Can an enlarged prostate cause erectile dysfunction?

Erectile dysfunction (ED), also known as impotence, is when you can’t get or maintain an erection firm enough for sexual activity. If you struggle to get an erection on occasion, this doesn’t mean that you have ED.It’s actually normal to have erection problems sometimes, especially if you’ve drunk alcohol or feel particularly stressed. However, if you struggle to get and maintain an erection regularly, you may have ED.

While psychological factors can contribute to occasional problems getting an erection, ED is predominantly caused by physical conditions that affect blood flow and/or nerve functioning. For example, diabetes, kidney disease, multiple sclerosis, atherosclerosis, vascular disease, and alcoholism. In addition, some types of prostate disorders, including having an enlarged prostate, can contribute to ED.

Let’s talk about what causes an enlarged prostate, the relationship between prostate disorders and ED, enlarged prostates and ejaculation as well as the prostate disorders that can cause ED.

What is an enlarged prostate?

The prostate surrounds part of the urethra (the tube through which urine and ejaculate leaves the body). An enlarged prostate can cause this tube to get blocked, resulting in problems with peeing and ejaculating, such as: 

• a weak stream  
• frequent urination  
• having an urgent need to pee
• waking up at night to pee 
• pain during peeing
• pain after ejaculating  
• pee that smells
• urinary incontinence

Having an enlarged prostate is extremely common. In fact, almost all men get an enlarged prostate as they older. This is known as benign prostatic hyperplasia (BPH). By age 60, around 50% of people with a prostate will have some signs of BPH. This figure grows to 90% by age 85.

But why does an enlarged prostate affect a man sexually? Let’s find out.

The link between prostate disorders and ED

Let’s explore BPH and some of the other prostate conditions that might affect penile function:  

Benign prostatic hyperplasia

BPH is just another term for a non-malignant enlarged prostate, which causes problems with urination and ejaculation, as above. Without treatment, BPH can lead to a further blockage in your urethra and cause:

• urinary tract infections (UTIs)
• bladder stones
• blood in your pee 
• kidney damage, if you pee backflows from your bladder up to your kidney and increases pressure on your kidney

BPH is the most common prostate problem among males. The condition itself doesn’t cause ED. However, some medications and surgical techniques used to treat BPH can cause ED. These include:

• finasteride (Proscar) and dutasteride – 5-alpha reductase inhibitors that prevent testosterone from being converted into the hormone DHT, which can enlarge the prostate
• transurethral resection of the prostate (TURP) – a surgical technique used to remove the extra prostate tissue causing BPH if medication fails. ED is a relatively uncommon effect of this surgery, however, and tends to resolve after six months    

Prostate cancer

Is erectile dysfunction linked to prostate cancer? Well, prostate cancer itself does not cause ED, but some of the treatments can damage the nerves that you need to get an erection and affect the levels of hormones you need to get and maintain an erection.  

Treatments for prostate cancer that can lead to ED include:

• radical prostatectomy – surgery to remove the prostate gland can damage the nerves you need to get an erection. Some men can get erections again after surgery, depending on the nerves that are affected and the extent of the damage. But this can take time. Others may need support or treatment to help with erections for the rest of their lives. Radical prostatectomy can also lead to dry orgasms, when you do not ejaculate when you orgasm
• hormone therapy – prostate cancer depends on the hormone testosterone to grow. So hormone therapy is often used to treat prostate cancer by lowering the amount of testosterone in your body. This can affect your ability to get and maintain an erection, cause less intense orgasms and a decreased sex drive
• radiotherapy – radiotherapy uses high energy waves to destroy prostate cancer cells. However, this can also destroy the nerves that control your ability to get an erection

How long does ED last after prostate surgery?

It can take six to 18 months for your nerve fibres to recover from the trauma of a radical prostatectomy and for your sexual function to be restored.

Prostatitis

Prostatitis is inflammation of the prostate gland which can be caused by a bacterial infection. It causes symptoms like:

• pain in your lower abdomen, genitals or perineum
• a frequent urge to pee
• painful urination
• blood in your pee
• blood in your semen
• pain during sex
• painful ejaculation

This condition can also cause ED, either directly or as a complication due to the amount of pain it can cause. Put simply, finding sex and ejaculation painful is unlikely to turn you on.

Can you take Viagra with an enlarged prostate?

There is some early research to suggest that some ED medications may provide relief from the symptoms of an enlarged prostate.

These include:

• vardenafil (Levitra)
• sildenafil (Viagra)
• tadalafil (Cialis)

For example, one study found that 10mg of vardenafil twice a day for eight weeks improved prostate symptoms significantly compared to a placebo drug.

Another study found that men who took up to 5mg of tadalafil a day saw significant improvements in their prostate symptoms.

So, in short, you can potentially take Viagra with an enlarged prostate. However, you should speak to a medical provider before taking Viagra if you have an enlarged prostate, as not all ED medications are suitable for everyone.

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