign prostatic hyperplasia, or BPH), urinary symptoms, and men's sexual health. The experts reviewed existing scientific literature and found strong evidence that men with BPH and urinary problems frequently also experience sexual difficulties, including trouble getting or maintaining erections, problems with ejaculation, reduced sex drive, and hormonal imbalances such as low testosterone. These connections are significant enough that doctors should routinely assess sexual health when evaluating and treating urinary symptoms in men.
The consultation reviewed a range of treatments for BPH and urinary symptoms—from lifestyle changes and medications to minimally invasive procedures and surgeries like TURP, HoLEP, and Aquablation—and found that each treatment option carries a different risk profile for causing or worsening sexual dysfunction. This means that choosing the right treatment requires careful consideration of each individual patient's sexual health concerns and priorities, rather than applying the same approach to everyone. Prostate artery embolization is also noted among the treatment options reviewed.
This research suggests that managing BPH and urinary symptoms should involve a team of specialists and should not overlook the impact on sexual wellbeing. Educating both patients and their partners about these connections and the potential sexual side effects of various treatments may help improve quality of life. The experts call for future studies to better define how to diagnose related sexual problems and to develop new treatments that are less likely to cause sexual side effects.
Yafi F, Dewitte M, Elterman D, Hammad M, Lotti F, Manfredi C, et al.. (2026). Lower urinary tract symptoms and male sexual function: recommendations from the fifth international consultation on sexual medicine (ICSM 2024).. Sexual medicine reviews. https://doi.org/10.1093/sxmrev/qeaf071