Lower Urinary Tract Symptoms (LUTS) and Sexual Function in Both Sexes

doi:10.1016/j.eururo.2004.04.005

European Urology

Volume 46, Issue 2, August 2004, Pages 229-234

https://doi.org/10.1016/j.eururo.2004.04.005 Get rights and content

Abstract

Objectives: It has been stated that lower urinary tract symptoms (LUTS) do not affect sexual function to any significant degree, but a recent study has suggested that there might be an association in men. The present study was conducted to investigate the relationship between LUTS and sexual problems in both men and women aged 40–65 years.

Methods: The survey was conducted in Denmark between May and June 2003. Detailed questionnaires were mailed to a random sample of 15,000 men and women aged 40–65 years. LUTS and sexual function were assessed by validated symptom scales. Multivariate regression analysis was performed using logistic regression for dichotomous dependent variables of sexual function. The independent variables for both sexes were age, LUTS, partner status, body mass index (BMI), alcohol consumption and co-morbidities.

Results: A total of 15,000 questionnaires were mailed out, 8491 were completed and returned, and 7741 were deemed valuable and included in the analysis. LUTS and sexual dysfunction were common in both men and women. Logistic regression analysis of items related to erection problems and satisfaction with sex life in men and sexual function in women showed that LUTS are an independent risk factor for sexual dysfunction in both men and women aged 40–65 years. Significant effects on sexual function were also found for the independent variables of partner status and co-morbidities.

Conclusions: The presence of LUTS is an independent risk factor for sexual dysfunction in men and women. These results highlight the clinical importance of evaluating LUTS in patients with sexual dysfunction, and the need to consider sexual issues in the management of patients with LUTS.

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.

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Prevalence of co-existing pelvic floor disorders: A scoping review in males and females
2022, Continence
Dysfunction of the pelvic floor may lead to pelvic floor symptoms within different domains simultaneously, such as lower urinary tract symptoms (LUTS), bowel symptoms, pelvic organ prolapse, sexual problems and genito-pelvic pain. The aim of this scoping review is to provide an overview of the prevalence of concomitant pelvic floor symptoms, and the associated risk factors, in the general male and female population, and to identify knowledge gaps.
A literature search was conducted in the electronic database PubMed to identify relevant articles published in English. Articles were eligible when at least two different pelvic floor symptom domains were mentioned, or one type of pelvic floor symptom was mentioned as a risk factor for another pelvic floor symptom, and when the study was conducted in the general adult population or in the primary care setting.
In total 91 articles were selected, describing data from 73 different (cohort) studies. Twenty articles were found describing concomitant pelvic floor symptoms in both sexes, predominantly assessing double incontinence (DI). Twenty-six articles were found in male (sub)populations, of which 25 articles described the co-occurrence of sexual problems with another type of pelvic floor symptom. Concomitant LUTS and erectile dysfunction was common with prevalence estimates ranging from 14%–61%. Prevalence of DI in male populations ranged between 1%–14%. Forty-five articles were found in female (sub)populations. Most articles described DI, with prevalence rates ranging between 4%–15%. About a quarter to one third of females had one or more pelvic floor symptoms (i.e. urinary incontinence, fecal incontinence, pelvic organ prolapse) and around 1% had two or three of the above mentioned pelvic floor symptoms.
For males, there is limited information on concomitant pelvic floor symptoms, especially including bowel symptoms and pelvic pain. When bowel symptoms are assessed, this is done predominantly in studies assessing DI. In the female population, pelvic pain and sexual dysfunction are rarely studied. In general, less research is performed in the male population than in the female population.
Olfaction Is Associated With Sexual Motivation and Satisfaction in Older Men and Women
2021, Journal of Sexual Medicine
Sensory function declines with age and may impact sexual function in older adults. Indeed, the sense of smell plays a uniquely strong role in sexual motivation. Therefore, olfactory dysfunction in older adults may be intimately linked to changes in sexual desire and satisfaction.
To test whether impaired olfactory function is associated with decreased sexual activity and motivation in older adults.
Cross-sectional analysis of a nationally representative sample of community-dwelling older U.S. adults from the National Social Life, Health, and Aging Project.
2 modalities of olfactory function were measured (sensitivity to n-butanol and odor identification) via validated methods (Sniffin’ Sticks). Respondents answered survey questions about frequency of sexual thoughts (motivation) and sexual activity, and satisfaction with their most recent sexual relationship. A wide range of demographic, health, and social information were also collected.
Decreased olfactory function in older U.S. adults was associated with decreased sexual motivation (odds ratio 0.93, P = .03) and less emotional satisfaction with sex (odds ratio 0.89, P = .04), but not decreased frequency of sexual activity or physical pleasure, in analyses that were adjusted for age, gender, race, education, cognition, comorbidities, and depression.
Olfactory dysfunction may affect sexuality in older adults. Potentially treatable causes of sensory loss should be addressed by clinicians to improve quality of life.
These results rely on validated olfactory testing, detailed measures of sexual attitudes and behaviors, and extensive demographic, health, and social history in a nationally representative sample of older U.S. adults. Owing to the cross-sectional nature of these analyses, we cannot determine causality.
Olfactory dysfunction in older U.S. adults is associated with decreased sexual motivation and emotional satisfaction, potentially due to evolutionarily-conserved neurological links between olfaction and sexuality.
Siegel JK, Kung SY, Wroblewski KE, et al. Olfaction Is Associated With Sexual Motivation and Satisfaction in Older Men and Women. J Sex Med 2021;18:295–302.
Association Among Lower Urinary Tract Symptoms, Erectile Function, and Sexual Satisfaction: Results from the Brazil LUTS Study
2020, Sexual Medicine
Citation 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
Lower urinary tract symptoms (LUTS) affect ≥60% of adult men and are associated with erectile dysfunction (ED) and sexual dissatisfaction.
The aim of this study was to evaluate the relationship among male LUTS, ED, and sexual satisfaction.
This was a secondary analysis of the Brazil LUTS study, a cross-sectional, epidemiological survey conducted by telephone interview in 5 cities in Brazil. This analysis included men aged ≥40 years.
LUTS were identified using International Continence Society definitions. LUTS severity was assessed using the International Prostate Symptom Score questionnaire. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire and sexual satisfaction was rated on a 5-point scale.
2,433 men participated in the study. Of 2,183 men reporting data on LUTS, 873 (40%) had LUTS “about half the time” or more. The prevalence of ED and sexual dissatisfaction was 14.4% and 7.8%, respectively. The proportion of men reporting ED and sexual dissatisfaction was higher among men with LUTS (24.6% and 13.8%, respectively) than men without LUTS (8.7% and 4.5%, respectively; P < .001). LUTS severity was negatively correlated with IIEF-5 scores (r = –0.199; P < .001); we estimated a 0.431-point decrease in IIEF-5 score per 3-point increase in International Prostate Symptom Score. Increased age and the presence of LUTS were associated with a greater chance of ED and sexual dissatisfaction; depression/anxiety and diabetes were associated with a greater chance of sexual dissatisfaction only. Among men with LUTS, urgency with fear of leaking, urgency urinary incontinence, and nocturnal enuresis were associated with a greater chance of ED, whereas slow stream and urgency urinary incontinence were associated with a greater chance of sexual dissatisfaction.
These results demonstrate that the presence of LUTS is associated with an increased chance of ED and sexual dissatisfaction in Brazilian men and reinforce the importance of a comprehensive assessment of these conditions.
Gomes CM, Averbeck MA, Koyama M, et al. Association Among Lower Urinary Tract Symptoms, Erectile Function, and Sexual Satisfaction: Results from the Brazil LUTS Study. Sex Med 2019;8:45–56.
Links between lower urinary tract symptoms, intermittent hypoxia and diabetes: Causes or cures?
2018, Respiratory Physiology and Neurobiology
Citation 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.
Bothersome lower urinary tract symptoms (LUTS) manifest as urinary frequency, urgency, incontinence and incomplete bladder emptying. Existing treatments ameliorate but do not eliminate most symptoms, leading to financial and personal burdens attributable to sustained medical therapies that may last a lifetime. The purpose of this review is to highlight evidence of causal associations between LUTS and several common comorbidities, including intermittent hypoxia (IH) concomitant with obstructive sleep apnea (OSA), obesity, metabolic syndrome and type 2 diabetes. Links between these conditions, including therapies targeted to co-occurring complications that have demonstrated benefits for LUTS, suggest compelling avenues of research and also underscore critical gaps in understanding the mechanisms underlying urinary dysfunction. These gaps are prominent in the IH field, where an acknowledged link between OSA and LUTS has gone largely uninvestigated. New tools, models, or reappropriation of existing ones, especially rodent models, is required to parse the associations between IH/OSA, LUTS and obesity/diabetes and to elucidate their underlying, and potentially shared, etiologies.
Erectile Dysfunction and Lower Urinary Tract Symptoms
2017, European Urology Focus
Lower urinary tract symptoms (LUTSs) and erectile dysfunction (ED) are substantial health concerns with a significant impact on the overall male quality of life.
To evaluate the available evidence of the association between LUTSs and ED in patients with benign prostatic hyperplasia (BPH), and discuss possible clinical implications for the management of LUTS/BPH.
A systematic review of the existing literature published between 1997 and June 2017 and available in the Medline, Scopus, and Web of Science databases was conducted using both the Medical Subject Heading (MeSH) and free-text protocols. The MeSH search was conducted by combining the following terms: “lower urinary tract symptoms,” “LUTS,” “benign prostatic hyperplasia,” “BPH,” “erectile dysfunction,” “sexual dysfunction,” “BPE,” and “benign prostatic enlargement.” The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed.
Several community-based studies in different geographical areas have provided strong evidence of an age-independent association between LUTSs and ED. Several biological mechanisms have been proposed to explain this association, but further research is required to better understand the molecular pathways involved. It is necessary to evaluate the possible impact of the metabolic syndrome treatment on LUTS/ED management. Considering the possible relationship between LUTSs and ED, their impact on the quality of life, and the possible adverse effects associated with LUTS medical treatment, clinicians should always evaluate ED in patients with LUTSs and take the opportunity to evaluate patients reporting ED for LUTSs.
Data from the peer-reviewed literature suggest the existence of an association between LUTS/BPH and ED, although their casual relationship has not been established yet. Emerging data also suggest that pathophysiological mechanisms involved in the metabolic syndrome are key factors in both disorders. Considering the association, it is also recommended that men presenting with LUTSs or ED should be evaluated for both disorders. A better understanding of the molecular pathways behind this association may also help identify new possible targets and develop novel therapeutic approaches to manage LUTSs and ED.
In this manuscript, we report on all the available evidence linking erectile dysfunction and lower urinary tract symptoms. Our findings suggest the existence of a strong relationship between these two conditions. On the basis of these findings, we recommend that clinicians always explore both conditions in male patients presenting with either of symptoms.
The Physiology of Female Sexual Function and the Pathophysiology of Female Sexual Dysfunction (Committee 13A)
2016, Journal of Sexual Medicine
The article consists of six sections written by separate authors that review female genital anatomy, the physiology of female sexual function, and the pathophysiology of female sexual dysfunction but excluding hormonal aspects.
To review the physiology of female sexual function and the pathophysiology of female sexual dysfunction especially since 2010 and to make specific recommendations according to the Oxford Centre for evidence based medicine (2009) “levels of evidence” wherever relevant.
Recommendations were made for particular studies to be undertaken especially in controversial aspects in all six sections of the reviewed topics. Despite numerous laboratory assessments of female sexual function, genital assessments alone appear insufficient to characterise fully the complete sexual response.

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Lower Urinary Tract Symptoms (LUTS) and Sexual Function in Both Sexes

Abstract

Introduction

Section snippets

Material and methods

Results

Discussion

Acknowledgements

Urol. Clin. North Am.

J. Urol.

J. Urol.

J. Clin. Epidemiol.

Eur. Urol.

J. Urol.

Eur. Urol.

J. Urol.

J. Urol.

The aging bladder: Morphology and urodynamic

World J. Urol.

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.