Can an Enlarged Prostate Cause ED?

Does an Enlarged Prostate Affect Erectile Dysfunction? 

Erectile dysfunction (ED) is the inability to attain and / or maintain an erection for sexual intercourse at least 1/4th of the time.  This is also called impotence. There are many causes for ED, ranging from problems arising from the prostate to medications. 

While an enlarged prostate itself does not directly cause ED, the enlarged prostate can receive “collateral” supply as it enlarges from nearby structures, including the penis. Various disease states and / or treatments for enlarged prostates can also cause ED. In patients who undergo surgery for prostate cancer, for example, inadvertent injury to surrounding structures (e.g. nerves or arteries) may affect the ability to attain an erection. In patients who undergo a prostatectomy – removal or the prostate – it is also common to lose some erectile function. Complications from TURP (transurethral resection of the prostate) and other invasive procedures to treat BPH may also result in ED. 

Symptoms of Benign Prostate Hyperplasia (BPH) 

What is BPH? 

Benign prostate hyperplasia (BPH) is a common medical issue that occurs with gradual aging. As men age, the prostate gland becomes larger over time. This typically occurs during the second decade of life and continues throughout the rest of one’s life. As a result, the enlarging prostate may block the flow of urine out the bladder, as it surrounds the urethra, where urine flows out. This can inadvertently cause additional bladder, urinary tract, or kidney issues. Symptoms of BPH include: 

  • Increased urinary frequency or urgency – This is increased need or feeling of needing to void 
  • Increased night time urination – Also called nocturia, an enlarged prostate may also cause increased disruptions in sleeping due to the urge to void throughout the night 
  • Difficulty initiating urination – As the prostate surrounds the urethra through which urine flows from the bladder, it is common for patients to feel as if they have to achieve greater force to initiate urinating 
  • Weak urine stream – Disruption of the urethra due to the prostate can cause a weakened or intermittent urine stream 
  • Dribbling at the end of urination – As the prostate can impinge on the urethra, it is possible to experience dribbling at the end of urination 
  • Incomplete bladder emptying, or the sensation of – An enlarged prostate may cause pressure on the bladder, which can lead to the sensation of incomplete bladder emptying. Additionally, given that the prostate can obstruct the flow of urine from the bladder, it is further possible to not achieve complete bladder emptying in the setting of having an enlarged prostate. 

How Does BPH Affect Erectile Function? 

Some BPH treatments affect the ability to attain or maintain an erection TURP, radical prostatectomy, and other invasive treatment of BPH, may injure surrounding structures including nerves and blood vessels that play important roles in erectile function. Some medications used for BPH also cause ED, including anti-testosterone medications. 

Enlarged Prostate and Sex 

BPH can directly and indirectly cause sexual performance issues. Treatment of BPH include anti-testosterone medications, which may decrease sexual drive, in addition to causing ED. Certain procedures including transurethral resection of the prostate (TURP) and prostatectomy, can also cause sexual dysfunction. 

Treatments for BPH and Erectile Dysfunction

The first line treatment for ED include oral medications, including sildenafil (Viagra), in addition to lifestyle modifications. Lifestyle modifications include tobacco cessation, regular exercise, weight loss, improved control of comorbidities (e.g. diabetes, hypertension, hyperlipidemia). Second line therapies include alprostadil and vacuum-assistance.

Treatment for BPH also begins with lifestyle modifications. Medications for BPH commonly used are: 

  • Alpha blockers
  • 5-alpha reductase inhibitors 
  • Combination therapy 
  • Tadalafil 

Notably, some of these medications may cause ED. 

Procedures for BPH are options when medications are insufficient or cause unwanted side effects. These include: 

  • Prostate artery embolization (PAE)
  • Transurethral incision of the prostate (TUIP) 
  • Transurethral microwave thermotherapy (TUMT) 
  • Laser therapy 
  • Urolift
  • Water vapor thermal therapy (WVTT)

BPH and Erectile Dysfunction Treatment in Houston, Texas

Prostate artery embolization (PAE) is a minimally-invasive, safe, and effective procedure that alleviates BPH without many sexual side effects. If you or a loved one are suffering from BPH and unwanted sexual side effects, call or book an appointment at Access Vascular to speak with Dr. Michelle Maneevese about your options. 

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