Lower Urinary Tract Symptoms (LUTS) and Sexual Function in Both Sexes
Introduction
Aging is associated with profound structural and functional alterations in the lower urinary tract which can ultimately lead to lower urinary tract symptoms (LUTS) [1], [2]. The mean increase in LUTS from the age of 20 is 3.9%/decade for women and 7.3%/decade in men [3]. A strong relationship between aging and sexual function is also found, with sexual activity being higher in younger age groups [4].
LUTS in men are usually assumed to be caused by benign prostate hypertrophy (BPH). Symptoms vary on an individual level, but generally fall into three groups: (i) “voiding” (also known as obstructive) includes reduced stream, hesitancy, and straining; (ii) “storage” (also known as irritative) includes frequency, nocturia, and symptoms of incontinence, and (iii) mixed “voiding” and “storage” [5]. Studies using validated symptom scales, such as the International Prostate Symptom Score, have shown an overall prevalence rate of LUTS of 20% to 50% in men aged >50 years [6], [7]. The prevalence of LUTS in women defined as urinary leakage, associated with social or hygienic problems, has been reported as high as 19% and 22% in two Danish studies [8], [9]. In a Swedish survey of 10,000 women, aged 46–86 years, the prevalence of LUTS increased in a linear fashion, from 12% in the 46-year-olds to 25% in 86-year-olds [10].
The prevalence of sexual dysfunction in women is not well known, but it has been estimated that 40% of women complain of at least one sexual problem [4]. Prevalence of sexual problems in incontinent women is even higher and varies from 41% to 71% and is most common in women with urge incontinence [11]. Until now, no study has been conducted to investigate the relationship between LUTS and sexual problems in women.
The Massachusetts Male Aging Study showed that 35% of men aged 40–70 years had erectile dysfunction, which was strongly related to age, diabetes, depression and cardiovascular disease [12]. While the Massachusetts Male Aging Study stated that neither BPH itself nor LUTS affect sexual function in men to any significant effect, a number of recent studies have suggested that there might be such an association [13], [14], [15], [16], [17], [18]. Even though the pathogenetic relationship between LUTS and erectile dysfunction is not yet completely understood, a recent study postulates a direct association between these two symptom complexes in the aging male [19].
If an association between LUTS and sexual function exists, this will have implications for the management of LUTS. This study was conducted to investigate the relationship between LUTS and sexual dysfunction in both men and women aged 40–65 years.
Section snippets
Material and methods
This survey was conducted in Denmark between May and June 2003. Questionnaires were mailed to a randomly selected age- and sex-stratified population of 15,000 persons between 40 and 65 years of age, reflecting Danish sex and age structure. The questionnaire was sent by post; in case of non-response, study subjects were sent a reminder. A total of 8491 questionnaires were completed and returned, and 7741 (52%) were deemed valuable and included in the analysis. With a view to assess possible
Results
A random selection of 7500 women (49.8±10.5 years; range 40–65 years) and 7500 men (49.1±11.0 years; range 40–65 years) were recruited for this study. The age distribution of the female and male study population was comparable to the Danish population.
The prevalence of LUTS in men was 39.1% and in women 41.3%. Prevalence of LUTS was associated with age in both sexes; the highest prevalence was in the age group 50–59 years. Erectile dysfunction was significantly increasing with age and the total
Discussion
This study showed that LUTS and sexual dysfunction are very common disorders and that LUTS are an independent risk factor for sexual dysfunction in both men and women aged 40–65 years.
This study is the largest study to date on the prevalence of LUTS and sexual dysfunction in a representative sample of both men and women aged 40–65 years. In addition to the large sample size, the study is noteworthy for the use of standardised, validated scales of LUTS and sexual dysfunction. These scales
Acknowledgements
Distribution and collection of the questionnaires were carried out by the Mentor Institute, Copenhagen, Denmark. Funding support for the study was provided by an unrestricted grant from Pfizer.
References (28)
- et al.
Epidemiology of urinary symptoms in the geriatric population
Urol. Clin. North Am.
(1996) - et al.
Impact of symptoms of prostatism on level of bother and quality of life of men in French community
J. Urol.
(1995) - et al.
Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study
J. Urol.
(1994) - et al.
The relationship between sexual function and urinary condition in the French community
J. Clin. Epidemiol.
(1996) - et al.
Lower Urinary Tract Symptoms and male sexual dysfunction: the Multinational Survey of the Aging Male (MSAM-7)
Eur. Urol.
(2003) - et al.
Sexual dysfunction in 1.274 European men suffering from lower urinary tract symptoms
J. Urol.
(2003) - et al.
Lower urinary tract symptoms and erectile dysfunction: co-morbidity or typical “aging male” symptoms? Results of the Cologne male survey
Eur. Urol.
(2003) - et al.
The prevalence of prostatism: a population-based survey of urinary symptoms
J. Urol.
(1993) - et al.
Enhanced force generation by corpus cavernosum smooth muscle in rabbits with partial bladder outlet obstruction
J. Urol.
(2002) - et al.
The aging bladder: Morphology and urodynamic
World J. Urol.
(1998)
A comparative cross-sectional study of Lower Urinary Tract Symptoms in both sexes
Eur. Urol.
Sexual dysfunction in the United States
JAMA
New words for old: Lower urinary tract symptoms for “prostatism”
BMJ
“Prostate-related symptoms” in Canadian men 50 years or older: prevalence and relationships among symptoms
Br. J. Urol.
Cited by (76)
Olfaction Is Associated With Sexual Motivation and Satisfaction in Older Men and Women
2021, Journal of Sexual MedicineAssociation Among Lower Urinary Tract Symptoms, Erectile Function, and Sexual Satisfaction: Results from the Brazil LUTS Study
2020, Sexual MedicineCitation Excerpt :Furthermore, several common biological mechanisms between ED and LUTS have been proposed,6 although a causal relationship has not been established. An association between LUTS and ED has been widely demonstrated among men in Asia,7 Europe,8,9 and the United States.8,10 In line with these findings, an analysis of Brazilian men aged ≥45 years who participated in a prostate cancer screening program reported a prevalence of ED among men with LUTS of 58% and demonstrated that men with LUTS are more likely to develop ED than those without LUTS.11
Links between lower urinary tract symptoms, intermittent hypoxia and diabetes: Causes or cures?
2018, Respiratory Physiology and NeurobiologyCitation Excerpt :Further, quality of life is greatly impacted for LUTS patients, whose symptoms range from bothersome to potentially embarrassing and painful to lethal in infrequent cases of acute urinary retention (Agarwal et al., 2014; Kupelian et al., 2006; Robertson et al., 2007). LUTS have been shown to correlate significantly with erectile dysfunction, anxiety and depression (Coyne et al., 2009; Hansen, 2004; Kirby et al., 2013; Rom et al., 2012). In aggregate, the potential financial and personal burdens exacted by LUTS demand continued development of rapid and effective methods for diagnosis and treatment.
Erectile Dysfunction and Lower Urinary Tract Symptoms
2017, European Urology FocusThe Physiology of Female Sexual Function and the Pathophysiology of Female Sexual Dysfunction (Committee 13A)
2016, Journal of Sexual Medicine