Derek Burnett
Derek Burnett is a Contributing Writer at Bottom Line Personal, where he writes frequently on health and wellness. He is also a contributing editor with Reader’s Digest magazine.
Developing an enlarged prostate, known medically as benign prostatic hyperplasia, or BPH, is an unfortunate fact of life for most men. Beginning in a man’s 50s, the prostate typically begins to undergo excessive, but non-cancerous, cell growth, and it usually continues to expand throughout the rest of his life.
Because of the prostate’s location beneath the bladder and surrounding the urethra (the tube that transports urine from the bladder to the penis), it can cause significant urinary symptoms. This is because the expanded tissue of the enlarged prostate crowds the urethra, narrowing it or pinching it off. Men with BPH sometimes find it difficult to begin urinating, have a weak or intermittent stream, dribble when they think they’ve finished urinating, and feel a frequent or excessively urgent need to pee, including at night.
But given that the prostate is not directly involved in erections and instead is an internal sex gland that contributes to a man’s reproductive capability, it makes sense to ask…Does an enlarged prostate affect a man sexually?
Without question, BPH very often occurs alongside sexual problems such as diminished libido, trouble getting and keeping an erection (erectile dysfunction, or ED), pain or discomfort during or after ejaculation, and diminished sexual satisfaction. A Korean study found that the worse a man’s BPH-related urinary symptoms get, the more likely he is to experience sexual dysfunction. It’s therefore tempting to think that the enlarged prostate directly causes sexual problems. In the case of painful ejaculation, this may be true; pressure caused by crowding of the urethra by the enlarged prostate can cause discomfort when ejaculating. Yet for the rest of these sexual issues, there is little evidence directly implicating BPH. Instead, the appearance of these two conditions at around the same time in a man’s life probably has to do with the following factors:
Age. Looking at the prevalence rates for BPH and for ED reveals a striking parallel. About 50% of men in their 50s have an enlarged prostate, as do 60% of men in their 60s and 70% of men in their 70s. And the pattern for ED is almost exactly the same…In his 40s, a man has about a 40% chance of experiencing ED…in his 50s, 50%…in his 60s, 60%…and in his 70s, 70%. With age serving as such a powerful risk factor for both conditions, it’s little wonder that many men experience both BPH and ED, even absent a causal relationship between them.
Changing hormones.Low testosterone is known to be a risk factor for ED, and it may also be one for BPH. Although elevated levels of a form of testosterone known as dihydrotestosterone (DHT) are thought to contribute to overgrowth of the prostate, it may also be an imbalance of estrogen and testosterone that creates the conditions for prostate enlargement.
Shared risk factors.Many of the diseases and conditions that contribute to ED risk are also likely factors in BPH. These include:
BPH medications.In many cases, the sexual problems experienced by men with BPH may be traced directly to the medications they take to manage the condition. In particular, certain members of the BPH drug classes known as alpha blockers and 5-alpha-reductase inhibitors have recognized side effects of erectile dysfunction and diminished sex drive. Men taking these drugs for BPH who experience sexual problems should talk to their doctors, who may guide them toward other treatments.
BPH treatments.Some surgeries and procedures to treat BPH appear to be a cause of ED and ejaculation issues. This includes the most common such treatment, known as transurethral resection of the prostate, or TURP.
BPH’s impact on quality of life. An enlarged prostate can be a difficult thing to live with. Men struggling with the psychological blow of such things as incontinence, disturbed sleep, lost work productivity, stigma, shame, and a damaged self-image might lose interest in sex or might experience depression or a loss of confidence that makes it difficult to get or maintain an erection. If living with BPH is taking a toll on your sex life, start a conversation with your doctor or seek out a therapist who can help you come to grips with your condition.
Because BPH and ED share so many physiological aspects and risk factors, men can often find relief for both conditions through similar methods. One of the first things to try is improving your diet. Shifting toward a more natural diet heavy on vegetables, fruits, whole grains, lean protein and polyunsaturated fats can help not just with BPH and ED but with nearly every other aspect of your health. So can shifting from a sedentary lifestyle to a more active one that includes 150 minutes of moderate-intensity aerobic exercise (“cardio”) or 75 minutes of vigorous aerobic exercise each week.
Talk to your doctor about whether your sexual problems might be attributable to the side effects of your BPH medications. It may be worth trying alternatives to see if you can control your BPH without sacrificing your sex life.
If your doctor is suggesting a procedure to treat your BPH, explore all of your options. Some of the newer treatments have not been associated with sexual dysfunction.
One of the most convenient ways to treat both ED and BPH simultaneously is with the medication tadalafil (Cialis). It’s a daily tablet that makes you “ready” for an erection whenever you’re aroused. It also happens to be an effective treatment for men with BPH, as does sildenafil (Viagra). Unfortunately, many men are unable to take these ED drugs because of a history of heart attack or stroke, unmanaged hypertension, or unstable angina. And even for men who can take them, while they may help with BPH, they may not constitute sufficient treatment for the condition.
Of course, not everyone will be able to treat both conditions through the same methods. You may therefore need separate medications or even procedures for BPH and for ED. If you would like to maintain an active, enjoyable sex life while living with BPH, you’ll need to confront any sexual problems head-on.
