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Enlarged prostate and erectile dysfunction: How are they related?

An enlarged prostate is common and often happens as men age. While it may cause troublesome symptoms and require treatment, an enlarged prostate is not always harmful. In fact, it often goes unnoticed. However, your physician should always check and manage this condition if you have it. 

Erectile dysfunction (ED)¹ is a different condition. It’s sex-related and involves difficulty gaining and maintaining an erection. Experts have found that ED may be related to prostate enlargement.²

The relationship between an enlarged prostate and ED is quite complex. The conditions can occur together with some links between them, possibly due to the similar risk factors contributing to each condition. Risk factors include obesity and high blood pressure.Researchers believe prostate enlargement and its treatments contribute to ED. 

Medications designed for improving ED³ can improve symptoms of prostate enlargement. 

How can an enlarged prostate cause erectile dysfunction? 

It’s unknown whether an enlarged prostate directly causes ED. Experts have suggested possible reasons for the links between prostate enlargement and ED.⁴ These include the conditions both being age-related and having similar risk factors. 

Other evidence suggests that an enlarged prostate can cause issues with the urinary system, potentially contributing to ED. 

This process is still not fully known, but a few theories exist.Researchers⁵ have found that an enlarged prostate can cause the bladder outlet to be partially blocked. This may cause some changes in the structures of the penis that are involved in erection. Since these erectile structures don’t work, ED occurs. 

Researchers have also found a few cellular parts that don’t function properly in prostate enlargement and ED. 

What is benign prostatic hyperplasia? 

Benign prostatic hyperplasia (BPH)⁶ is the technical term for an enlarged prostate. It’s a widespread condition where the prostate gets bigger, often associated with older age. The majority of men will have some form of BPH by the age of 80. The word “benign” means that this growth is not because of cancer. 

What are the effects of benign prostatic hyperplasia? 

BPH can cause many physical changes in men. These changes depend on the size and position of the prostate enlargement. If the prostate is enlarged in certain places, it can block or partially block the bladder outlet. The urethra can also become blocked. 

These changes can cause many urinary and sexual symptoms⁷ in men. However, the effects aren’t just physical or medical. BPH and related sexual problems can be distressing and possibly cause relationship difficulties. 

What are some sexual problems of men with benign prostatic hyperplasia 

BPH relates to a few sexual problems,⁸ including ED, lower sex drive/desire, and ejaculatory dysfunction. Ejaculatory dysfunction⁹ covers many issues like inability to ejaculate, premature or delayed ejaculation, and ejaculation with less semen. 

BPH medication is also known to cause sexual problems. 

The relationship between sexual problems and BPH is complicated, and experts don’t know exactly how it works. The links between BPH and sexual difficulties could be physical, psychological, or both.

Sometimes, men have to have medications¹⁰ or surgeries¹¹ for BPH, which can cause ED and other sexual issues. 

What are the symptoms of benign prostatic hyperplasia? 

The symptoms of BPH are mainly related to the lower urinary tract. Symptoms vary widely from person to person. 

Some people may never get symptoms or have very mild symptoms, and others may eventually develop severe impacts that affect the bladder and kidneys and require medical treatment, including surgery. This often depends on where in the prostate the enlargement is. 

Common symptoms include: 

  • Frequent urination 

  • Urinary tract infections 

  • Difficulty passing urine 

  • Blood in the urine 

More severe effects are: 

  • Significant obstruction of the bladder outlet 

  • Kidney failure 

Symptoms fall into two categories: Storage symptoms and voiding symptoms. These categories might affect the types of treatment that work best. 

Storage symptoms include: 

  • More frequent urination

  • A greater sense of urgency to urinate 

  • Incontinence 

Voiding symptoms include: 

  • Pain or a feeling of difficulty urinating 

  • The feeling that the bladder hasn’t completely emptied

  • A poor/slow urine stream

What causes benign prostatic hyperplasia? 

BPH is strongly related to age and the processes of aging. In men over 60 years old, levels of the hormone testosterone begin to drop gradually. Because one function of testosterone is controlling cell growth, this decrease in testosterone can cause excess growth of the prostate. 

The structures of cells that make up the prostate also change with age, contributing to BPH. Finally, long-term inflammation caused by infections can also contribute to BPH. 

As well as age, experts have found a few risk factors¹² linked to BPH, including more severe cases of BPH.Risk factors include: 

  • Obesity 

  • Metabolic syndrome and diabetes 

Diagnosis and tests for benign prostatic hyperplasia 

If the doctor suspects BPH, they might perform a digital rectal examination.¹³ The exam involves your doctor inserting a gloved finger into your rectum to feel the shape and size of the prostate. A digital rectal exam is the traditional BPH screening method, although doctors may use more effective, newer methods.

Many other screening and diagnostic tests for BPH are available, including the prostate-specific antigen (PSA) test. This blood test can identify an issue with the prostate.

However, this test isn’t specific to BPH and could indicate a few other issues, so you’ll need additional tests alongside the PSA text. 

BPH is now commonly screened for with ultrasound. Doctors use ultrasound to view the shape and size of the prostate. This is a comfortable, noninvasive way to diagnose BPH. 

Another test the doctor might perform is uroflowmetry. It measures how much urine you release during urination and how fast this happens. Uroflowmetry is important because the bladder and urethra can be blocked and stop urine from flowing in BPH and some other conditions. 

The doctor might also perform a urine test to rule out infection or other urinary conditions. 

How is benign prostatic hyperplasia treated? 

The treatment of BPH¹⁴ varies. When diagnosing BPH, doctors can use a specially-designed survey to determine what symptoms you’re experiencing and how much your quality of life is affected by it. 

If symptoms are mild or do not affect your quality of life much, your doctor might delay treatment and see how the symptoms progress while providing advice about lifestyle changes to manage symptoms. Some changes might include reducing caffeine and alcohol and changing some medications. 

Some people's symptoms are more severe and affect their quality of life, or their mild symptoms might worsen. 

In these situations, you may need medication. Your doctor may prescribe several types of medicines depending on how bad your symptoms are and any allergies or other conditions you may have. 

Various medications work for different types of BPH. Some people have mainly “storage” symptoms. Drugs used for this type of BPH include: 

  • Tolterodine (Detrol) 

  • Festoredine (Toviaz)

Other men have mostly “voiding” symptoms. Treatments for “voiding” symptoms include:

  • alfuzosin (Uroxatral)

  • doxazosin (Cardura)

  • tamsulosin (Flomax)

  • tadalafil (Cialis)

  • dutasteride (Avodart). 

Possible associations¹⁵ exist between some medications that treat BPH and sexual problems like ED. These vary from person to person and by drug. 

Surgical treatments for BPH are also available. Surgery is often necessary when medication has not relieved symptoms or improved quality of life. Your doctor may suggest it if symptoms are severe and cause other serious health impacts like bladder stones.

Many prostate surgery options are available, and your surgeon will cater to your specific needs. ED is a known side effect¹⁶ of some surgical procedures for BPH. 

How long does erectile dysfunction last after prostate surgery? 

Prostate surgery doesn’t always result in ED. This depends on the type of operation and other personal factors like pre-existing sexual dysfunction. Studies have found that some procedures, like prostatic urethral LIFT,¹⁷ largely preserve sexual function.

In most surgeries, sexual activity (presumably erectile function) tends to return to normal within a year¹¹ if the surgery affects it. This is provided that no rare complications like nerve damage occur. 

It’s important to note that ED is very common in those with BPH, and many find that their erectile function is recovered after surgery for BPH. 

How is benign prostatic hyperplasia prevented? 

BPH is very common in older men because of the natural decline in testosterone as men age. This means that, especially as men get older, it’s nearly impossible to prevent BPH completely. However, you can target some risk factors to reduce the chance of developing a more severe case of BPH. 

Moderate exercise and maintaining a healthy weight and blood pressure could influence BPH risks and outcomes.

Furthermore, your doctor should treat any infections quickly to reduce BPH risks. Chronic or untreated infections can cause inflammation that can contribute to BPH risks in the long term. 

When should a doctor be consulted? 

If you’re worried you have BPH, it’s a good idea to see a doctor. Your doctor needs to rule out any other conditions with urinary- or prostate-related symptoms.

However, if any of the following symptoms are present, see a doctor immediately: 

  • Blood in the urine

  • Inability to urinate

  • Pain when urinating 

For BPH, the doctor might suggest trying lifestyle changes before considering medication. 

If you’re experiencing ED, see a doctor. Although ED is common and often easily treated, it can sometimes signify other health problems. A doctor should examine you and run tests to ensure you’re in good health. 

If you feel that ED is affecting your sex life or general quality of life, a doctor can help. Seeking help for ED as soon as possible improves the chances for good outcomes. 

The lowdown 

The links between benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) are quite complex. Both have similar risk factors, and BPH and its treatments can lead to ED. ED medication can also alleviate symptoms of BPH. 

The symptoms of BPH include difficulty and pain when urinating, incomplete urination, incontinence, and more frequent urination. These vary based on how large the prostate is and the position of the enlargement. Hormone levels changing with age and factors like inflammation and obesity can contribute to BPH. 

BPH can be treated by medication and surgery, both of which can contribute to ED. However, treating BPH can also alleviate ED, so it can be a difficult balance to consider. Any ED related to prostate surgery should resolve within 12 months under normal circumstances. 

See a doctor if you’re experiencing any BPH or ED symptoms.

  1. Erectile dysfunction (2016)

  2. Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction (2019)

  3. A review of the use of tadalafil in the treatment of benign prostatic hyperplasia in men with and without erectile dysfunction (2014)

  4. Association between prostate zonal volume and erectile dysfunction in patients with benign prostatic hyperplasia (2020)

  5. Acute urinary retention in benign prostatic hyperplasia: Risk factors and current management (2007)

  6. Pathophysiology of benign prostatic hyperplasia and benign prostatic enlargement: A mini-review (2019)

  7. Quality of life and sexual function in patients with benign prostatic hyperplasia (2003)

  8. Epidemiology of clinical benign prostatic hyperplasia (2017)

  9. Ejaculations and benign prostatic hyperplasia: An impossible compromise? A comprehensive review (2021)

  10. Finasteride and erectile dysfunction in patients with benign prostatic hyperplasia or male androgenetic alopecia (2019)

  11. A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: Efficacy, sexual function, quality of life, and complications (2021)

  12. Risks of developing BPH | Urologix

  13. Digital rectal examination for prostate cancer screening in primary care: A systematic review and meta-analysis (2018)

  14. Current treatment for benign prostatic hyperplasia (2020)

  15. Finasteride and erectile dysfunction in patients with benign prostatic hyperplasia or male androgenetic alopecia (2019)

  16. Transurethral procedures in the treatment of benign prostatic hyperplasia (2018)

  17. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study (2017)

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