Sexual Dysfunction Related to Drugs: a Critical Review. Part V: α-Blocker and 5-ARI Drugs

Area of Science:

• Pharmacology
• Urology
• Sexual Medicine

Background:

• Sexual dysfunction is a recognized adverse effect of medications used to treat benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS).
• Current literature on this topic is extensive but often limited by methodological flaws, particularly in diagnosing ejaculatory and sexual desire dysfunction.
• Few randomized controlled trials (RCTs) exist, hindering definitive conclusions.

Purpose of the Study:

• To critically review the current literature on sexual dysfunction associated with drugs for BPH and LUTS.
• To identify specific drug classes and agents with notable sexual side effect profiles.
• To explore potential intervention strategies for managing treatment-emergent sexual dysfunction.

Main Methods:

• A literature search was conducted using keywords related to BPH/LUTS drugs, sexual dysfunction, and phosphodiesterase type 5 (PDE5) inhibitors.
• Studies published between 2002 and December 2014 were included, focusing on those reporting sexual dysfunction data for alpha-blockers and 5-ARIs.
• Research evaluating combination therapy with PDE5 inhibitors was also reviewed.

Main Results:

• Alpha-blockers and 5-ARIs can cause erectile dysfunction, ejaculatory disorders, and reduced sexual desire, with varying profiles.
• Silodosin shows a high incidence of ejaculatory disorders among alpha-blockers.
• Persistent sexual side effects after finasteride discontinuation warrant further investigation.

Conclusions:

• Methodological limitations in existing studies necessitate the use of validated diagnostic tools for sexual dysfunction, especially for ejaculatory and desire disorders.
• More research is needed to specifically assess sexual dysfunction induced by alpha-blockers and 5-ARIs.
• Long-term studies on combination therapy with PDE5 inhibitors and BPH/LUTS drugs are required.