Does an Enlarged Prostate Affect You Sexually? Understanding BPH

Benign prostatic hyperplasia (BPH) is the medical term for an enlarged prostate. BPH is not cancerous, but it can cause frustrating symptoms like frequent urination, a weaker urine stream, and difficulty emptying the bladder. BPH is common, affecting half of men over 50 and up to 80% of those over age 70.

Your prostate is the gland that sits below your bladder and adds fluid to your semen. Given its position and role, it’s natural to wonder if an enlarged prostate can affect you sexually, too — especially if you’ve been experiencing issues with your erections, ejaculation, or sex drive.

Why BPH Can Affect Sexual Health

The prostate gland sits just below your bladder and wraps around the urethra, the tube through which you urinate. With BPH, your prostate gland starts to grow, undergoing hyperplasia, which is the term for an increased number of cells. This puts excessive pressure on your bladder, urethra, and pelvic floor, causing both an increased urgency to urinate as well as more difficulty in urinating.

BPH itself is not known to affect sexual function directly. However, BPH commonly overlaps with sexual dysfunction issues because the treatment options for BPH can cause sexual side effects such as:

• Erectile dysfunction
• Problems with ejaculation
• Reduced sex drive (libido)

Erectile Dysfunction (ED)

Erectile dysfunction (ED) is the inability to achieve or maintain an erection firm enough for satisfactory sex. ED is extremely common in men with BPH. Men with severe lower urinary tract symptoms are 3 to 4 times more likely to have ED, and men with ED are up to six times more likely to have BPH.

Despite the statistics above, having either ED or BPH does not guarantee that you will develop the other one. BPH does not cause ED, or vice versa. However, the two often coexist for a number of reasons:

1. They’re both more common as you age. The older you are, the more likely you are to develop ED or BPH.
2. They share several risk factors. Both BPH and ED are linked to depression, obesity, and diabetes.
3. Some medications prescribed for BPH can cause ED as a side effect. These include 5-alpha reductase inhibitors (5-ARIs) like dutasteride (Avodart) and finasteride (Proscar).

Treatment for ED and BPH may involve a mix of alpha-blockers and PDE-5 inhibitors. PDE-5 inhibitors like tadalafil (Cialis), sildenafil (Viagra), and vardenafil (Levitra) are the first-line treatment for ED. Sildenafil and vardenafil are typically taken 30 to 60 minutes before sexual activity, while tadalafil may be taken as needed before sex or once daily at a lower dose. 

Tadalafil 5 mg once daily is also FDA-approved to treat both ED and the urinary symptoms of BPH. They’re prescribed for ED in general, but have also been shown to be effective in men who have ED due to an enlarged prostate. 

However, combining a PDE-5 inhibitor with an alpha-blocker — a common treatment for enlarged prostate — may be even more effective at improving both urinary and erectile function, according to some research. 

Changes to Ejaculation

If you’re getting treated for an enlarged prostate, you might also notice changes in your ejaculation, such as:

• Lower ejaculate volume
• Pain or discomfort during ejaculation
• “Dry” orgasms, where you ejaculate very little or nothing at all

Nearly half (46%) of men with enlarged prostate experience ejaculation issues. But remember that having BPH or taking one of these medications does not guarantee that you will experience these issues. 

These changes can be disconcerting, but they are usually not a sign of something more serious. As with ED, BPH itself doesn’t cause ejaculation issues, but the treatments for BPH can, including alpha-blockers like tamsulosin (Flomax), 5-ARIs like finasteride (Proscar), and BPH surgery.

These treatments can sometimes affect ejaculation, although the specific side effects vary by medication. Some men notice a reduced amount of semen during orgasm, while others may experience absent ejaculation or retrograde ejaculation, a condition in which semen enters the bladder instead of exiting through the penis. These effects are generally reversible after the medication is discontinued. 

Your doctor may try switching you to another BPH medication to see if that resolves your ejaculation-related side effects. Alfuzosin, for example, isn’t known to cause ejaculation issues. If you’re currently taking both a 5-ARI and an alpha-blocker, your doctor may try having you stop one of the medications, since taking both types of BPH medications triples your risk for ejaculation problems. 

Finally, they might recommend tadalafil (Cialis). While it’s more well-known as a treatment for ED, tadalafil is also FDA-approved to treat BPH.

Fatigue and Libido Issues

While BPH doesn’t directly affect sex drive, the resulting exhaustion certainly can. BPH makes you need to urinate more often, which could mean you need to urinate in the middle of the night. These sleep disruptions can contribute to chronic sleep deprivation, causing your energy levels to plummet and your libido to tank. Lack of sleep can also worsen the symptoms of an enlarged prostate. 

For some men, effectively treating your BPH may reduce the midnight bathroom runs. However, if your sleep or libido issues haven’t resolved after starting treatment, it may be worth making an appointment with your doctor. A small percentage of men taking BPH medications — such as dutasteride and finasteride — experience a drop in their sex drive unrelated to fatigue. Your doctor can assess your symptoms and suggest an appropriate treatment plan, whether that includes a sleep supplement or switching up your BPH medications.

The BPH Sleep Deprivation and Low Testosterone Combo

As men age, their testosterone production naturally declines and so does their sleep quality,  especially if they’re dealing with nighttime interruptions from BPH. Researchers believe that chronic sleep disruption may contribute to lower testosterone levels, and some studies suggest this may play a role in symptoms such as: 

• Less sexual desire
• More fatigue
• Reduced fertility
• Erectile dysfunction 

If you’re dealing with these symptoms, talk to your doctor. They can recommend ways to improve your sleep quality, such as limiting your fluid intake before bed, and prescribe appropriate treatment to manage your enlarged prostate and support healthy testosterone levels.

Your Options When BPH Medications Limit Performance

Sometimes, the very medications designed to treat your BPH can end up creating new problems in the bedroom. For example, 5-ARIs work by blocking the conversion of testosterone into dihydrotestosterone (DHT). DHT is the main androgen (sex hormone) that causes prostate growth, so lower DHT levels can help stop the prostate from growing. However, having lower levels of DHT can also lower libido and affect erectile function in some men.

If you feel like your BPH medications are limiting your sexual performance, you have options. Your doctor may try switching you to a different BPH medication, or prescribe a PDE5 inhibitor to treat your ED. In particular, tadalafil (Cialis) has been shown to successfully treat both ED and BPH.

Your Next Steps

An enlarged prostate is a completely normal part of aging for most men. It can throw an unexpected wrench into your sex life, but it does not have to signal the end of it. Whether you’re dealing with low libido, ED, or dry orgasms, your healthcare provider can help you find the right treatment for both your ED and your BPH.

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