Selecting therapy for maintaining sexual function in patients with benign prostatic hyperplasia
blackwell-synergy.com/doi/pd … 05.05610.x
Selected bits:
"SEXUAL DYSFUNCTION (ED AND EJD)
Penile erection is a complex neurovascular event involving the sympathetic, parasympathetic and somatic nervous systems, which mediate psychogenic and reflexogenic erections via the spinal cord. This process involves a balance of pro-erectile and anti-erectile neurotransmitters, e.g. noradrenaline, serotonin, dopamine and g-amino butyric acid.
The normal process of ejaculation proceeds initially with stimulation by the sympathetic nervous system, which results in contraction of the prostate, vas deferens, epididymis and seminal vesicles, and ends with the flow of seminal fluid into the urethra.
EjD may occur in the presence of any pathological disorder that involves the lower urinary tract structures in the ejaculation pathway, including the prostate.
In addition, neurological and psychological factors may also be implicated in the development of EjD [14]."
"FINASTERIDE
Treatment with finasteride, a competitive 5ARI acting on one isozyme that does not bind to the androgen receptor, effectively reduces prostate size, by 19% after 1 year [36] and by 27% after 3 years [37]. The greatest reductions appear to occur in men with larger prostates at the initiation of therapy. Finasteride has also yielded an improvement in urinary flow rates and in symptom relief.
Finasteride is associated with significant adverse effects on sexual function in 10% of subjects [30,36,38], which has led to discontinuation of patients from the drug in several studies [36,38].
In a 2-year, prospective, double-blind trial of finasteride 5 mg/day, 15.8% of finasteride-treated subjects developed ED, 10% reported decreased libido and 7.7% developed EjD."