L’hypertrophie bénigne de la prostate (Adenome)

Benign prostatic hyperplasia and sexual dysfunction

Studies have shown Prostate Adenoma or ‘Benign Prostatic Hyperplasia’ (BPH) & erectile dysfunction (ED) are connected. The good news: efficient treatments to reduce ED do exist and help patient to maintain normal sex life in conjunction with sexologist assistance wherever needed.

 

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is diagnosed when the prostate is enlarged. The prostate gland surrounds the urethra, the tube carrying urine from the bladder out of the body.

As the prostate growth in size, it may squeeze the urethra or partially block it. This often causes for the patient difficulties urinating.

BPH affects men, especially upon crossing age 50. In the UK 25% of men from +50 age group are concerned representing a population of approximately 2.500.000 post age 65, 30% of men will face urinary problems.

A wide range of treatments are available when patient comfort is altered and/or when the development of prostate adenoma might damage irreparably the bladder:

  1. The use of pharmaceutical treatments,
  2. Conventional surgical methods: open Adenomectomy or Trans Urethral Resection of the Prostate (TURP),
  3. Endoscopic procedures using LASERS including enucleation of the adenoma via holmium laser (HoLEP),
  4. The endoscopic bipolar vaporization using high energy electric current,
  5. Local elevation of intra-prostatic temperature (or thermotherapy) through transurethral microwaves to expand the prostatic portion of the urethra,
  6. Prostatic arterial embolization (PAE) where tiny particles are injected right into the small arteries which nourish the prostate aiming to diminish the adenoma size.

 

BPH Impacts on sexuality

At first glance, the adenoma does not affect erectile capacities that are not physiologically connected to the prostate.

It should not reduce ejaculatory abilities since the semen enters the urethra via the ejaculatory ducts, reaching next the area located under the enlarged prostate area while the prostate function is limited to produce the fluid in which spermatozoon are found after being generated by the testicles.

Yet, half of patients report sexual problems: less intense ejaculation and orgasmic sensations and more common erection disorders.

Studies show that sexual activity decreases with accentuation of urinary difficulties.

 

BPH Impact on patient sexual life

The volume of atypical adenomatous prostate compresses vessels and nerves associated with erectile/ejaculatory capacity, which can lead to painful or impossible ejaculations as well as erectile dysfunction. Bladder draining disorders can also cause pain during erections. Finally,  infection or prostate biopsies can result in blood presence in the semen.

These are common motives that lead men to the urologist’ door.

Prostate adenoma treatments, like those prescribed for other medical issues such as high blood pressure, may also impact patients sexual life.

Surgical procedures can have various effects:

  1. In 80% of cases, patient post-surgery will not succeed to perform normal ejaculation, his ejaculation will be retrograde (ejaculate goes back into the bladder instead of out) while the patient will still experience “dry” orgasms not harming his sensation of pleasure.
  2. They can also lead to erectile dysfunction or libido fall.

The urinary difficulties raise patient anxiety towards marital relations, which can psychologically affect his sexuality. BPH treatments, by phasing out those difficulties, can ‘liberate’ the sexual function and help patient recovering a satisfactory sex life.

In most cases, patients age plays the determining role explaining some of erections and/or ejaculations disorders.

A study conducted over 14.000 patients reported by the French Association of Urology confirms the double impact of BPH and age on patients sexuality.

 

BPH & Solutions to improve Sexual life

Statistics are showing that more than 80% of men aged +50 and half of men aged +80 keep having an active sexual life.

Consulting an urologist help patient approaching the various solutions that will treat possible sexual disorders.

The initial evaluation of patient sexuality is an essential prerequisite before deciding on therapeutic options, exposing the patient each options benefits and possible adverse side effects.

A gradation is advised in treatments implementation.

The preferred option remains the simplest one: oral drugs ingestion.

Usage of Aphrodisiacs will be sometimes advised,  in most cases the Urologist will prescribe erection facilitators from the 5-alpha-reductase-inhibitors family as the SILDENAFIL.

Various molecules and different dosages exist, granting the Urologist an ability to adjust drug action duration and medication timetable according to patient’s wishes and couple’s sexual habits.

In case of oral medications failure, intra-cavernous injections should be considered or mechanical solutions such as vacuum constriction devices or penile implants. We’re addressing these treatments through this dedicated article.

Libido is also likely to be harmed by treatments side effect but also by the routine accompanying the couple throughout the aging process. Therefore it is essential to encourage patient and his partner to defuse the situation. The couple should put an emphasis on dialogue, understanding and complicity efforts that will have to be demonstrated, guidance of a sexologist might be required in some cases.

 

Some bibliographic elements:

English:

Benign prostatic hyperplasia

http://urofrance.org/congres-et-formations/formation-initiale/referentiel-du-college/cancer-de-la-prostate.html

http://documentation.ledamed.org/IMG/html/doc-10831.html

 

French:

Impacts of the adenoma on sexuality

http://www.urologie-cupl.com/wp-content/uploads/2012/11/Prostateetsexualite.pdf

http://www.lamutuellegenerale.fr/le-mag-sante/senior/adenome-de-la-prostate-et-sexualite.html

Connection between urinary and sexual disorders

http://urofrance.org/science-et-recherche/base-bibliographique/article/html/troubles-urinaires-du-bas-appareil-et-dysfonction-sexuelle-masculine-lenquete-msam-7-ou-enquete.html

HBP & Erectile dysfunction

Adenoma of the prostate and erectile dysfunction Presentation by Vincent Hupertan

Testimonials

http://www.chu-nimes.fr/docs/patients/Compte_rendu_rencontre_helpp_10janv2013.pdf