Lower urinary tract symptoms (LUTS) are a common clinical condition in aging men, often associated with benign prostatic hyperplasia (BPH) and characterized by storage, voiding, and post-micturition symptoms that significantly impair quality of life. The prevalence of LUTS increases with age, affecting up to 60–80% of men over the age of 60 years (1,2). In recent years, considerable attention has been directed toward understanding the relationship between LUTS and sexual dysfunction, including erectile dysfunction (ED), ejaculatory disorders, and reduced libido (3). Several epidemiological studies have demonstrated a strong, bidirectional association between LUTS and sexual dysfunction, independent of age and comorbidities such as diabetes, hypertension, or cardiovascular disease (4,5). Both conditions share common pathophysiological mechanisms, including pelvic atherosclerosis, autonomic hyperactivity, nitric oxide deficiency, and alterations in smooth muscle tone of the lower urinary tract and penile tissue (6,7). In addition, psychological stress, sleep disturbances due to nocturia, and medication use may further exacerbate sexual dysfunction in men with LUTS (8). Given the growing aging population, the coexistence of LUTS and sexual dysfunction represents a significant public health concern. Evaluating this association is essential for comprehensive management of aging males, as addressing both urinary and sexual symptoms can improve overall well-being and treatment adherence (9,10). Aim and Objectives Aim: To evaluate the association between lower urinary tract symptoms (LUTS) and sexual dysfunction in aging males. Objectives: To assess the prevalence and severity of LUTS in aging male patients. To evaluate the prevalence and types of sexual dysfunction—including erectile, ejaculatory, and libido disorders—in the same population. To analyze the correlation between the severity of LUTS and the degree of sexual dysfunction. To identify potential contributing factors such as age, comorbidities, and medication use that may influence this association.

Study Design and Setting: A cross-sectional observational study was conducted in the Department of Urology at Konaseema institute of medical science Amalapuram AP India a tertiary care teaching hospital over a period of 12 months. The study included aging male patients attending the outpatient and inpatient departments with lower urinary tract symptoms. Study Population: Men aged 50 years and above presenting with LUTS were enrolled after obtaining informed written consent. Patients with known neurological disorders, previous pelvic surgery, urethral stricture disease, or on medications known to affect sexual function (such as antidepressants or hormonal therapy) were excluded. Sample Size: A total of 120 male patients fulfilling the inclusion criteria were included in the study. Data Collection: All participants underwent detailed history taking and physical examination. The International Prostate Symptom Score (IPSS) questionnaire was used to assess the severity of LUTS, categorizing symptoms as mild (0–7), moderate (8–19), or severe (20–35). Sexual function was evaluated using the International Index of Erectile Function (IIEF-5) questionnaire, assessing erectile function, sexual desire, and satisfaction. Investigations: Routine laboratory investigations including serum prostate-specific antigen (PSA), fasting glucose, and testosterone levels were performed. Ultrasonography of the prostate and post-void residual urine measurement were conducted to assess prostate volume and bladder emptying. Statistical Analysis: Data were analyzed using SPSS version 25.0. Continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were expressed as percentages. The correlation between LUTS severity and sexual dysfunction was assessed using Pearson’s correlation coefficient. A p-value of <0.05 was considered statistically significant. Ethical Considerations: The study was approved by the Institutional Ethics Committee, and informed consent was obtained from all participants prior to enrollment.

A total of 120 aging male patients with lower urinary tract symptoms (LUTS) were included in the study. The mean age of participants was 63.4 ± 8.2 years (range: 50–82 years). The majority of patients (48.3%) belonged to the 60–69-year age group. Based on the International Prostate Symptom Score (IPSS), 32 (26.7%) patients had mild, 58 (48.3%) had moderate, and 30 (25%) had severe LUTS. The mean IPSS was 17.6 ± 6.1. Sexual dysfunction, as assessed by the International Index of Erectile Function (IIEF-5), was observed in 92 (76.7%) patients. Among these, 24 (20%) had mild, 38 (31.7%) had moderate, and 30 (25%) had severe erectile dysfunction. Decreased libido was reported in 70 (58.3%), and ejaculatory dysfunction in 64 (53.3%) participants. A statistically significant positive correlation was observed between the severity of LUTS (IPSS score) and the degree of sexual dysfunction (r = 0.62, p < 0.001). The prevalence of sexual dysfunction increased progressively with LUTS severity. Table 1. Relationship between LUTS severity and sexual dysfunction in aging males LUTS Severity (IPSS) No. of Patients (n=120) Mean IIEF-5 Score ± SD Erectile Dysfunction (%) Ejaculatory Dysfunction (%) Decreased Libido (%) Mild (0–7) 32 (26.7%) 20.4 ± 2.8 12 (37.5%) 10 (31.3%) 8 (25%) Moderate (8–19) 58 (48.3%) 15.6 ± 3.1 46 (79.3%) 34 (58.6%) 38 (65.5%) Severe (20–35) 30 (25%) 11.2 ± 2.5 28 (93.3%) 20 (66.7%) 24 (80%) Total 120 (100%) — 92 (76.7%) 64 (53.3%) 70 (58.3%) Statistical Correlation: A significant inverse relationship was observed between IPSS and IIEF-5 scores, indicating that higher LUTS severity corresponded with worsening sexual function (p < 0.001).

The present study demonstrated a significant association between the severity of lower urinary tract symptoms (LUTS) and sexual dysfunction in aging males. The prevalence of sexual dysfunction in our cohort was 76.7%, consistent with earlier studies showing rates between 70–80% among men with moderate to severe LUTS (11,12). The findings support the hypothesis that LUTS and sexual dysfunction share overlapping pathophysiological mechanisms beyond the influence of age and comorbidities. Rosen et al. (8) in the MSAM-7 multinational study reported that both erectile and ejaculatory dysfunction increased proportionally with LUTS severity, independent of age. Similarly, McVary et al. (4) and Kim et al. (5) demonstrated that LUTS severity is an independent risk factor for erectile dysfunction. In our study, nearly all patients with severe LUTS had concomitant erectile dysfunction, further strengthening this correlation. The mechanisms linking LUTS and sexual dysfunction are multifactorial. Increased sympathetic nervous system activity, reduced nitric oxide bioavailability, pelvic atherosclerosis, and impaired smooth muscle relaxation in both the bladder neck and penile vasculature have been implicated (13,14). Endothelial dysfunction, a key contributor to both conditions, leads to reduced blood flow and impaired smooth muscle tone (15). In addition, nocturia and disturbed sleep patterns associated with LUTS may contribute to fatigue, reduced libido, and psychogenic erectile difficulties (16). Pharmacological factors also play a role. Medications used to treat LUTS, such as α-blockers and 5α-reductase inhibitors, can influence sexual function. While α-blockers may improve erectile function by reducing sympathetic tone, 5α-reductase inhibitors like finasteride can lead to decreased libido and ejaculatory disturbances (17,18). Hence, treatment decisions should balance urinary and sexual outcomes to optimize patient satisfaction. Our findings align with studies by Gratzke et al. (10) and Giuliano (9), which emphasize the need for integrated management approaches. Evaluation of sexual function should be a routine part of the assessment of men with LUTS, as addressing both aspects improves quality of life and adherence to therapy. Limitations: This study was limited by its cross-sectional design, which precludes causal inference. Hormonal levels and psychological parameters influencing sexual function were not evaluated in depth. Longitudinal studies with larger sample sizes are warranted to confirm these associations and explore therapeutic interventions.

The study confirms a strong, positive association between LUTS severity and sexual dysfunction in aging males. Both conditions are common, interrelated, and share common pathophysiological pathways. Comprehensive evaluation and management of LUTS should include assessment and counselling for sexual health to improve overall well-being and treatment outcomes.

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