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.

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

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.

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.

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

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.

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.

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.