As we age, our bodies change with us, and can sometimes throw us surprises, like an enlarged prostate. This condition is quite common in men over 50, and it can have an impact on your quality of life and sexual health, especially your performance in the bedroom.
Can an enlarged prostate cause erectile dysfunction? Although there is no established medical link between the two conditions, in this article we will explore the causes of benign prostatic hyperplasia (BPH) and erectile dysfunction (ED), how the two can sometimes collide and the treatment options available.
What is benign prostatic hyperplasia (BPH)?
Let’s break it down. The prostate is a small, walnut-sized gland that only men have. It’s placed right below the bladder and wraps around the urethra, which is like a tube that carries pee out of the body. Now, the prostate's main job is to produce fluids that mix with sperm to make what we call semen. Plus, it helps shoot that semen through the urethra during fun times in the bedroom. In a nutshell, it’s a small but mighty gland in your body.
As you grow older, the prostate and its surrounding tissue enlarge and BPH happens when they grow large enough to cause health issues. The gland presses against the urethra, narrowing it and causing the bladder walls to become thicker, meaning you lose the ability to empty it completely.1 All these conditions cause most problems associated with BPH.
BPH is usually diagnosed through tests that include the inspection of the prostate, blood tests and urine analysis.
What are the symptoms of BPH?
BPH is a widespread health issue in men over 50, but it’s worth noting that it’s non-cancerous.2 Common symptoms of BPH or enlarged prostate include:
- Difficulty to urinate. An enlarged prostate alters the pressure of your bladder and makes it harder to pass urine. This issue might affect your kidneys in the long run if left untreated.3
- Weak urine stream. As the enlarged prostate presses on the urethra and constrains it, you might get a weaker urine stream.3
- Fluctuating need to pee. You might swing between being unable to urinate or having to go suddenly because of the pressure on the urethra mentioned above.3
- Difficulty staying asleep. You might wake up throughout the night due to the need to empty your bladder often.3
- Infections. If left untreated, BPH can lead to health complications such as urinary tract infections (UTIs) and acute urinary retention (AUR).2
Benign prostate enlargement is quite common in men above 50 and is thought to affect 70-80% of men above 75.5 It’s also estimated around 50% of men over between the ages of 51 and 60 in the UK have lower urinary tract symptoms (in the bladder and urethra) due to an enlarged prostate.6
Understanding prostate enlargement
If you’re wondering what causes BPH, well, the exact cause of prostate enlargement is unknown. However, it seems to be linked to certain cells responding to a hormone called dihydrotestosterone, which sends cells a message to grow, resulting in prostate tissue getting bigger.7
Several risk factors can influence the development of BPH:
- Age. This condition is considered a normal part of ageing and the risk of contracting it is higher in older men.
- Medical history. If men in your family have a history of the condition, it’s more likely you will develop it too.
- Metabolic syndrome and obesity. Studies have shown that men who are obese or suffer from metabolic syndrome (a group of risk factors for cardiovascular disease and diabetes) are more likely to develop BPH.7
Although an enlarged prostate isn’t a life-threatening condition, it can affect your quality of life in different ways. Men who moderately or intensively suffer from lower urinary tract symptoms have declared that their mental health, vitality and sex life have worsened since being diagnosed. BPH symptoms can also affect your partner’s well-being, with a study highlighting sleep disturbance, inadequate sex life and fear of prostate cancer as the most common issues when living with a partner with an enlarged prostate.8
From the studies, the effect of BPH on sex life and a couple’s life seems quite clear. Let’s explore how an enlarged prostate can interfere with your sexuality and ability to keep an erection.
What is erectile dysfunction?
Erectile dysfunction (ED) happens when you have trouble getting or keeping an erection long enough for sex. Basically, it means your penis isn't getting enough blood flow to get hard. In the UK, it's a common problem for men. It’s estimated that 1 in 3 men in the UK experience some degree of ED.*9
Causes behind ED can be physical when a condition alters blood flow, hampers the nervous system or both, or psychological, for example, stress or performance anxiety. Among the many causes, prostate diseases and treatments (especially treatments for prostate cancer) can be responsible for erectile dysfunction.10
*Irrational quantitative survey 2021, where 3,445 (i.e. 34%) of 10,197 adult men qualified or identified as suffering from Erectile Dysfunction.
What’s the link between enlarged prostate and ED?
So, onto the burning question: does an enlarged prostate cause erectile dysfunction? The answer is not so simple. While BPH doesn’t directly cause erectile difficulties, some treatments for it can affect your sex drive and your ability to keep an erection. Studies have shown that certain anti-testosterone drugs prescribed for BPH can interfere with the ability to get an erection and can diminish your libido.10
A common surgical procedure called transurethral resection of the prostate, which removes a section of the prostate that’s causing your symptoms, has also been linked to ED in a small percentage of men.10
How to treat enlarged prostate
There are a few treatment options available for an enlarged prostate, depending on the intensity of your symptoms.
Lifestyle changes
Simple changes in your habits, such as consuming fewer fizzy drinks, alcohol and caffeine can help reduce the risk of irritating your bladder. Eating more fibre (found for example in apples, strawberries, avocado, broccoli, artichoke, Brussel sprouts, oats, and legumes) can also help with constipation, which can put pressure on your bladder and worsen your symptoms. Drinking less fluids in the evening can also be recommended to avoid waking up in the night.11
Medicines
If lifestyle changes don’t help, your GP might prescribe medicine. Speak to your doctor so you can work together to find a treatment plan that suits you.
Surgery
Some more severe cases of BPH require surgery. The most popular type of surgery is transurethral resection of the prostate (TURP), which removes part of the prostate causing your symptoms. Other options include Holmium laser (HoLEP), which uses a laser to remove the part of the gland that’s stopping the flow of pee, and water ablation which uses water pressure to destroy part of the prostate tissue.11
Can you take ED medications if you have an enlarged prostate?
If you have an enlarged prostate, make sure to speak to your doctor before starting on an erectile dysfunction treatment like Cialis Together®. Some medicines may be affected by Cialis Together® tablets or they may affect how well Cialis Together® tablets will work.
Importance of Seeking Medical Advice
Although proper causal relation hasn’t been established, it’s believed that 70% of men suffering from BPH also have a case of erectile dysfunction. The more severe the symptoms of BPH, the harder it can be for a man to get an erection and get sexual satisfaction.12 That’s why it’s important you seek medical advice to get a personalised diagnosis. A healthcare professional can carry out various tests and give you a treatment plan to improve both conditions.
Conclusion
So, can a swollen prostate cause erectile dysfunction? Even though there isn’t a final medical answer, the two conditions seem to overlap frequently. The good news is that both are treatable and with the help of a healthcare professional and the right medication you can gain confidence in your sex life again.
Cialis® Together 10mg tablets. For Erectile Dysfunction in adult men. Before taking Cialis Together tablets, discuss with your pharmacist to ensure the product is suitable for you. Contains tadalafil. Always read the label.
References:
1 https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia#benign
1. As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. The narrowing of the urethra and urinary retention—the inability to empty the bladder completely—cause many of the problems associated with benign prostatic hyperplasia.
2 https://www.nhs.uk/conditions/prostate-enlargement/
1. BPE is common in men aged over 50. It's not a cancer and it's not usually a serious threat to health.
2. Benign prostate enlargement can sometimes lead to complications, such as:
a. a urinary tract infection (UTI)
b. chronic urinary retention
c. acute urinary retention
3 https://www.nhs.uk/conditions/prostate-enlargement/symptoms/
1. finding it difficult to start peeing
2. straining to pee
3. having a weak flow of urine
4. "stop-start" peeing
5. needing to pee urgently and/or frequently
6. needing to get up frequently in the night to pee
7. accidentally leaking urine (urinary incontinence)
4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812890/#B1
1. These symptoms are common, and their prevalence increases as men age. They are present in 8% of men aged 31 to 40 years, 50% in those age 51 to 60 years, 70% in those age 61 to 70 years, and 90% in those age 81 to 90 years.
5 https://www.england.nhs.uk/2024/01/kings-prostate-diagnosis-sees-1000-jump-in-visits-to-nhs-advice/#:~:text=Ian%20Eardley%2C%20National%20Clinical%20Director,to%20have%20an%20enlarged%20prostate.
1. Ian Eardley, National Clinical Director for NHS England and a consultant urological surgeon in Leeds, said: “Benign prostate enlargement is common in men over the age of 50 and you would expect around 70-80% over the age of 75 to have an enlarged prostate.
6 https://prostatematters.co.uk/benign-prostatic-hyperplasia-bph/
1. It may result in bothersome symptoms in approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.
7 https://www.yalemedicine.org/conditions/enlarged-prostate-benign-prostatic-hyperplasia-bph
1. As men age, the cells of the prostate proliferate in response to the presence of a hormone called dihydrotestosterone. This causes the prostate to grow in size, resulting in an enlarged prostate, also known as benign prostatic hyperplasia, or BPH.
2. Several risk factors increase the chances that a man will develop BPH:
Age. BPH is often considered a normal part of aging. The risk for BPH increases as men get older.
Family history. Several studies have shown that men who have a family history of BPH are more likely to develop it than men without a family history of the condition.
Metabolic Syndrome and obesity. Some evidence suggests that men who are obese or who have the metabolic syndrome (a group of risk factors for cardiovascular disease and diabetes including, among others, abdominal obesity, high blood pressure, insulin resistance, and low HDL cholesterol levels) are at increased risk for developing BPH.
8 https://www.eu-openscience.europeanurology.com/article/S1569-9056(06)00301-0/fulltext#secd9456154e133
1. With regard to the effect that BPH has on the patient's partner, the morbidity reported was due to sleep disturbance, disruption of social life, psychological burden, inadequate sex life, and fear of surgery or prostate cancer.
9 https://www.cialistogether.com/en-gb/what-is-erectile-dysfunction
8 million men in the UK have Erectile Dysfunction (ED)* and 1 in 3 UK men experience some degree of ED.*
1. In the past, it was thought that most cases of erectile dysfunction were psychological in origin, the result of such demons as performance anxiety or more generalized stress. While these factors can cause erectile dysfunction, doctors now think that 70% of the time the problem can be traced to a physical condition that restricts blood flow, hampers nerve functioning, or both. Such conditions include diabetes, kidney disease, multiple sclerosis, atherosclerosis, vascular disease, and alcoholism.
However, some types of prostate disease and treatments (particularly for prostate cancer) may also be responsible.
2. Although BPH does not itself cause these problems, some of the treatments used for BPH can do so. For example, finasteride (Proscar), an anti-testosterone drug prescribed for BPH, has been linked to erectile dysfunction in 3.7% of men who use it and to diminished libido in 3.3%.
3. Transurethral resection of the prostate, a surgical technique often used when medication fails, also causes erectile dysfunction in a small percentage of men.
10 https://www.nhs.uk/conditions/prostate-enlargement/treatment/
1. Drink fewer fizzy drinks and less alcohol, caffeine and artificial sweeteners
Fizzy drinks and drinks that contain alcohol, caffeine (such as tea, coffee or cola) and artificial sweeteners can irritate the bladder and make urinary symptoms worse.
Drinking less fluid in the evening
Try to reduce the amount of fluids you drink in the evening and avoid drinking anything for 2 hours before you go to bed. This might help you avoid getting up in the night. Make sure you're still drinking enough fluid earlier in the day.
2. Eating more fibre (which is found in fruit, vegetables and wholegrain cereals) can help you avoid constipation, which can put pressure on your bladder and make the symptoms of an enlarged prostate worse.
3. Alpha blockers relax the muscle in your prostate gland and at the base of your bladder, making it easier to pee. Commonly used alpha blockers are tamsulosin and alfuzosin.
Anticholinergics relax the bladder muscle if it's overactive.
5-alpha reductase inhibitors are used to treat larger prostate glands. They shrink the prostate gland if it's enlarged. Finasteride and dutasteride are the two 5-alpha reductase inhibitors available.
4. Transurethral resection of the prostate (TURP)
TURP involves removing part of the prostate gland using a device called a resectoscope that's passed through the urethra (the tube through which urine passes out of the body). It's suitable for men who have an enlarged prostate.
Holmium laser (HoLEP)
This treatment uses a laser to remove the portion of the prostate that is blocking the flow of pee.
The procedure uses a laser fibre passed along the inside of the urethra, so the surgeon will not need to make a cut in your skin.
Water ablation
There are 2 types of water ablation procedure. In the first, water is injected into the prostate using a probe passed up the urethra. The pressure of the water is then used to destroy some of the prostate tissue, making it smaller.
The second type is very similar except steam, rather than water, is used to destroy prostate tissue.
11 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292219/#:~:text=Although%2C%20proper%20causal%20relationship%20has,form%20of%20BPH%20(19
1. Although, proper causal relationship has not been established, it is believed that 70% of men with BPH has an associated ED (18). Men with severe BPH have significantly decreased libido, greater difficulty in achieving an erection, and lower level of sexual satisfaction as compared to men with milder form of BPH
MAT-XU-2402928 (v1.0) March 2025