Does silodosin cause sexual arousal problems, including erectile dysfunction?

Silodosin and Sexual Arousal Problems

Silodosin does not cause erectile dysfunction or impair sexual arousal; in fact, it may improve erectile function, but it very commonly causes ejaculatory dysfunction, particularly retrograde ejaculation and anejaculation, which occurs in approximately 28% of patients. 1

Primary Sexual Side Effect: Ejaculatory Dysfunction, Not Arousal Problems

The most critical distinction is that silodosin affects ejaculation, not arousal or erectile function:

• Retrograde ejaculation/anejaculation occurs in 28.1% of patients taking silodosin 8 mg daily versus 0.9% with placebo in controlled trials 1
• This is the highest rate of ejaculatory dysfunction among all alpha-1 blockers, significantly more than tamsulosin or other agents 2
• The ejaculatory dysfunction is reversible upon discontinuation of treatment 1

Effect on Erectile Function and Arousal

Contrary to causing arousal problems, evidence suggests silodosin may actually improve erectile function:

• In a study of 98 sexually active men treated with silodosin for BPH, erectile function improved as measured by SHIM scores (P = 0.009) at 3 months 3
• Patients experienced improved estimated intravaginal ejaculatory latency time (IELT) and premature ejaculation profiles 3
• Even among the subgroup experiencing anejaculation, better erectile outcomes were observed compared to those ejaculating naturally 3
• One study noted a slight decrease in erectile function domain scores (26.7 vs 22.9, P <0.05), but this was in the context of 90% of patients experiencing impaired ejaculation, suggesting the erectile changes may be secondary to ejaculatory concerns rather than direct drug effect 4

Alpha-1 Blockers and Libido

Alpha-1 blockers do not affect libido according to European Association of Urology guidelines 2. This is an important distinction from 5-alpha reductase inhibitors (finasteride, dutasteride), which do cause reduced libido, erectile dysfunction, and ejaculatory disorders 2.

Clinical Implications

When counseling patients about silodosin:

• Warn specifically about ejaculatory dysfunction (anejaculation, retrograde ejaculation, reduced semen volume), which affects roughly 1 in 4 to 9 in 10 patients depending on the study 1, 3, 4
• Reassure about erectile function and arousal, which are typically preserved or may improve 3
• Explain that 8% of patients may request drug withdrawal specifically due to anejaculation 3
• Note that 2.8% discontinue therapy due to retrograde ejaculation in clinical trials 1
• Consider alternative alpha-blockers if ejaculatory function is a priority for the patient, as silodosin has the highest ejaculatory dysfunction rate among this drug class 2, 5, 6

Other Sexual Considerations

Silodosin has been investigated as a potential treatment for premature ejaculation precisely because it delays ejaculation, with studies showing significant prolongation of IELT from 3.4 to 10.1 minutes (P = 0.003) 7. This further confirms that the drug's mechanism affects ejaculation timing and occurrence, not arousal or erectile capacity.

Additional Non-Sexual Side Effects

Common adverse effects include dizziness (3.2%), diarrhea (2.6%), orthostatic hypotension (2.6%), headache (2.4%), and nasal congestion (2.1%) 1. One case of priapism has been reported 1.