Can an enlarged prostate impact erectile dysfunction?

Reviewed by our clinical team

The prostate is a small gland, about the size of a walnut, which is located deep inside the pelvis underneath the bladder. It surrounds the urethra, the tube that carries urine out through the penis. It releases a fluid that gets mixed with sperm to produce semen during ejaculation. It’s part of the male reproductive system and can sometimes cause problems, usually because it gets bigger. 

If the prostate grows in a certain way it can squeeze the urethra or irritate the bottom of the bladder, making urination difficult. This happens to most people with prostates as they get older and it's usually harmless. The medical term for this is benign prostate hyperplasia (BPH). It is not the same as prostate cancer, although both conditions can present with similar symptoms. That's why you should discuss any urinary symptoms with your GP.

Some people are concerned that an enlarged prostate can cause erectile dysfunction (ED), or can impact the quality and duration of erections. In this article, we’ll answer some other frequently asked questions about enlarged prostates

Symptoms of enlarged prostate 

Difficulty urinating

If your prostate is enlarged, you might have trouble initiating urination. This is because the prostate alters the pressure of your bladder and makes it difficult to pass urine. Left untreated, this can damage your kidneys.

Weak urine stream

An enlarged prostate can also press on the urethra, which passes through the prostate on its way to the penis, leading to a weaker urine stream.

Sudden need to urinate

You may go from not being able to urinate at all to very suddenly needing to urinate because of the way the enlarged prostate constrains the urethra.

Difficulty staying asleep

You might wake up several times during the night having to empty your bladder.

Urinary tract infections and bladder stones

Since you may not be able to properly empty your bladder due to the enlarged prostate, there’s a chance you could develop urinary tract infections (UTIs) and other issues such as bladder stones.

Causes of an enlarged prostate 

We don’t actually know what causes prostate enlargement. Potential factors include:

• Age
• Changes in the cells of the testicles
• Hormone levels
• Ethnicity
• Diabetes
• Family history

We do know that men who have their testicles removed - for example, due to testicular cancer - do not experience prostate enlargement. 

If the testicles are removed after prostate enlargement occurs, the prostate begins to shrink (though this isn’t used as a treatment for enlarged prostates.)

What we do know is that:

• Your chances of developing an enlarged prostate increase with age
• Enlarged prostates are so common that it’s believed all males will eventually experience an enlarged prostate if they live long enough. In fact, over 90% of males over 80 have BPH.
• There are no specific risk factors for prostate enlargement, other than having testicles.

Impact of an enlarged prostate  

An enlarged prostate can impact your life in a few different ways, particularly your sex life, which can in turn knock your confidence and cause stress and anxiety. 

Enlarged prostate and erections

Can an enlarged prostate cause erectile dysfunction? We don’t know for certain that enlarged prostates cause ED but there is some data linking the two, and some BPH treatments, such as alpha blockers, can cause ED. Conversely, some erectile dysfunction treatments can in fact relieve the symptoms of an enlarged prostate.

So, can a swollen prostate cause erectile dysfunction? There simply haven’t been enough studies to confirm a link between erectile dysfunction and enlarged prostates. If you are experiencing erectile dysfunction alongside symptoms of BPH, the best thing to do is talk to your doctor.

You can find out more about erectile dysfunction causes here. 

Enlarged prostate and ejaculation 

It is unlikely that BPH on its own will cause problems with ejaculation. However, some of the treatments used for managing the symptoms of BPH can cause ejaculatory dysfunction. Many of the common BPH treatments, such as finasteride and dutasteride, can trigger issues with ejaculation, including a total inability to ejaculate or retrograde ejaculation, where the ejaculate goes into the bladder rather than out of the penis.

Enlarged prostate and sex drive 

Although we can’t say for certain that an enlarged prostate will cause erectile dysfunction or problems ejaculating, there is plenty of evidence that the condition can and does impact the sex lives of those who experience it. BPH can affect your sex drive (libido), because you might feel generally stressed or anxious about your symptoms.

If you feel that your prostate is impacting your sex life, you should talk to your doctor.

Enlarged prostate and urination 

Outside of sexual dysfunction, difficulty urinating is the most common symptom of an enlarged prostate. This is because when the prostate becomes enlarged, it can press on the bladder and make it difficult to start urinating. You might also find that you have a very weak flow due to the pressure on your urethra, or even that you wake up regularly during the night to use the bathroom. 

You should talk to your doctor if you have suddenly developed problems urinating. They might ask you to answer a series of questions to give you an International Prostate Symptom Score (IPSS). This helps the clinician understand what treatment might be best for you and the general health of your water works. 

Can you take Viagra with an enlarged prostate?

There’s no harm in taking Viagra or other erectile dysfunction medications if you have an enlarged prostate. In fact, studies have shown that taking erectile dysfunction medication can actually ease the symptoms of BPH. Viagra and other medications work by relaxing blood vessels in the penis, and it’s thought that they also relax the bladder, making it easier to pass urine.

However, ED medications are not typically prescribed for enlarged prostates, and you should not use them to self medicate. If you think you are experiencing an enlarged prostate, you should talk to your GP about this. To make this conversation easier, you could also do a  questionnaire such as the IPPS to assess the severity of your symptoms.

Treatment for enlarged prostate 

There are a few ways to ease the symptoms of BPH.

Medication

Common medications for enlarged prostates include alpha blockers such as terazosin and tamulosin, which relax the prostate and bladder muscles and reduce the discomfort. You may also be prescribed dutasteride or finasteride which block the hormones that cause the prostate to grow.

As mentioned above, there are some erectile dysfunction medications that can improve the symptoms of an enlarged prostate, but these aren’t commonly prescribed by GPs for BPH. 

Surgery

In severe cases, your doctor might refer you to a specialist for surgery or laser treatment. This is an option for men whose symptoms  have not been helped by  medication and/or lifestyle measures.

How long does erectile dysfunction last after prostate surgery?

This is a difficult question and may depend on your natural healing time, health, the amount of tissue removed, and other factors. Your doctor might prescribe ED medication to help you achieve an erection.

Lifestyle changes

Certain lifestyle changes might help with your symptoms. These include:

• Avoiding liquids a few hours before bedtime
• Limiting caffeine and alcohol, as these may stimulate the urge to urinate
• Eating a low-fat diet
• Eating plenty of veg
• Eating a few servings of fruit per day
• Exercising and maintaining a healthy weight

There’s no guarantee lifestyle changes will help, and you may still need medical treatment. Nevertheless, this is good advice for maintaining good urinary health and staying healthy in general.

Conclusion

Although it occurs in most biological males eventually, BPH can be uncomfortable and a source of frustration and even shame. It can contribute to or worsen any sexual difficulties, for example, making it difficult to achieve or maintain an erection.

It’s important to remember that BPH is very common, and it’s not caused by a genital hygiene or previous sexual performance. 

However, just because it is common does not mean you need to live with it. If you find yourself struggling with the symptoms and effects of an enlarged prostate, don’t be afraid to seek help. Doctors are equipped with the skills, knowledge, and training to diagnose and treat you the right way, helping you to get back on track.

References
https://www.healthline.com/health/enlarged-prostate/sexual-function
https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/expert-answers/enlarged-prostate-and-diet/faq-20322773
https://prostatematters.co.uk/benign-prostatic-hyperplasia-bph/
https://www.ruh.nhs.uk/patients/urology/documents/patient_leaflets/form_ipss.pdf
https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-treatment/drc-20370093