Can a Swollen or Enlarged Prostate Cause ED?

Maybe you’re a prostate pro. But chances are, the extent of your prostate knowledge is an ill-conceived joke about prostate exams.

We get it. Guys aren’t bringing up their prostate health in casual conversations. Still, prostate issues are common, especially in older men. They can cause symptoms like frequent urination and painful ejaculation.

But can an enlarged prostate cause ED?

Erectile dysfunction (ED) is another common men’s health concern that touches many. And like prostate health issues, living with a condition that causes sexual dysfunction can be stressful.

ED makes it harder to get or maintain an erection, impacting quality of life and sexual satisfaction. The causes of ED can vary from underlying emotional issues to physical factors, including prostate problems.

Below, we’ll dig into the link between prostate issues and ED. 

First, we’ll discuss how trouble with your prostate gland might impact your ability to get or maintain an erection. Then we’ll go over the different prostate issues that can result in ED symptoms, from benign to more serious ones like cancer.

How an Enlarged Prostate Affects Your Sex Life

An enlarged prostate can affect your sex life in a number of ways, none of which are ideal. Benign prostatic hyperplasia — the enlargement or swelling of prostate tissue — causes a number of problems for men as they age.

Symptoms of BPH may present the following challenges for your sex life:

• A need to pee more. BPH can increase the frequency of urination and urinary tract infections in men, meaning the urethra may be uncomfortable or otherwise occupied more often than before.

• Distracting discomfort. Discomfort and pain are both symptoms of an enlarged prostate — not to mention the UTIs and other potential symptoms that can cause even more pain.

• Reduced libido. A problematic prostate can also cause sexual problems related to testosterone levels, meaning you may not have any interest in sex even if you’re not experiencing other symptoms.

How An Enlarged Prostate Can Lead to Erectile Dysfunction

As for the question of whether an enlarged prostate can cause ED, that’s more complicated. While experts can’t confirm a cause-effect relationship between this prostate issue and ED, they can definitely say there’s an association between the two, according to a 2020 review of studies.

The review points to a potential link between total prostate volume (TPV) and ED, but the study results weren’t consistent enough to suggest a definitive link.

So, what’s going on? 

Let’s dive into some of the most common prostate issues and how they might affect penile function, potentially causing sexual side effects.  

Benign Prostatic Hyperplasia (BPH)

BPH, short for benign prostatic hyperplasia, is a non-cancerous enlargement of the prostate. It’s particularly common in older men, and the risk of developing the condition increases with age.

BPH typically produces lower urinary tract symptoms like:

• Frequent urination (going more than eight times per day)

• Frequent urination during sleep

• Urinary urgency

• Trouble urinating (e.g., a weak urine stream or difficulty getting a stream started)

• Urinary incontinence (loss of bladder control)

• Dribbling urine at the end of urination

• Urine with an odd smell or color

• Painful ejaculation

You have a higher risk of developing benign prostatic hyperplasia if:

• Someone in your family has it

• You have circulatory disease or heart disease

• You have a sedentary lifestyle 

Another risk factor for benign prostatic hyperplasia? 

You guessed it: ED.

But it’s worth mentioning that while there is a link between BPH and ED, it’s unclear how they’re connected.

The fact that BPH and ED share similar risk factors — like high blood pressure, high cholesterol, and diabetes — may help explain the association between the two conditions.

So, while there are studies linking BPH symptoms to ED, we can’t say for sure whether the former directly causes the latter. Still, it makes sense that the uncomfortable and painful effects of an enlarged prostate might dampen your libido and make it tougher to get and stay “excited.”

Additionally, one 2011 review notes that there seems to be a link between the severity of BPH symptoms and sexual health issues. In other words, the more severe your lower urinary tract symptoms, the more likely you are to experience sex problems.

Certain medications and other BPH treatments may also cause side effects, including ED symptoms. Here’s a breakdown of some medications doctors prescribe for BPH:

• Alpha-blockers. Medications like tamsulosin, doxazosin, and terazosin help relax the prostate and bladder muscles. This can help alleviate BPH symptoms, but it could also cause abnormal ejaculation and ED.

• 5-alpha reductase inhibitors. Drugs like finasteride, Proscar, and dutasteride are 5-alpha reductase inhibitors (5ARIs) that block the hormone (dihydrotestosterone) DHT, which can cause the prostate to become enlarged. Healthcare providers sometimes also prescribe these medications for hair loss. Possible side effects include ED and low sex drive.

Additionally, healthcare professionals may recommend a surgical procedure called transurethral resection of the prostate (TURP) for severe BPH symptoms. And while the surgery is pretty effective in most cases, there’s a very minimal risk of erection problems. 

A more common side effect is “dry orgasm,” when semen flows into the bladder during ejaculation — clearly not where it’s supposed to go! This complication doesn’t affect sexual function but can impact fertility.

Fixing or reducing BPH symptoms with surgery may improve sexual function. However, it’s understandable if you don’t feel ready for sex right after surgery with a catheter in your penis.

Prostatitis

You can get inflammation pretty much anywhere, including your prostate. An inflamed prostate is called prostatitis.

Prostatitis can be chronic or acute:

• Acute prostatitis. Acute means the inflammation develops suddenly with severe symptoms. This kind of prostatitis can cause fever, chills, pain, and typical symptoms of an enlarged prostate, like a frequent urge to urinate. Since bacteria is the most common cause, you’ll likely need antibiotics to clear up the infection.

• Chronic prostatitis. When prostate inflammation comes and goes repeatedly or develops slowly and lasts a long time, it’s known as chronic prostatitis.

Whether you have acute or chronic prostatitis, it’s usually pretty unpleasant and painful.

While this type of prostate disease typically produces urinary-related symptoms, ED can also occur as a complication of the infection.

As with BPH, prostatitis-related pain might contribute to ED and problems with ejaculation, according to the same 2011 review mentioned above.

That’s because getting frisky is probably the last thing on your mind when you're in pain, especially down there.

Prostate Cancer

No joke: there’s a good reason to get regular prostate exams. Roughly one in eight men will get a prostate cancer diagnosis in their lifetime, according to the American Cancer Society. And prostate screenings can help with early detection.

The American Cancer Society recommends talking with your healthcare provider about prostate cancer screening, depending on your age and risk level.

You should start having conversations with your doctor about screening at age 40 if you have a very high risk of developing prostate cancer. You’re at very high risk if you have a close relative who developed prostate cancer at a young age.

If you have an average risk and you’re in good health, consider bringing up prostate screening with a healthcare provider when you hit 50.

Of course, if you have any worrisome symptoms before then, discuss them with a healthcare provider right away.

So, what does prostate cancer have to do with ED?

First off, getting a cancer diagnosis can put the brakes on your sex drive, and it’s not uncommon for stress and anxiety to cause ED symptoms.

These common treatments for prostate cancer can also impact your ability to get and maintain an erection:

• Surgery. ED after prostate surgery (radical prostatectomy) can result from injury to the neurovascular bundle, a bundle of nerves that plays a role in erectile function. Estimates suggest that ED after radical prostatectomy might happen in as many as 85 percent of cases, though data varies pretty widely. 

Thankfully, newer surgical techniques have reduced the frequency of surgical injuries that could result in ED. It’s also important to note that not everyone has issues with sex after a prostatectomy. Still, it’s always good to be aware of the potential risks of surgery.

• Radiation. Radiation to the pelvic area can cause injuries, including nerve injuries, that affect sexual function. However, older data suggests radiation is less likely to affect satisfaction with sexual functionlead to erection problems than surgery.

• Hormonal treatments. Hormonal treatment to block testosterone can also impact your libido and erectile function. However, not everyone experiences these side effects.

How to Treat Erectile Dysfunction From Prostate Issues

If you’re experiencing ED, you might be wondering if you can take Viagra with an enlarged prostate — and you’re wise to get medical advice before starting any new prescription meds.

It’s probably safe to take Viagra if you have an enlarged prostate. However, that’s not your only option.

Tadalafil (the generic version of Cialis®) is the only drug approved to treat both ED and BPH symptoms. Tadalafil is part of a class of drugs called PDE5 inhibitors, which inhibit the PDE5 enzyme.

This relaxes the blood vessels near the penis and encourages blood flow to the area, making it easier to get and keep an erection. PDE5 inhibitors can also help with premature ejaculation.

Here are the other PDE5 inhibitors a healthcare provider may prescribe for ED:

• Viagra® (sildenafil)

• Cialis® (tadalafil)

• Stendra® (avanafil)

• Vardenafil

Lifestyle changes may also help reduce ED symptoms. These include eating a nutritious diet, exercising regularly, quitting smoking, and limiting alcohol intake.

For erection troubles stemming from emotional or psychological problems, psychotherapy is also an option.

Enlarged Prostate and ED: A Recap

There’s a lot of overlap between ED symptoms and prostate problems, so it’s probably no surprise there’s an association between the two conditions — and that they often show up together.

Here’s what to keep in mind:

• Both conditions are common. According to the National Institutes of Health (NIH), about 50 percent of men between 51 and 60 have BPH, and ED affects about 30 million U.S. men.

• They can both cause sexual dysfunction. Both a swollen prostate and ED can make it harder to have a satisfying sex life, which can mess with your sex drive.

• They’re both treatable. The good news? ED symptoms and prostate enlargement are very treatable. In some cases, they even share the same treatment, like ED medication.

Remember, if you’re experiencing ED with a swollen prostate, you’re not alone. And treatment is available.

Ready to get help? Start an online consultation with a healthcare provider now to get the lowdown on erectile dysfunction treatments.