Alfuzosin (brand name Uroxatral) is a medication primarily prescribed to manage the symptoms of Benign Prostatic Hyperplasia (BPH), commonly known as an enlarged prostate. BPH is a common issue in aging men that causes uncomfortable lower urinary tract symptoms. Because the drug acts on the muscular system in the pelvic region, patients often inquire about its potential to affect sexual function. This article addresses Alfuzosin’s effect on ejaculation, providing context on its mechanism and comparing its profile to other drugs in its class.
What Alfuzosin Treats and Its Mechanism of Action
Alfuzosin is classified as an alpha-1 adrenergic receptor blocker, or alpha-blocker. The drug is used to relieve lower urinary tract symptoms caused by BPH, such as difficulty starting urination, a weak stream, and frequent nighttime urges. The therapeutic effect is achieved by blocking norepinephrine’s action on alpha-1 receptors found on smooth muscle cells in the prostate, prostatic capsule, and bladder neck. Inhibiting these receptors causes the smooth muscles in these areas to relax. This relaxation reduces resistance to urine flow, lessening the obstruction and improving urinary symptoms.
Direct Impact on Ejaculation
The smooth muscles targeted by Alfuzosin, specifically those controlling the bladder neck, are also involved in ejaculation. During normal ejaculation, the bladder neck muscles contract to prevent semen from traveling backward into the bladder. Alfuzosin’s muscle-relaxing effect can interfere with this mechanism, leading to changes in ejaculation. The most reported change is a reduction in semen volume or, in some cases, retrograde ejaculation. Retrograde ejaculation occurs when the bladder neck fails to close completely, diverting semen back into the bladder instead of being expelled through the urethra. Clinical trial data indicates that the incidence of abnormal ejaculation with Alfuzosin is relatively low, generally reported at less than 1.5%. In studies comparing Alfuzosin to other treatments, the rate of significantly decreased ejaculate volume was around 20%. If a patient experiences a noticeable change in ejaculation, they should consult their prescribing physician. The side effect is often reversible upon stopping the medication, but dosage adjustments or switching to an alternative treatment may be considered.
Comparing Alfuzosin to Other Alpha-Blockers
Alfuzosin’s profile concerning ejaculatory side effects is often viewed favorably when compared to other common alpha-blockers used for BPH. Other drugs in this class, such as Tamsulosin (Flomax) and Silodosin (Rapaflo), are highly selective for the alpha-1A receptor subtype, which is concentrated in the reproductive tract muscles responsible for semen propulsion and bladder neck closure. Because Alfuzosin is less selective for the alpha-1A receptor, its effect on the ejaculatory muscles is generally milder. Clinical trials show that patients taking Tamsulosin reported abnormal ejaculation at a much higher rate (4% to 26%), with some studies showing anejaculation in over 30% of participants. Silodosin is associated with the highest incidence, with abnormal ejaculation rates reported up to 34.4%. The lower rate of ejaculatory dysfunction makes Alfuzosin a preferred option for younger, sexually active men seeking BPH treatment. The decision between these medications involves balancing the relief of urinary symptoms against the potential for specific sexual side effects.