The relationship between sexual life and urinary condition in the French community

doi:10.1016/0895-4356(96)00213-2

Journal of Clinical Epidemiology

Volume 49, Issue 10, October 1996, Pages 1171-1176

https://doi.org/10.1016/0895-4356(96)00213-2 Get rights and content

Abstract

As part of a large, nationwide community-based study in France on health and urinary condition, involving 2011 men aged between 50 and 80 years, information was collected on sexual life factors (e.g., frequency of sexual desires and sexual relations, and the frequency of having difficulties with erection and ejaculation) in addition to an assessment of overall sexual life satisfaction. Data on sexual life were obtained by means of a self-administered questionnaire, while information on the frequency of urinary symptoms was obtained by a professional interviewer.

The median number of sexual relations decreased with age from “once per week” in those aged 50–59 years to “less than once per week” in those aged 60–69 years to “never” in those aged over 70 years, while the percentage reporting difficulty with erection at least some of the time increased from 20 to 38% between 50–59 and 70–79 years, respectively. The number of sexual relations during the past month was by far the most important factor having an influence on overall sexual life satisfaction, with those men reporting relations less than once per week almost 10 times more likely to be dissatisfied. Severity of overall urinary symptoms (as well as many individual symptoms) was also inversely related to sexual life satisfaction, and the association persisted after taking account of the strong influence of age and the frequency of sexual relations. All other factors being equal (age, number of relations, comorbidities, and previous prostate surgery), the likelihood of men being dissatisfied with sexual life increased twofold in men with moderate symptoms and fourfold in those with severe symptoms.

The results obtained in the current study should be considered preliminary, given the complexity of the relationship between these two factors and the lack of previously published evidence. They certainly call for further studies, which should include a detailed assessment of sexual function and a clinical assessment of the urinary condition.

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Cited by (118)

Impacts of medical treatments for lower urinary tract symptoms suggestive to benign prostatic hyperplasia on male sexual functions
2016, Urological Science
Although alpha blockers with or without 5-alpha reductase inhibitors (5-ARIs) have become the standard of treatment for men with moderate to severe lower urinary tract symptoms suggestive to benign prostatic hyperplasia (LUTS/BPH), their negative adverse effects on male sexual functions have become another major issue, which may have a direct impact on patients' quality of life and overall satisfaction. Erectile dysfunction, ejaculation disorders, reduced libido, or anorgasmia have been noted among patients receiving these standards of treatments and these adverse events may be irreversible even after discontinuation of medications. Physicians should inform and discuss with their patients about these potential side effects before prescribing these medications for their LUTS/BPH treatment. Tadalafil is the first phosphodiesterase type 5 inhibitor which has the indications for LUTS/BPH and erectile dysfunction and its efficacy is comparable to alpha-blockers with regards to the reduction of LUTS and improvement of quality of life. Moreover, early clinical studies have showed that the combination use tadalafil with alpha blockers or 5-ARIs may have an additional benefit on symptom relief and maximum urinary flow rate (Q_max) improvement. As expected, the improvement on erectile function is significant, especially among patients taking 5-ARIs regularly. Although there are promising data from the combination use of tadalafil with 5-ARIs or tadalafil with alpha-blockers, more large-scale clinical studies are still needed to confirm their long term safety and efficacy profiles.
The incidence, prevalence, and natural history of erectile dysfunction
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Over the past 20 years, there have been numerous reports on the epidemiology of erectile dysfunction (ED). Most studies have reported prevalence rates in a variety of different populations using a variety of methodologies and a variety of definitions of ED. The varying methodologies, definitions, and populations make comparison difficult, but in high‐quality studies there is a consistent association with age, and analytical studies suggest an association with cardiovascular risk factors, depression, and lower urinary tract symptoms. There is emerging evidence of a link with smoking and obesity. A smaller number of studies have reported the incidence of ED, again using a variety of different methodologies, definitions, and study populations. While the methodological differences were again prominent, there was a consistent correlation with increasing age. Only two reports have studied the natural history of ED, and both demonstrated not only that there was commonly disease progression, but also that in some men there was remission of ED. Remission was commoner in younger men, suggesting that in these men psychological and lifestyle factors might be the cause of temporary self‐limiting ED. These studies also suggest that lifestyle modifications might be helpful in the prevention and treatment of ED. Eardley I. The incidence, prevalence, and natural history of erectile dysfunction. Sex Med Rev 2013;1:3–16
Critical analysis of the relationship between sexual dysfunctions and lower urinary tract symptoms due to benign prostatic hyperplasia
2011, European Urology
This review focuses on the relationship among sexual dysfunction (SD), lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), and related therapies.
We reviewed the current literature to provide an overview of current data regarding epidemiology and pathophysiology of SD and LUTS. Moreover, we analysed the impact of currently available therapies of LUTS/BPH on both erectile dysfunction (ED) and ejaculatory dysfunction and the effect of phosphodiesterase type 5 inhibitors (PDE5-Is) in patients with ED and LUTS.
We conducted a Medline search to identify original articles, reviews, editorials, and international scientific congress abstracts by combining the following terms: benign prostatic hyperplasia, lower urinary tract symptoms, sexual dysfunction, erectile dysfunction, and ejaculatory dysfunction.
We conducted a comprehensive analysis of more relevant general population–based and BPH/LUTS or SD clinic-based trials and evaluated the common pathophysiologic mechanisms related to both conditions. In a further step, the overall impact of current BPH/LUTS therapies on sexual life, including phytotherapies, novel drugs, and surgical procedures, was scrutinized. Finally, the usefulness of PDE5-Is in LUTS/BPH was critically analysed, including preclinical and clinical research data as well as possible mechanisms of action that may contribute to the efficacy of PDE5-Is with LUTS/BPH.
Community-based and clinical data demonstrate a strong and consistent association between LUTS and ED, suggesting that elderly men with LUTS should be evaluated for SD and vice versa. Pathophysiologic hypotheses regarding common basics of LUTS and SD as discussed in the literature are (1) alteration of the nitric oxide (NO)–cyclic guanosine monophosphate (cGMP) pathway, (2) enhancement of RhoA–Rho-kinase (ROCK) contractile signalling, (3) autonomic adrenergic hyperactivity, and (4) pelvic atherosclerosis. The most important sexual adverse effects of medical therapies are ejaculation disorders after the use of some α-blockers and sexual desire impairment, ED, and ejaculatory disorders after the use of α-reductase inhibitors. Minimally invasive, conventional, and innovative surgical treatments for BPH may induce both retrograde ejaculation and ED. PDE5-Is have demonstrated significant improvements in both LUTS and ED in men with BPH; combination therapy with PDE5-Is and α1-adrenergic blockers seems superior to PDE5-I monotherapy.
Re: Effects of tadalafil on lower urinary tract symptoms secondary to benign prostatic hyperplasia in men with or without erectile dysfunction
2010, European Urology
Phosphodiesterase type 5 inhibitors for lower urinary tract symptoms associated with benign prostatic hyperplasia
2010, Urological Science
Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are two common diseases among men aged over 50. Population or community-based epidemiologic studies have shown higher prevalence of male ED among men with LUTS associated with BPH. The exact mechanisms are unclear, but nitric oxide/cyclic guanosine monophosphate signal may be involved in the common pathway in the pathogenesis via smooth muscle relaxation control. Phosphodiesterase type 5 (PDE5) inhibitors have become the mainstay treatment of choice for male ED since the launch of sildenafil citrate in 1998. However, more evidence has shown that men receiving PDE5 inhibitors for their ED treatment have also benefited from improvement on their LUTS. Early randomized clinical studies has shown that daily dosing with PDE5 inhibitors (sildenafil, tadalafil and vardenafil) could improve the irritative or obstructive symptoms based on reduction in the International Prostate Symptom Score but had little effect on uroflow rate or post-voiding residuals. The combined use of PDE5 inhibitors and α-blockers has revealed more promising results on LUTS alleviation, but the safety profiles of this kind of combined use should be further evaluated and confirmed by greater-scale, randomized and comparative clinical studies.
Epinephrine is associated with both erectile dysfunction and lower urinary tract symptoms
2010, Fertility and Sterility
To determine whether patients with erectile dysfunction (ED) have a higher incidence of insulin resistance (IR) when compared with controls.
Prospective case–control study.
Academic medical center.
Twenty-nine nondiabetic men aged 18–66 years were enrolled. Of these, 28 completed the study: 17 had ED, and 11 did not.
Validated ED questionnaires, examination, serum hormones evaluation, and oral glucose tolerance testing.
Association of IR with ED.
The association between worsening degrees of both lower urinary tract symptoms (LUTS) and ED was reaffirmed, as was a potential correlation between the two—epinephrine. There was a negative association between serum levels of epinephrine and scores on the 5-item version of the International Index of Erectile Dysfunction for ED (Spearman correlation coefficient = −0.38). On the other hand, men with ED were not more likely to have IR compared with controls.
Epinephrine may be the common link between ED and LUTS.

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^☆: Supported by a grant from Merck, Sharp, and Dohme.

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Original articleThe relationship between sexual life and urinary condition in the French community☆

Abstract

J Urol

Lancet

J Urol

J Urol

J Urol

Symptom status and quality of life following prostatectomy

J Am Med Assoc

Sexual disorders after operation for benign prostatic hypertrophy

Ann Urol (Paris)

Sexual functioning in the elderly

Arch Intern Med

Original article
The relationship between sexual life and urinary condition in the French community☆