Alpha-blocker use in men associated with decreased incidence of sexual dysfunction

A study published in Urology demonstrated that alpha-blocker use is associated with a lower risk of sexual dysfunction in men aged >40 years. The study results also suggested that there was a correlation between improvement in lower urinary tract symptoms (LUTS) and decreased incidence of sexual dysfunction among patients who took alpha-blockers.

In this population-based study, researchers assessed a cohort of white men aged 40 to 79 years who were randomly selected from the 1990 population of Olmsted County, Minnesota. Men with a history of prostate or bladder surgery, urethral surgery or stricture, or other conditions that could affect urinary function were not eligible for participation in the study. Included patients were evaluated biennially for 14 years. At the initial study visit and biennially beginning in 2000, participants were asked to report all prescribed and over-the-counter medications taken daily. Additionally, in 1998 and biennially thereafter, patients were also questioned about drugs for benign prostatic hyperplasia (BPH). The Brief Male Sexual Function Inventory was also incorporated into the patient evaluation, and at each round, patients completed a self-administered questionnaire about LUTS severity.

A total of 1,724 men were included in the analysis; 263 (15.3%) reported use of alpha-blockers. Patients treated with alpha-blockers were more likely to have hypertension and coronary heart disease. Incidence of sexual dysfunction at baseline was similar in patients treated with alpha-blockers and those not treated with alpha-blockers. At follow-up, however, alpha-blocker use was associated with a significantly lower risk of sexual dysfunction (defined as erectile function domain less than or equal to 3, sexual drive domain less than or equal to 2, ejaculatory function domain less than or equal to 2, sexual problem assessment domain less than or equal to 3, and sexual satisfaction domain less than or equal to 1) compared with nonuse (dysfunction in erectile function domain, age-adjusted HR=0.53; PPP=.01; sexual problem assessment domain, age-adjusted HR=0.69; P=.06; sexual satisfaction domain, age-adjusted HR=0.66; P=.01).

The investigators also assessed the potential correlation between changes in LUTS severity scores and the incidence of sexual dysfunction. They observed that patients who were treated with alpha-blockers and had an improvement in LUTS severity were more likely to have fewer sexual problems (HR=0.38–0.78) compared with patients who did not use alpha-blockers and did not have an improvement in LUTS severity scores.

The authors pointed out that their study is limited by the use of patient self-reporting, as well as by the lack of information about alpha-blocker dose, type, and duration of therapy. Additionally, they stated that their results might not be generalizability to a wide population as only white men aged >40 years were included in the analysis.

In an editorial comment, Kevin McVary, MD, stated that, although this study “offers an interesting missing piece of a puzzle,” the results should be interpreted with caution as “the LUTS paradigm is in flux.”

Source
Kumar R, Nehra A, Jacobson DJ, et al. Alpha-blocker use is associated with decreased risk of sexual dysfunction. Urology. 2009;74:82–88.