Men who reported first sexual intercourse at 20 years or older had a lower risk of lower urinary tract symptoms in both study cohorts, while associations with sexual frequency differed.
Investigators analyzed 4,241 adult men who participated in the 2005 to 2018 National Health and Nutrition Examination Survey (NHANES) and 1,240 men aged 30 years or older who participated in a cross-sectional survey in China from April to December 2024. The NHANES analysis assessed lower urinary tract symptoms (LUTS) using questions about urinary habits, with the full definition requiring at least 2 of the 4 symptoms. The Chinese study assessed LUTS using the International Prostate Symptom Score (IPSS), with a score of 8 or higher used to classify participants as having LUTS. The investigators used multivariable logistic regression to examine associations between sexual behavior-related factors and LUTS.
In the NHANES cohort, 1,034 men had LUTS. Those reporting sexual activity at least 104 times per year had 0.73 times the adjusted odds of LUTS compared with those reporting sexual activity 0 to 11 times per year. The intermediate frequency groups had no statistically significantly associations with LUTS following adjustment.
Age at first sexual intercourse was also associated with LUTS in the US cohort. Compared with men reporting first intercourse at age 15 years or younger, those reporting first intercourse at ages 16 to 19 years and those at ages 20 years and older had 0.72 and 0.75 times the adjusted odds of LUTS, respectively.
In the Chinese cohort, 334 of the men had an IPSS of 8 or higher. Unlike in the US cohort, annual sexual frequency was not significantly associated with LUTS. However, men reporting first intercourse at age 20 years or older had 0.27 times the adjusted odds of LUTS compared with those reporting first intercourse at age 15 years or younger. The association among men reporting first intercourse at ages 16 to 19 years was not statistically significant.
Further, immediate postcoidal urination was associated with 1.83 times the adjusted odds of LUTS, and use of drugs to enhance sexual function was associated with 1.99 times the adjusted odds. Compared with men who reported being unsatisfied with their sexual activity, those reporting moderate satisfaction had 0.56 times the adjusted odds of LUTS, and those reporting extreme satisfaction had 0.33 times the adjusted odds.
Several nonsexual factors were also associated with LUTS, including hypertension and diabetes in both cohorts; ages 46 years or older, overweight or obesity, heart attack, and sleep disorders in the NHANES cohort; and heart attack and alcohol consumption in the Chinese cohort.
Because the analyses were cross-sectional, the investigators could not establish causal relationships between sexual behaviors and LUTS. Survey responses may have been affected by recall or social desirability bias. Language or cultural differences may also have influenced IPSS reporting, and the Chinese cohort may not have been nationally representative. The investigators cited the relatively small sample size and the need for validation in larger studies.
The cross-sectional findings did not establish that modifying sexual behaviors would reduce LUTS.
“Clinicians should proactively assess the sexual behaviors of patients with LUTS,” wrote Jiatong Zhou, of the Department of Urology at The First Affiliated Hospital at the Zhejiang University School of Medicine, and Yu Zhang, of the Department of Urology at the Xiangshan Hospital of Wenzhou Medical University.
The study authors reported no conflicts of interest.
Source: Asian Journal of Urology
