New research on improved sexual function for men with enlarged prostate

Welcome news for men with an enlarged prostate (BPH) appears with the publication of new research on an effective way of treating both the BPH and the sexual dysfunction that often accompanies it.

Men are very likely to experience the symptoms of an enlarged prostate at some point in their life – it affects 50% of men by the time they reach 50, and almost 100% of men that reach 80. [1]

Enlargement of the prostate is hence very commonly encountered and is a different condition to prostate cancer. As the prostate enlarges, it impinges on the space available for urine to pass through on its way out from the bladder, and causes many unpleasant symptoms, such as:

  • A feeble urinary stream
  • Difficulty getting started when needing to urinate
  • Stopping and starting rather than a steady stream
  • Having to urinate frequently and urgently
  • Having to get up frequently in the night to urinate
  • Feeling that you can’t empty your bladder completely
  • Recurrent urinary tract infections

It also increases the likelihood of sexual dysfunction.

What is sexual dysfunction?

Sexual dysfunction encompasses:

  • Erectile dysfunction (impotence) – persistent inability to achieve and maintain an erection sufficient for satisfactory sexual performance
  • Ejaculatory dysfunction – disturbance of the ejaculatory reflux, including loss of ejaculation with a decreased amount of semen, premature ejaculation, delayed ejaculation, and retrograde ejaculation (when semen enters the bladder instead of going out through the penis)
  • Lack of drive/ lack of libido

The key factors predicting sexual dysfunction in elderly men are:

  • Age
  • Benign Prostatic Hypertrophy (enlarged prostate or BPH)
  • Disease such as diabetes, high blood pressure, high cholesterol levels or pelvic surgery

Sexual dysfunction and BPH

Of these, the most significant factor and predictor for erectile dysfunction is BPH. Men with BPH symptoms are nearly 4 times more likely to develop erectile dysfunction during the 2-year period after the onset of BPH symptoms.

Men aged 30-80 have a 38% chance of having erectile dysfunction if they don’t have BPH, but 72% if they do. The more severe the symptoms, the more frequent and severe the occurrence of erectile and ejaculatory dysfunctions.

Conventional treatment of BPH does not help sexual dysfunction

Unfortunately standard synthetic medication for BPH also increases the likelihood of sexual dysfunction, with erectile dysfunction affecting up to 38% of men taking 5-alpha-reductase inhibitors such as finasteride, and up to 30% of long-term users of alpha-blockers such as tamsulosin experiencing abnormal or retrograde ejaculation.

The result of this dilemma has been the concomitant use of BPH medication and phosphodiesterase-5 inhibitors such as Viagra, which is expensive and still associated with side effects. It remains the case that adverse sexual side effects are the main reason for men stopping their BPH treatment.

How can Saw Palmetto help?

There is a plethora of research on the benefits of Saw Palmetto for relieving symptoms of BPH. There are also records of Saw Palmetto’s traditional use for sexual problems such as loss of libido and impotence. One doctor’s account of a patient treated with Saw Palmetto for BPH and loss of libido ends with the patient not only restored to his normal vigour but also bemoaning the state of affairs that made it illegal for him to have more than one wife… [2]

The clinical evidence

In this pilot study, 69 men aged on average 57 years old with BPH and sexual dysfunction lasting more than 2 months, were treated with Saw Palmetto for 8 weeks to monitor the effects not only on the BPH but also on their sexual function. [3] Their symptoms had to be caused by the BPH rather than other diseases or mental health problems (such as depression), and they had to be free of other medication for BPH, or antidepressants or anti-inflammatory drugs.

The men’s BPH symptoms were assessed using the International Prostate Symptom Score (IPSS), and over the 8-week study the symptoms went down by an impressive 51% from 14.4 to 6.9. This type of improvement has, however, been shown previously in Saw Palmetto research.

The men’s sexual function was assessed using both the Brief Sexual Function Inventory (covering sexual drive, erections, ejaculation, and overall satisfaction), and the Urolife BPH Quality of Life (QoL) questionnaire, which covers sexual desire, satisfaction with erections and satisfaction with sex life.

During the study, the men’s ability to get and keep an erection improved by 64%, and having problems with lack of drive and ejaculation each improved by 54%. Feeling sexual drive improved by 47%, and their ability to have an erection firm enough to have sexual intercourse improved by 42%, which brought it from less than ‘fairly often’ to ‘usually’. There was an improvement of 35% in the symptoms listed in the Urolife questionnaire.

Both the study participants and the investigators found Saw Palmetto to have a beneficial effect, with the investigators being particularly impressed by the safety associated with the remedy. When asked what Saw Palmetto had helped most during the study, 8% of the patients indicated erectile function, 26% libido, and 66% erectile dysfunction and libido together.

[1] Madersbacher S, Studer U E. Benige Prostatahyperplasie. Schweiz Med Forum. Nov 2002; 45: 1068-73

[2] Dr A. L Davidson, Mount Pleasant, Utah, 1896, Traditional Use of Saw Palmetto

[3] Suter A et al. Phytother Res. 2012 Apr 23. doi: 10.1002/ptr.4696



Alison BA (Hons), DN, DNT (Dist) qualified as a nutritional therapist in 1997 and has a busy practice in Glasgow. She has worked in the health industry since 1987 and currently combines her practice with the role of Education Manager for A.Vogel Herbal Remedies. Alison lectures, trains and writes extensively on health issues, and is often to be found quoted in health magazines and on health-related websites.

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