Can an Enlarged Prostate Cause Erectile Dysfunction?
Here’s why having difficulty maintaining an erection could point towards prostate health problems.
Updated: Tuesday 28 November 2023
With erectile dysfunction, it’s not always immediately clear what’s causing it. Psychological factors like stress or anxiety can play a part, but physical factors like high cholesterol or diabetes are often the main culprit. One such physical health condition that has been linked to erectile dysfunction in men is benign prostatic hyperplasia (BPH), more commonly known as having an enlarged prostate.
In this health centre article, we’ll define benign prostatic hyperplasia, explore the connection between the condition and ED, and explain the effects of different treatments like Viagra and Tadalafil.
What is Benign Prostatic Hyperplasia (BPH)?
Benign prostatic hyperplasia (BPH), also known as prostate enlargement, is a common non-cancerous condition affecting men, mostly older men, when the prostate and surrounding tissue expands. The prostate undergoes two main growth phases, one during puberty, and the other from the age of around 25 which continues for most of a man’s life. Normal prostate growth becomes BPH when it gets large enough to cause health problems.
Typically the size of a golf ball in adult men, the prostate can reach the size of an orange. Growth of the prostate gland can squeeze the urethra, thicken the bladder wall, and cause the bladder to weaken over time.
As a result, benign prostatic hyperplasia can cause lower urinary tract symptoms. These include:
- Needing to pass urine more often (every 1 to 2 hours)
- Incomplete emptying of the bladder
- Needing to stop and start multiple times during urination
- Suddenly needing to pass urine
- Having a weak urine flow
- Needing to strain to pass urine
- Blood in the urine
Since these symptoms may also be a result of prostate cancer, it’s important that you visit your doctor for a check up.
How does BPH Link to Erectile Dysfunction?
As well as the lower urinary tract symptoms (LUTS) listed in the last section, a swollen prostate can also affect sexual functioning. Studies show that approximately 70% of men with BPH have associated erectile dysfunction.
Men with BPH have an imbalance in the autonomic control of smooth muscles, such as the corpus cavernosum smooth muscles that are relied upon to contract and relax to take the penis between flaccid and erect states, and hence are more likely to suffer with erectile dysfunction.
Some men, especially those under 50, may experience erectile dysfunction prompted by the pain caused by prostatitis, an inflammation of the prostate.
Which Treatments for BPH Might Cause ED?
Some treatments used to alleviate the symptoms of benign prostatic hyperplasia can cause difficulties in maintaining an erection. Treatments containing alpha reductase inhibitors like dutasteride and finasteride may lead to men experiencing ED and possibly reduced sex drive. In the case of BPH, symptoms of erectile dysfunction can largely be overcome with the aid of ED medication.
If you have to undergo treatment for prostate cancer, such as nerve-sparing prostatectomy and radiation therapy, erectile dysfunction is not only common (25% to 50% of men) but also unlikely to subside naturally. However, once again ED treatment can be used in many (although not all) of these cases to successfully gain and maintain an erection, as we discuss below.
ED Treatments and Enlarged Prostate
For most men with BPH-induced erectile dysfunction, phosphodiesterase type 5 (PDE5) inhibitors like Sildenafil (Viagra) and Tadalafil (Cialis) can help them to achieve an erection for long enough to enjoy sex. These medications come in the form of a tablet or capsule taken orally, which increase blood flow to the penis and allow for an erection to more easily be obtained following sexual arousal.
Sildenafil is the active ingredient found in the best-known ED medication - Viagra - and is effective in most men at enabling an erection within 30 minutes. Since Sildenafil (generic Viagra) contains the same quantity of the active ingredient as the branded Viagra, it is the preferred choice for many when considering affordability. There are several options for erectile dysfunction treatment depending on your particular needs and how well you respond to the medication. For an over-the-counter equivalent to Viagra, that doesn’t require a prescription, Viagra Connect provides a convenient ED solution. If speed is of the essence, Spedra cuts the time between taking and achieving an erection down to just 15 minutes. Tadalafil offers an affordable alternative that is equally as effective on a full stomach as it is an empty stomach, unlike Sildenafil.
It’s reported that around three quarters of men who have undergone nerve-sparing prostatectomy or more precise radiation therapies for prostate cancer found oral ED medication to be effective at helping them achieve erections. Although less common and potentially more daunting to administer, penile injection therapy is a self-administered injection of medication into the shaft of the penis that works by relaxing the smooth muscle and widening the blood vessels, causing an erection. Whilst not as simple as swallowing an oral tablet like Viagra, penile injections are the single most effective treatment for those who experience ED as a result of prostate surgery.
On top of this, there is evidence suggesting some erectile dysfunction treatments may actually be effective at improving BPH. In theory, ED medication could increase cyclic guanosine monophosphate (cGMP) levels in the bladder and prostate, a chemical that increases blood flow to the penis, causing the bladder and prostate to relax and promoting better urinary control. One study found that men who took tadalafil daily significantly reduced both BPH and ED symptoms, with other studies finding similar results with vardenafil.[6,7]
Whilst PDE-5 inhibitors are not currently approved to treat BPH, the positive findings indicate a useful additional benefit of taking the treatment when treating ED.
- Urology Health Foundation, 2021. What is Benign Prostatic Hyperplasia (BPH)?
- Kardasevic, 2016. The Correlation Between Prostate Volume in Patients with Benign Prostatic Hyperplasia in Relation to Erectile Dysfunction
- Harvard Health Publishing, 2021. Sex and the Prostate: Overcoming erectile dysfunction when you have prostate disease
- John Hopkins Medicine, 2022. Erectile Dysfunction After Prostate Cancer
- Memorial Sloan Kettering Cancer Center, 2021. Penile Injection Therapy
- Egerdie et al., 2011. Tadalafil 2.5 or 5 mg administered once daily for 12 weeks in men with both erectile dysfunction and signs and symptoms of benign prostatic hyperplasia: results of a randomized, placebo-controlled, double-blind study
- Stief et al., 2008. A randomised, placebo-controlled study to assess the efficacy of twice-daily vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia