Symptomatic benign prostatic hyperplasia (BPH) as characterized by lower urinary tract symptoms suggestive of obstruction is a common condition in the elderly male population. Although there are some country-specific differences, symptomatic PBH in general occurs in approximately 20 to 30% of men aged 60 years or over.

Patients consulting for symptomatic PBH are not only seeking to be relieved from their symptoms but certainly wish to retain an acceptable quality of life. From self-administered questionnaires, the aspects reported to be the more affected and to be the more important in PBH patients were sleep, anxiety and worry about the disease, impact of symptoms on daily activities, but also sexual functions and satisfaction with sexual relationships.

Indeed, epidemiological studies revealed that, independently of age, LUTS are strongly associated with sexual dysfunction and a spoilt sex life. Moreover, the prevalence of erectile dysfunction and reduced ejaculation increases with the severity of LUTS, affecting about 2/3 patients with severe LUTS. Both conditions are also highly bothersome: among those patients with severe LUTS, respectively 93% and 78% of patients with reduced erection and reduced ejaculation, consider it to be a problem.

On the other hand, assessments of patients with erectile dysfunction revealed that the prevalence of LUTS was very common, up to 72.2%.

BPH treatment modalities, either surgical or medical, may also impair sexual function. Transurethral resection of the prostate (TURP), for example, may cause bothersome retrograde ejaculation in more than 70% and impotence in about 5 to 8% of men undergoing the procedure. Plant extracts do not interfere noticeably with sexuality.

Direct comparative studies have shown that finasteride, a 5a-reductase inhibitor, is associated with an increased incidence of ED, decreased libido and abnormal ejaculation compared with alpha-blockers as alfuzosin, doxazosin and terazosin. An abnormal ejaculation is reported by 4% to 6% of patients treated with tamsulosin in Europe. These percentages are much more important in US where up to 30% of patients complain of abnormal ejaculation over a mean exposure of 16 months. Conversely, ejaculatory disorders appear to be negligible with alfuzosin and terazosin. Moreover, when analysing alfuzosin results in population trials, a sexual status improvement was noted.

With increasing age, men experience significant changes in their sexual function, namely the average frequency of intercourse and the ability in getting or maintaining erection. Nevertheless, regular sexual activity is a normal finding in ageing men and satisfaction with sex life is an important dimension of quality of life which is rarely considered when managing LUTS.

Medical treatment of LUTS may also impact on sexual function and side-effects should be discussed with the patient before initiating a therapy.