Can BPH affect your sex life?

Can an enlarged prostate affect your sex life even if your main concern is frequent urination or getting up several times at night? What is the connection between BPH and sex life?

The short answer is yes. Benign prostatic hyperplasia (BPH), or an enlarged prostate, is primarily known for causing urinary symptoms. However, research suggests that men with lower urinary tract symptoms related to BPH are also more likely to experience sexual problems, including erectile difficulties and changes in ejaculation.¹

This does not mean that BPH automatically causes sexual dysfunction. Several factors can contribute to sexual problems as men age, including cardiovascular disease, diabetes, medications, stress, hormonal changes, and other health conditions. Still, the connection between prostate health and sexual health is worth understanding.

What is BPH?

BPH stands for benign prostatic hyperplasia. It happens when the prostate gland becomes enlarged. The prostate sits below the bladder and surrounds part of the urethra, the tube that carries urine out of the body.

As the prostate grows, it can press against the urethra and affect the normal flow of urine. This can lead to symptoms such as a weak urine stream, difficulty starting urination, frequent urination, urgency, dribbling, or the feeling that your bladder has not completely emptied.²

BPH is not prostate cancer, and having BPH does not mean that you have a higher risk of developing prostate cancer. However, bothersome urinary symptoms can have a significant effect on quality of life.

How can BPH affect your sex life?

The relationship between BPH and sexual health is complicated. BPH itself may not directly cause every sexual problem, but urinary symptoms, changes in the prostate, medications, and other health conditions can all play a role.

One large review found that men with more severe lower urinary tract symptoms had a higher risk of sexual dysfunction.¹ This means that the more troublesome the urinary symptoms become, the more likely sexual function may also be affected.

Here are some of the ways this can happen.

Erectile difficulties

Erectile dysfunction (ED) means having difficulty getting or maintaining an erection that is firm enough for sexual activity.

Men with BPH and urinary symptoms may also experience ED. The two conditions share several possible risk factors, including aging, obesity, high blood pressure, diabetes, cardiovascular disease, and problems with blood vessel function.

Because of this overlap, sexual difficulties in a man with BPH should not automatically be blamed on the prostate. Your doctor may need to look at your overall health to determine what could be contributing to the problem.

Changes in ejaculation

BPH and its treatment can sometimes affect ejaculation.

Some medications used to treat an enlarged prostate can cause changes in ejaculation. Alpha-blockers, for example, may affect ejaculation in some men. 5-alpha-reductase inhibitors such as finasteride and dutasteride have also been associated with sexual side effects, including decreased libido and erectile dysfunction in clinical studies.³

This does not mean that everyone taking these medications will experience sexual problems. Your doctor will consider the potential benefits and side effects before recommending a treatment.

Lower sexual desire

Having bothersome urinary symptoms can also affect your interest in sex.

Imagine constantly worrying about finding a bathroom, waking several times every night to urinate, or feeling tired because your sleep is repeatedly interrupted. Over time, these problems can affect mood, energy, confidence, and intimacy.

For some men, concerns about sexual performance can create additional stress, which may make sexual difficulties worse.

Changes in your relationship

Sexual health is not only about erections and ejaculation.

BPH symptoms can affect intimacy in less obvious ways. Poor sleep, fatigue, anxiety about urinary accidents, and concerns about sexual performance can make some men less interested in sexual activity or less comfortable being intimate with their partner.

Talking openly with your partner and healthcare provider can help. Sexual problems are common, and there is no need to feel embarrassed about bringing them up.

Does treating BPH improve sexual function?

It can, but the results depend on the individual and the type of treatment.

When urinary symptoms improve, some men may feel more comfortable and confident during sexual activity. However, treatment does not guarantee that erectile or ejaculation problems will disappear.

The type of BPH treatment also matters. Some procedures can affect ejaculation or other aspects of sexual function. On the other hand, newer minimally invasive treatments may offer options for men who are particularly concerned about preserving sexual function. Recent research suggests that some minimally invasive procedures can maintain or even improve certain measures of sexual function, although results vary by procedure and patient.⁴

This is one reason why it is important to tell your doctor if maintaining your sexual function is a priority when discussing treatment.

Treatment options for BPH

There is no single best treatment for every man with BPH. Your doctor may recommend an approach based on your symptoms, prostate size, general health, medications, and personal preferences.

Lifestyle changes

For mild symptoms, your doctor may initially recommend lifestyle changes and monitoring.

These may include reducing fluids before bedtime, limiting caffeine and alcohol if they worsen urinary symptoms, staying physically active, and avoiding medications that may make urinary symptoms worse unless they are medically necessary.

Lifestyle changes may not shrink an enlarged prostate, but they can sometimes make urinary symptoms easier to manage.

Alpha-blockers

Alpha-blockers relax muscles around the prostate and bladder neck, which can make it easier to urinate.

They may improve urinary symptoms relatively quickly, but they do not generally shrink the prostate. Possible side effects can include dizziness, low blood pressure, and changes in ejaculation, depending on the medication.

5-alpha-reductase inhibitors

Medications such as finasteride and dutasteride can reduce the production of a hormone involved in prostate growth. They may help shrink the prostate and reduce the risk of urinary retention over time.

However, sexual side effects are possible. Studies have found associations between these medications and problems such as reduced sexual desire and erectile dysfunction.³

Talk to your doctor before stopping or changing any prescribed medication because of sexual side effects.

Tadalafil

Tadalafil is another possible treatment option worth discussing with your doctor, particularly for men who have both BPH symptoms and erectile dysfunction.

Tadalafil belongs to a group of medicines called phosphodiesterase type 5 (PDE5) inhibitors. It is approved for the treatment of erectile dysfunction and the signs and symptoms of BPH.⁵

Unlike some BPH medications, tadalafil can address both urinary symptoms associated with BPH and erectile dysfunction. However, it is not appropriate for everyone.

For example, tadalafil can interact with nitrate medications used for certain heart conditions and can cause a potentially dangerous drop in blood pressure when used with them.⁵ Your doctor should review your medications and medical history before prescribing it.

Procedures and surgery

If BPH symptoms are severe, cause complications, or do not improve with medication, a procedure may be considered.

Traditional procedures such as transurethral resection of the prostate (TURP) can effectively improve urinary symptoms, but changes in ejaculation are possible.⁶

There are also minimally invasive options designed to treat an enlarged prostate while potentially preserving sexual function. The appropriate procedure depends on factors such as prostate size, anatomy, symptoms, and your treatment goals.⁴

If maintaining ejaculation or erectile function is important to you, tell your urologist before choosing a procedure.

When should you talk to a doctor?

Do not assume that changes in your sex life are simply a normal part of getting older.

It is worth talking to a doctor if you experience persistent erectile difficulties, reduced sexual desire, painful ejaculation, blood in your urine or semen, or significant changes in ejaculation. You should also seek medical advice if urinary symptoms are interfering with sleep, work, relationships, or daily activities.

Some symptoms that seem like BPH can have other causes. A healthcare professional can evaluate your symptoms and determine whether you need tests or treatment.

You should seek urgent medical attention if you suddenly cannot urinate, especially if you have significant lower abdominal pain or discomfort.

What can you do about sex and bph?

The most important step is to talk honestly with your doctor about both your urinary and sexual symptoms.

Men sometimes mention difficulty urinating but leave out erectile problems or changes in ejaculation because they feel embarrassed. However, these details can help your doctor choose a treatment that addresses your overall quality of life.

Keep track of when your symptoms started, how often you experience them, whether they are getting worse, and whether they changed after starting a medication. Also tell your doctor about other medicines and supplements you take.

Most importantly, do not stop a prescribed BPH medication on your own because of sexual side effects. Your doctor may be able to adjust the dose, change medications, or discuss another treatment option.