The effect of anticholinergics and β-3 agonists on erectile function: a narrative review

Overactive bladder (OAB) is a prevalent condition in men, often requiring pharmacologic treatment with anticholinergics or β-3 adrenergic receptor agonists. While effective in managing urinary symptoms, the impact of these therapies on male sexual function, particularly erectile function, remains underexplored and clinically significant.

This manuscript reviews current evidence regarding the influence of OAB medications on male sexual function, with a focus on molecular mechanisms, clinical outcomes, and therapeutic implications.

A narrative review of preclinical and clinical literature was conducted to evaluate the effects of anticholinergics and β-3 agonists on erectile physiology and function.

Molecular studies indicate that β-3 agonists may exert beneficial effects on erectile tissue via smooth muscle relaxation, independent of the NO-cGMP pathway. Clinical studies of mirabegron suggest variable improvements in erectile function, while vibegron shows benefits limited to intercourse satisfaction. Among anticholinergics, fesoterodine and tolterodine may have neutral or positive impacts on sexual function, although data are inconsistent across agents.

OAB pharmacotherapy may influence male sexual health; however, evidence remains mixed. Further high-quality research is needed to elucidate these relationships and guide individualized treatment strategies that address both urinary and sexual function in men.