Managing Sexual Concerns if You Have BPH

Medically Reviewed by Michael W. Smith, MD on February 28, 2014
3 min read

If you have an enlarged prostate, or BPH, you may experience sexual problems. But there are treatments that can help.

Studies have shown a connection between BPH (benign prostatic hyperplasia) and erectile dysfunction (ED).

"It's a complicated story, but men who get BPH often get ED. And men with ED get BPH," says Kevin T. McVary, MD, urology professor at Southern Illinois University School of Medicine.

Men with BPH have an enlarged prostate -- the gland that surrounds the tube that carries urine. Symptoms include:

  • Often feeling like you need to urinate
  • Trouble starting and stopping urination
  • Weak stream of urine

The symptoms may wake you up at night.

Scientists aren't sure why, but they agree that the worse your BPH symptoms are, the more likely you'll have sexual issues such as:

  • Reduced sex drive
  • Trouble keeping an erection
  • Less sexual satisfaction

It may have something to do with genetics or age. It's also possible that the sleeplessness or anxiety that can come from an enlarged prostate makes sexual problems worse.

Some of the risk factors for BPH and ED are the same as those for heart disease and diabetes, McVary says. So by eating a heart-healthy diet and being active, you may be able to stave off sexual problems.

"It's very convenient that a heart-healthy lifestyle is identical to an erectile-friendly lifestyle," McVary says.

Y. Mark Hong, MD, a urologist in Phoenix, suggests you avoid heavily processed foods and boost the amount of natural foods you eat. Salmon, trout, and mackerel are anti-inflammatory and high in omega-3 fatty acids. Vegetables like broccoli, kale, and cauliflower are good for the prostate.

Hong also says it's important to communicate with your partner. You may be inclined to keep your concerns to yourself, but understanding your condition and dealing with it together can be better for your relationship and your health.

You may be able to treat your BPH and your ED at the same time with erectile dysfunction medication. Pills for erectile dysfunction may also help BPH.

"When men with BPH take them on a daily basis, their symptoms improve," McVary says. They can help with BPH symptoms and ED, so doctors say you're able to take care of two conditions with one pill.

But ED drugs aren't for everyone, Hong says. "Many men will require further treatment for BPH," he says. And if you have a history of recent heart attacks, strokes, uncontrolled high blood pressure, or unstable angina, you shouldn't take ED pills.

Some treatments for BPH can have sexual problems as side effects. Two types of pills, alpha blockers and 5-alpha-reductase inhibitors, have traditionally been used to treat BPH. Both have sex-related side effects.

If you take 5-alpha-reductase inhibitors, you may have side effects such as:

  • ED
  • Drop in libido
  • Reduced semen release

Alpha blockers have been linked to problems with ejaculation. But two newer alpha blockers, alfuzosin and terazosin, may have fewer sex-related side effects. You can't take pills for ED if you take certain alpha blockers, so always check with your doctor before taking any new medicine.

If you're taking BPH medicines and having sexual problems, talk to your doctor. They may be able to change your medications.

Surgery can help reduce BPH symptoms, but it may lead to long-term sexual complications.

A common surgery called TURP (transurethral resection of the prostate) has been linked to ejaculation problems and erectile dysfunction. It's not clear why, says New York urologist Alex Shteynshlyuger, but there is an association.

Two newer types of surgery that are less invasive may have fewer sexual side effects:

  • TUIP (transurethral incision of the prostate)
  • TUMT (transurethral microwave thermotherapy)

Another new BPH treatment, Shteynshlyuger says, is a prostatic urethral lift. It's a minimally invasive and effective option that involves an insertion of a stent to keep open the tube that urine passes through.

McVary and several colleagues recently did a study of this treatment and found promising results. Not only did it help improve BPH symptoms, but it kept sexual function intact. "Nobody actually developed the onset of ED or ejaculatory dysfunction," he says.