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Can a Swollen or Enlarged Prostate Cause ED?

Katelyn Brenner FNP

Reviewed by Katelyn Hagerty, FNP

Written by Our Editorial Team

Published 02/04/2021

Updated 09/08/2023

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.

The prostate is a small gland near the bladder and rectum that helps produce semen. While it can naturally get bigger as you get older, a prostate that’s too large can cause problems.

While experts can’t confirm a cause-effect relationship between some prostate issues 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 goes up 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 trouble 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? Drum roll, please. 

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.

Although 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 probs.

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 DHT. Too much DHT in the prostate can cause it to become enlarged. Healthcare providers sometimes 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 fairly 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 actually improve sexual function. Though it’s understandable if you don’t feel ready for sexy time 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 other typical prostate symptoms, like a frequent urge to urinate. Since bacteria is the usual 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.

Think of it like this: When you’re in pain, what’s the last thing on your mind? Probably getting frisky (we’re not here to judge if a little BDSM is your thing, though). Having a painful medical condition likely isn’t most people’s first thought when they think about what makes them horny.

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Prostate Cancer

There’s a good reason to get regular prostate exams — and it has nothing to do with having fodder for prostate exam jokes.

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.

Conversations with your doctor about screening should start 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, make sure to 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.

Treatment for prostate cancer can also impact your ability to get and maintain an erection.

Below, we’ll cover treatment options for prostate cancer and how they might affect your erection abilities. 

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 prevalent data varies pretty widely.

As early detection for prostate cancer becomes more readily available, more people are getting their prostates removed.

Thankfully, newer surgical techniques have reduced the frequency of injuries in this area 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 lead 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.

Choose your chew

Dealing with both prostate issues and ED symptoms is a double whammy.

But you don’t have to suffer in silence. Treatment for ED is available.

You might be wondering if you can take Viagra with an enlarged prostate. If you’re dealing with prostate problems or are taking any other medications, you’re wise to get medical advice before starting any new prescription meds.

But yes, 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 that 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’s a breakdown of other PDE5 inhibitors a healthcare provider may prescribe for ED:

Lifestyle changes that might help reduce ED symptoms include eating a nutritious diet, getting regular exercise, quitting smoking and limiting alcohol intake.

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

If you can’t take ED medications or they don’t work for you, other treatments include injectable penile medications like alprostadil, vacuum devices (aka penis pumps) or surgery in severe cases.

FYI: Many shady companies out there peddle alternative treatments for ED. And while it’s ultimately your choice to take over-the-counter (OTC) supplements like saw palmetto, know that the research is generally thin.

Supplements aren’t regulated by the FDA (U.S. Food and Drug Administration) like prescription drugs, so the drugstore supplement aisle is a bit like the Wild West.

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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:

  • They’re 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, messing 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.

25 Sources

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Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

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