Can an Enlarged Prostate Affect Your Sex Life? Erectile Dysfunction, Orgasms, and More

The prostate is one of those organs that go unnoticed for men until there’s an issue. This is a problem, given how important it is for sexual health. 

The prostate plays a key role in ejaculation, which helps sperm fertilize an egg during reproduction. And it also sits very close to nerves and blood vessels that feed the penis. That means any targeted treatment for an enlarged prostate, or benign prostatic hyperplasia (BPH), as it’s known in medical terms, may affect sexual function too.

Here, we’ll talk about how BPH is related to erectile dysfunction (ED), changes in your sex drive, and ejaculation problems. We’ll also dive into what treatment choices you have if ED is an issue for you.

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What is the function of the prostate gland?

The prostate is part of the male reproductive system. It’s located inside your body, near the base of your penis. Your prostate gland’s main function is to make fluid for semen (cum). During ejaculation, the muscles in your prostate also contract and help semen exit your body. 

Enlarged prostate symptoms

Having an enlarged prostate or BPH doesn’t typically affect sexual function. But it commonly leads to lower urinary tract symptoms, like:

• Having a sudden urge to urinate (pee)

• Being unable to form a full stream

• Feeling as if urine is trapped in your bladder

During a man’s lifetime, the prostate goes through two major growth spurts: one during puberty and another around 50 or 60 years of age. This second phase of prostate growth can lead to an enlarged prostate. Having an enlarged prostate is common. It’s estimated that half of men will have some form of BPH in their 50s — and that number increases with age. 

Can an enlarged prostate cause erectile dysfunction (ED)?

No, an enlarged prostate hasn’t been shown to be a direct cause of ED. The prostate is an important organ for male sexual function. But BPH is more of a urination issue than a sexual one. 

And, usually, an enlarged prostate isn’t much of a problem, unless symptoms become burdensome and treatment is needed. 

EXPERT PICKS: WHAT TO READ NEXT

• An enlarged prostate, or benign prostatic hyperplasia (BPH), can impact your quality of life. Here’s a list of medications that can help get BPH under control.

• The older you are, the more likely you are to have an enlarged prostate. Learn more about what causes an enlarged prostate, its symptoms, and treatment options.

• Erectile dysfunction (ED) isn’t always a lifelong diagnosis. Check out our list of curable causes of ED and their treatments.

But that’s where concerns about ED come in. To treat BPH, you have two choices: 

1. Medications that relax the prostate or stop it from getting bigger

2. Surgery 

Alpha blockers like Flomax are common medications used to treat BPH. Alpha blockers cause the blood vessels in the prostate to narrow. This relaxes the muscles in the prostate and makes it easier to urinate. But one possible side effect is less blood flow into the penis during an erection, which could lead to ED. 

Another medication used for BPH is Avodart. It’s an anti-testosterone medication that stops the prostate from growing. However, lower testosterone levels in the body may cause ED as well. 

Lastly, surgical procedures can also cause ED by damaging structures around the penis, which we’ll discuss below.

Can an enlarged prostate keep you from ejaculating?

No. On its own, an enlarged prostate won’t affect your ability to ejaculate. But here’s the catch: Many medications and treatments for BPH do have side effects that keep you from ejaculating. These include:

• Retrograde ejaculation: When you have an orgasm, you typically ejaculate semen out of the end of your penis. Retrograde ejaculation is when some, or all, of the semen goes into your bladder instead. 

• Inability to ejaculate: This is when you have an orgasm, but your body doesn’t ejaculate semen at all. 

These are both sometimes called “dry” orgasms. Though they’re not dangerous, dry orgasms can feel different from what you’re used to, which can be unsettling. They can also affect your fertility, as it’s harder to start a pregnancy if little — or no — semen comes out of your penis during sex.

Does an enlarged prostate (BPH) lower sexual desire?

No. Having an enlarged prostate won’t make you less interested in sex. But, if you’re taking a 5-alpha reductase inhibitor, these medications can lower your sex drive. Common examples are:

• Avodart (dutasteride)

• Proscar (finasteride)

These medications work by blocking testosterone from changing into dihydrotestosterone (DHT) in your body. This can help your prostate get smaller. But having lower amounts of DHT can lower your libido too. 

Does sex help prevent prostate enlargement?

Probably not. So far, there’s no clear evidence that having sex often can help shrink your prostate. It’s likely that your age has more of an effect on your prostate health than your sex life. 

One study looked at about 2,000 men with prostate enlargement. It found that — after the researchers took age into consideration — ejaculation frequency didn’t have any effect on prostate size.

Can I prevent ED after prostate surgery?

A simple prostatectomy is a surgery removing part of the prostate to make it smaller and help improve your BPH symptoms. These days, many prostatectomies use nerve-sparing techniques to lower the chances of injury to the tissue and prevent ED. Both can still happen though. 

Several other treatments are available for men after prostate surgery to help them regain erectile function and prevent ED. 

One option is called “penile rehabilitation,” which uses techniques to help improve blood flow into the penis. This may include the use of therapies like: 

• Sildenafil (Viagra)

• Penile injections (like Edex or Caverject)

• Vacuum erection devices

Current research on the benefits of this intervention is limited. Still, it’s recommended that men proceed with their usual sexual habits after healing, as it may help prevent long-term issues. They should also use medications to improve blood flow and erections.

I have ED after getting prostate surgery. What now?

For treating ED after prostate surgery, first-choice therapies include medications like:

• Viagra

• Cialis

• Levitra

Research has shown that these medications help improve erectile function. They do this by relaxing the blood vessels that supply the penis, so more blood can flow through. 

These medications might not work right after surgery though. One reason for that is that blood may not flow easily through blood vessels that are still healing. But after the blood vessels have healed enough, medication is likely to help with ED. In fact, up to 75% of men with ED after nerve-sparing surgery respond to Viagra. However, this may take anywhere from weeks to years.

In some people, Viagra, Cialis, or Levitra may not work. Or these medications might not be an option due to other issues (like a drug interaction). In these cases, an injection may be used instead. The good news is that there are options if you have ED and can’t take Viagra. 

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Written by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

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