It’s Complicated: Enlarged Prostate and Sex



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It’s Complicated: Enlarged Prostate and Sex.
Prostate enlargement, also known as benign prostatic hyperplasia (BPH), and erectile dysfunction (ED) are separate problems. Both increase with age, but one causes problems in the bathroom and the other in the bedroom. However, the two are somewhat linked.
BPH happens when your prostate becomes enlarged, but cancer isn’t the cause. A man’s prostate continues growing throughout most of his adult life. This is why many older men are affected by the condition.
ED is the inability to get or maintain an erection. It can be caused by physical conditions such as:
It can also be caused by psychological issues.
These two conditions don’t necessarily seem linked, but certain treatments that relieve BPH can cause ED and other sexual side effects. On the other hand, treating ED can improve enlarged prostate symptoms.
Postsurgical problems.
Prostate enlargement can interfere with urination. It can cause sudden side effects including:
A surgery called transurethral resection of the prostate (TURP) can help relieve these symptoms. Men who have this procedure often experience sexual side effects after surgery.
Between 50 and 75 percent of men experience retrograde ejaculation after TURP, according to Harvard Medical School. This means that semen released during orgasm enters the bladder rather than exiting the penis. Retrograde ejaculation is sometimes called dry orgasm. It’s not harmful but can affect male fertility.
Some men who undergo the TURP procedure also experience ED. This isn’t a common side effect of the surgery, but it does occur in 5 to 10 percent of men.
BPH medications and sexual side effects.
Some drugs used to treat BPH can cause difficulty in maintaining an erection. Men who take alpha-blockers such as doxazosin (Cardura) and terazosin (Hytrin) may experience decreased ejaculation. This is because alpha-blockers relax the bladder and prostate muscle cells.
Alpha reductase inhibitors can also cause ED. Additionally, reduced sex drive is a possible side effect of the alpha reductase inhibitors dutasteride and finasteride.
Approximately 3 percent of men taking dutasteride (Avodert) reported experiencing a decreased libido in the first six months. About 6.4 percent of those taking finasteride (Proscar) experienced this within the first year. Roughly 4.5 percent of men taking dutasteride-tamsulosin (Jalyn) reported decreased libido in the first six months.
Men who take these medications may also experience lower sperm count, decreased sperm volume, and lower sperm movement. Adverse events typically decrease with continued use.
ED treatments and BPH.
Medications that treat erectile dysfunction may help improve BPH. The ED drugs below have all been shown to reduce BPH symptoms:
However, they aren’t currently approved to treat BPH.
These medications inhibit a protein that breaks down a chemical called cyclic guanosine monophosphate (cGMP), which increases blood flow to the penis. By inhibiting the protein that breaks down cGMP, blood flow to the penis can be increased.
In theory, ED drugs can boost cGMP levels in the bladder and prostate as well. The increased cGMP and blood flow may allow bladder and prostate cells to relax, leading to greater urinary flow.
One study comparing tadalafil and a placebo showed that men who took 5 milligrams of tadalafil daily had significant improvement in both BPH and ED symptoms.
In another trial, 108 men who took 10 milligrams of vardenafil twice daily showed significant improvement in prostate symptoms compared with the 113 men who took a placebo. The men were 45 to 64 years old and had a history of BPH.
The study also included men who had ED. The results showed improvement in both BPH and ED symptoms in men who had both conditions.
Talk to your doctor.
The studies on ED medication and its ability to relieve enlarged prostate symptoms have only looked at short periods of time. They’ve also only looked at the differences between ED medications and a placebo. The results show promise, but the data is not long-term.
The studies haven’t fully shown that ED drugs are safe and effective to treat urinary symptoms of enlarged prostate. More evidence is needed from studies that directly compare ED drugs with medications for BPH.
ED medications and alpha-blockers both lower your blood pressure. If you’re taking both ED and BPH medications, your doctor may recommend taking them at different times of the day to avoid dizziness or a steep drop in blood pressure.
Your doctor may also be able to recommend lifestyle changes and exercises that can help improve your condition.
Avodart – soft gelatin capsules. (2014). http://us.gsk.com/products/assets/us_avodart.pdf ED pills and benign prostatic hyperplasia. (2011). http://www.health.harvard.edu/newsletters/Harvard_Mens_Health_Watch/2011/September/ed-pills-and-benign-prostatic-hyperplasia Egerdie RB, et al. (2012). Tadalafil 2.5 or 5 mg administered once daily for 12 weeks in men with both erectile dysfunction and signs and symptoms of benign prostatic hyperplasia: Results of a randomized, placebo-controlled, double-blind study. DOI: 10.1111/j.1743-6109.2011.02504.x Jalyn – capsules. (2015). http://us.gsk.com/products/assets/us_jalyn.pdf Mayo Clinic Staff. (2015). Erectile dysfunction. http://www.mayoclinic.com/health/erectile-dysfunction/DS00162 Proscar – tablets. (2013). http://www.merck.com/product/usa/pi_circulars/p/proscar/proscar_pi.pdf Steif CG, et al. (2008). A randomised, placebo-controlled study to assess the efficacy of twice-daily vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. DOI: 10.1016/j.eururo.2008.01.075 Your benign prostatic hyperplasia medication: When to consider a change. (2011). http://www.harvardprostateknowledge.org/your-benign-prostatic-hyperplasia-medication-when-to-consider-a-change.
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