Sexual Health Q&A

Does having an enlarged prostate (BPH) affect sexual performance?

It might. Some men with an enlarged prostate develop erectile dysfunction (ED) or problems with ejaculation.

The technical term for an enlarged prostate is benign prostatic hyperplasia (BPH).  BPH occurs when prostate tissue increases in size. This growth moves inward, pressing on the urethra (the tube that urine and semen flow through). As a result, some men with BPH have trouble urinating and need treatment.

Unfortunately, some treatments might have sexual side effects:

Medications. 5-alpha reducatase inhibitors (such as finasteride or dutasteride) and alpha-blockers (such as tamsulosin) are two types of drugs commonly prescribed for BPH. However, 5-alpha reducatase inhibitors might lower a man’s sex drive or interfere with erections. Alpha blockers could lead to difficulty ejaculating.

Finasteride in particular has been associated with a greater risk for ED. In a 2015 study of 700 men with BPH, men who took finasteride gradually developed ED while a comparison group of men who took tamsulosin did not.

Minimally-invasive procedures. These approaches, which could include stents, heat treatments, or laser treatments, can sometimes lead to ED or retrograde ejaculation (ejaculating backward into the bladder instead of forward out of the penis).

Surgery. Transurethral incision of the prostate (TUIP), which involves widening the urethra, sometimes results in ED. Transurethral resection of the prostate (TURP), in which the inner portion of the prostate is removed, can lead to retrograde ejaculation.

It should be noted that retrograde ejaculation is not harmful, as semen exits the bladder along with urine. However, couples who wish to conceive a child may need to see a fertility specialist.

Sometimes, doctors prescribe tadalafil, a phosphodiesterase type 5 inhibitor, to help with BPH symptoms with or without ED. The U.S. Food and Drug Administration (FDA) approved this use of tadalafil in 2011.

A man’s urologist can help him decide which BPH treatment is best for his situation. The doctor can also make adjustments in medication and suggest ways to improve sexual function is such side effects occur.