Many studies have been performed evaluating the effects of OAB medication on sexual function. We will highlight some of the most recent reviews. Due to the inherent availability of anticholinergic medications, numerous studies have focused on the relationship of these medications and their effects on sexual function. One study by Zachariou and Filiponi found that tolterodine ER 4 mg once daily had a significant improvement in FSFI scores in their prospective study compared to their control group [
31]. A more recent study by Lin et al. prospectively evaluated women with OAB-wet and dry treated with tolterodine 2 mg twice daily for 3 months [
19]. Compared to the control group, FSFI scores improved significantly after a 3-month introduction of tolterodine, and the arousal score in the OAB-wet group was significantly increased compared to OAB-dry. Cakir et al. prospectively reviewed the effects of tolterodine, darifenacin, solifenacin, propiverine (ER) and (IR), and fesoterodine on sexual function among 216 patients with OAB and 165 controls [
32•]. They found that over 85% of participants had clinically relevant increase in sexual function, and there were no significant differences in efficacy among the different medications. The combination of daily fesoteridine and vaginal estrogen for 12 weeks has been shown to improve sexual quality of life compared to fesoteridine alone, although not significantly (
p = 0.098) [
26]. Mirabegron 50 mg, a beta-agonist, has been shown to improve overall sexual function with significant FSFI score changes in both pre and postmenopausal women after 3 months of treatment [
33•].
A prospective, multicenter cohort study by Polland et al. specifically compared beta-agonists to anticholinergics and the effects on sexual function after 12 weeks of therapy [
34••]. Although their follow-up was limited to ninety-one patients (which did not meet the study power criteria), they found that postmenopausal women in the beta-agonist group had significantly better overall FSFI scores than women in the anticholinergic group. In fact, there was worse arousal scores in the anticholinergic cohort. This is a key finding, as anticholinergics can have a drying effect on mucosal tissue.
Overall, studies have demonstrated that both beta-agonist and anticholinergic medications can improve sexual function in women suffering from OAB.