ORLANDO — Assess sexual health in men with lower urinary tract symptoms because these symptoms negatively affect the frequency and enjoyment of sexual activity, according to an international, Internet-based survey with nearly 13,000 respondents.
Although lower urinary tract symptoms (LUTS) are a known risk factor for erectile dysfunction (ED), the impact of individual symptoms on men's sexual health had not been reported, Karen Coyne, Ph.D., said.
She and her colleagues launched the EpiLUTS study, a cross-sectional, population-representative survey conducted in three countries, to assess the impact of LUTS in men on sexual health. A total of 9,416 U.S. men and 3,517 U.K. men responded, for an overall response rate of 59%. Data from Sweden were still pending when Dr. Coyne presented findings at the annual meeting of the American Urological Association.
Men were asked how frequently they had experienced LUTS over the previous 4 weeks and to rate symptoms on a 5-point Likert scale. They also reported how much each symptom bothered them. The survey included the International Index of Erectile Function (IIEF) questionnaire and an additional question about premature ejaculation.
Respondents were older than 40 years (mean age, 56). In the U.S. sample, 76% were white, 11% black, 9% Hispanic, and 4% “other.” About three-quarters in both countries were married.
Terminal dribble, nocturia two or more times per night, and postmicturition incontinence were the most common LUTS reported in the survey. Dr. Coyne is a consultant/adviser for Pfizer Inc., which funded the study.
The survey also asked about sexual health. A total of 71% of U.S. respondents and 68% of U.K. respondents reported they were currently sexually active. Within this group, the majority reported sexual activity a few times a week (33%) or a few times a month (46%).
A total of 17% opted out of the sexual health questions. “We did not ask why they wanted to opt out of the survey. But we looked at the demographics, and they were slightly older,” suggesting that a reluctance to reveal sexual function may have been a factor, said Dr. Coyne, a researcher for United Biosource Corp.
The leading reasons that 29% of the U.S. men reported they were not currently sexually active included no partner (38%), their own health reasons (20%), and no desire (20%).
An overall 10% of respondents reported “somewhat to quite” decreased sexual activity because of their LUTS. In addition, 11% reported that their LUTS caused “somewhat to quite decreased” sexual enjoyment. Leaking during sex, bladder cancer, prostate cancer, and bladder pain were significantly correlated with decreased sexual enjoyment, according to a logistic regression.
A total of 25% of U.S. men and 24% of U.K. men reported some mild to severe ED, reflected by a score of 21 or less on the IIEF. Older age, hypertension, diabetes, and depression were significant predictors of ED, as expected. In addition, urgency with no fear of leaking, weak stream, splitting or spraying of stream, leaking for no reason, and leaking during sexual activity also were significantly associated with ED.
A total of 18% of men reported experiencing premature ejaculation at least half the time. Younger age, hypertension, prostatitis, nocturia, incomplete emptying, terminal dribble, splitting or spraying of stream, bladder pain, and pain during sex were significant predictors of premature ejaculation.