Does an Enlarged Prostate Affect a Man Sexually?

An enlarged prostate can cause sexual problems in men, such as:

  • Erectile dysfunction (the inability to attain and maintain an erection sufficient for sexual intercourse at least 25% of the time)
  • Reduced sex drive
  • Decreased sexual satisfaction

Sudden onset of erectile dysfunction (ED) may be a sign of prostate cancer and needs medical evaluation. Erectile dysfunctions may also occur after the therapy for prostate cancer including surgery, radiotherapy, and hormonal therapy.

Sexual problems, such as erectile dysfunction or ejaculation problems, may occur in men with noncancerous enlargement of the prostate (benign prostatic hyperplasia or BPH). Sexual dysfunction in BPH usually results from the treatment rather than the disease. Medications for BPH, such as the antitestosterone drug and finasteride (Proscar), have been associated with erectile dysfunction in 3.7% of men who use it. Finasteride is also linked with diminished libido in 3.3% men. Other medications for BPH, such as terazosin (Hytrin), tamsulosin (Flomax), and doxazosin (Cardura), can improve BPH symptoms with a lower risk of sexual side effects.

Surgical procedures for BPH, such as the transurethral resection of the prostate (TURP), are often used when medications fail. Erectile dysfunction can occur because of TURP in a small percentage of men.

What causes prostate enlargement?

The prostate gland or prostate is an important part of the male reproductive system. It produces fluid that carries sperm during ejaculation. The prostate gland is situated just below the bladder and in front of the rectum (the last part of the large bowel). It surrounds the urethra (the tube through which urine passes out of the body). It is roughly the size of a walnut.

The causes of prostate enlargement are not well understood. Research suggests that aging and changes in the cells of the testicles may play some role in the enlargement of the prostate. This is supported by the fact that males, who got their testicles removed at a young age because of reasons like testicular cancer, do not get BPH). Furthermore, in males with BPH, removal of the testicles causes the prostate to shrink in size. Removal of testicles, however, is not done to treat BPH since there are several other safe and effective treatment options. The chances of having an enlarged prostate increase with age. In several men over 40 years of age, a small amount of prostate enlargement is present. The condition, however, affects over 90% of the men over 80 years of age.

What are the symptoms of an enlarged prostate?

The symptoms of an enlarged prostate include:

  • Frequent urination
  • Strong and sudden urge to urinate
  • Dribbling at the end of urinating
  • Inability to urinate (urinary retention)
  • Inability to empty the bladder
  • Urinary incontinence (loss of bladder control)
  • Nocturia (needing to urinate two or more times per night)
  • Pain during urination or bloody urine (these may indicate infection or other serious problem)
  • Slowed or delayed the start of the urinary stream
  • Straining to urinate
  • Thin or weak urine stream

The symptoms of prostatic enlargement need urgent medical attention as they may be due to more serious conditions, such as infections (UTI), kidney diseases, or prostate cancer.


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