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Enlarged Prostate Treatment and Your Sex Life

Getting older? If you’re a man, the size of your prostate might become a concern.

Prostate growth is a natural part of aging. For most men, this typically walnut-sized gland starts getting bigger around age 40. About 90% of men over age 80 have an enlarged prostate.

The medical term is benign prostatic hyperplasia (BPH), and scientists aren’t exactly sure why it happens. The most important word is benign. The growth isn’t a sign of anything wrong. It’s not a tumor and it’s not related to prostate cancer, although it is possible to have both conditions at the same time.

Still, an enlarged prostate can create some problems due to anatomy. The urethra, which carries urine and semen out of the body, goes right through the prostate gland. And with BPH, tissue grows inward, putting pressure on the urethra, making urination difficult.

Lower urinary tract symptoms (LUTS) include problems with weak urine flow, an urgent need to urinate, and nocturia (needing to urinate several times during the night).

It’s usually the urinary bother that makes men seek treatment. Unfortunately, treatments can have sexual side effects, like erectile dysfunction (ED) and trouble with ejaculation.

Not all men have these complications, but you should know the possibilities before you move forward. Your urologist can tell you more about your personal situation.

Let’s look at the sexual side effects of BPH treatment in more detail.

How might enlarged prostate treatments affect my sex life?

The most common BPH treatments include medications (such as 5-alpha reductase inhibitors and alpha-blockers), minimally invasive procedures (such as stents and laser treatments), and surgery (such as transurethral resection of the prostate or TURP). Possible sexual side effects may include the following:

  • Low libido – a diminished interest in sex
  • Erectile dysfunction (ED) – difficulty getting and keeping an erection rigid enough for intercourse
  • Trouble ejaculating
  • Retrograde ejaculation – when semen flows backward into the bladder instead of forward out of the penis

Can the sexual side effects of BPH treatment be managed?

Yes.

For example, if you find your sex drive plummeting as a medication side effect, your doctor might suggest changing the drug or altering the dose. (Note: These changes should never be made without a doctor’s guidance. Always check with your provider first.)

Erectile dysfunction (ED) is treated in several ways, including pills, injections, vacuum devices, and penile implants. Most men start with medication and move on to other treatments if they don’t respond to the drugs. (Again, if you’re thinking about trying ED medications, check with your doctor first. These drugs are not appropriate for all men and need to be prescribed by a physician.)

Retrograde ejaculation isn’t always an issue. Even though semen travels into your bladder, it’s not harmful and it’ll pass with your urine. And you should still feel pleasure from orgasm. However, if you and your partner would like to start a family, you might need to use alternative methods for extracting sperm. A fertility specialist can help.

Are some BPH treatments more sex-friendly than others?

This question is difficult to answer because so much depends on your personal situation.

That said, there are several newer BPH treatments, and trials have had some encouraging results. For example, studies of aquablation, which uses waterjets to remove prostate tissue, suggest that this technique can preserve erections and ejaculatory function. But aquablation is still considered experimental, and scientists need to investigate its long term effects before it becomes routine.

What treatment should I choose for the best sexual results?

This is up to you. Be open with your urologist about your priorities and concerns. If you have a partner, you might consider bringing them to your doctor’s appointments so they can join the discussion.

Resources

International Society for Sexual Medicine

“Does having an enlarged prostate (BPH) affect sexual performance?”

https://www.issm.info/sexual-health-qa/does-having-an-enlarged-prostate-bph-affect-sexual-performance/

“Does surgery for benign prostatic hyperplasia (BPH) affect a man’s sexual function?”

https://www.issm.info/sexual-health-qa/does-surgery-for-benign-prostatic-hyperplasia-bph-lower-urinary-tract-sympt/

The Journal of Sexual Medicine

Bouhadana, David, MD, et al.

“Patient Perspectives on Benign Prostatic Hyperplasia Surgery: A Focus on Sexual Health”

(Full-text. Published: August 6, 2020)

https://www.jsm.jsexmed.org/article/S1743-6095(20)30755-4/fulltext

Medical News Today

Fletcher, Jenna

“What are the effects of an enlarged prostate on sex?”

(February 19, 2018)

https://www.medicalnewstoday.com/articles/320954

National Institute of Diabetes and Digestive and Kidney Diseases

“Prostate Enlargement (Benign Prostatic Hyperplasia)”

(September 2014)

https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia

SexHealthMatters.org

“Aquablation Studied as Enlarged Prostate Treatment”

https://www.sexhealthmatters.org/did-you-know/aquablation-studied-as-enlarged-prostate-treatment

Urology Care Foundation

“What is Benign Prostatic Hyperplasia (BPH)?”

(Updated: August 2020)

https://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-(bph)

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