Introduction
If you’re a man over 50 dealing with an enlarged prostate, you’re far from alone. Trust me, millions of guys are in the same boat. While most conversations about this condition (doctors call it benign prostatic hyperplasia or BPH) revolve around those frustrating urinary symptoms, there’s another question that many men think about but hesitate to ask: “What about my sex life?”
It’s a legitimate concern, and one that deserves an honest, straightforward answer. So let’s cut through the medical jargon and talk about what really happens to your sex life when your prostate decides to grow larger than it should.
What Exactly Is This Enlarged Prostate Thing?
Before diving into the bedroom talk, let’s get our facts straight. Your prostate is a small gland (about the size of a walnut when you’re younger) that sits below your bladder and wraps around your urethra – that’s the tube carrying urine from your bladder through your penis.
As you get older, your prostate naturally grows. For many men, it grows too much, and that’s what we call BPH. It’s just one of those things that comes with getting older – like gray hair or dad jokes.
Some Quick Facts You Should Know:
- Around half of all men in their 50s have some degree of BPH
- By the time you hit 80, more than 80% of men are dealing with it
- It’s NOT cancer and doesn’t increase your cancer risk (despite what your late-night Google searches might suggest)
- It won’t kill you, but it sure can be annoying
- Without treatment, it usually gets worse over time
So How Does This Affect What Happens in Bed?
Let’s get to the heart of the matter. Your enlarged prostate can mess with your sex life in several ways – some direct, some not so obvious.
Trouble Getting or Keeping an Erection
I’ve talked with countless men who noticed erectile problems around the same time their prostate started acting up. Turns out, there’s solid science behind this connection.
A major study from 2018 looked at over 35,000 men and found something eye-opening: guys with moderate to severe BPH symptoms had a 72% higher chance of dealing with erectile dysfunction compared to men without those symptoms.
As Dr. Alan Shindel (a urologist who specializes in this stuff) puts it: “These two conditions often travel together because they share common underlying causes – things like blood vessel changes, nerve issues, and hormone imbalances that happen as we age.”
The Ejaculation Situation
Here’s where things get really interesting. Your prostate isn’t just along for the ride during sex – it’s an active player. It produces about a third of your seminal fluid. When it’s enlarged, several things can happen:
- Less fluid comes out: Many men notice their ejaculation volume decreases
- The backward flow: Sometimes semen actually flows backward into your bladder instead of out through your penis (weird, I know, but it happens)
- Pain when you climax: Not fun, but inflammation can make ejaculation hurt
About a third of men with untreated BPH experience some type of ejaculation problem. That’s a significant number.
When Your Sex Drive Takes a Hit
“I just don’t feel in the mood like I used to.” I hear this all the time from men with BPH. There are several reasons why:
- Getting up three times a night to pee doesn’t exactly leave you feeling sexy the next day
- Worrying about urinary symptoms during sex can be a major turn-off
- The general discomfort and mental stress take their toll
A study from 2019 found men with severe BPH symptoms were twice as likely to report low sexual desire. That’s not just coincidence.
The Head Game: How BPH Messes With Your Mind
Sometimes the biggest sexual organ is the one between your ears. Let’s talk about how BPH affects your mental state:
Performance Anxiety Is Real
When you’re worried about whether you might leak urine during sex or whether you can maintain an erection, it creates a vicious cycle. The more you worry, the more likely problems will occur.
One of my patients described it perfectly: “I’m so focused on what might go wrong that I can’t enjoy what’s going right.”
The Depression Connection
I’ve seen how the constant discomfort and sleep disruption from BPH can lead to feeling down or anxious. Studies confirm that men with moderate to severe symptoms have higher rates of depression and anxiety. And we all know how those mood issues can kill your interest in sex.
What Happens to Your Relationship
When one partner is constantly getting up at night, feeling uncomfortable, and becoming less interested in sex, it puts strain on even the strongest relationships. The communication often breaks down exactly when you need it most.
As one patient’s wife told me, “It’s not just his prostate that’s the problem – it’s that he won’t talk about what’s happening.”
Treatments and Their Sexual Side Effects: The Trade-offs
Now for the tricky part. The very treatments that help your urinary symptoms might create their own sexual issues. It’s important to know what you’re getting into.
Medication Side Effects
Alpha-Blockers
These medications (like Flomax or Uroxatral) relax the muscles around your prostate and bladder neck, making it easier to urinate. The good news? They work pretty quickly. The bad news?
“I can get the urine out now, but nothing else comes out when I orgasm,” a patient once told me. He was experiencing retrograde ejaculation – when semen goes backward into the bladder. It happens in about 8-18% of men on these medications.
The reassuring part? This doesn’t hurt you and doesn’t affect the pleasure of orgasm for most men. It just means less or no fluid comes out.
5-Alpha Reductase Inhibitors
Medications like Proscar and Avodart actually shrink your prostate over time by blocking certain hormones. They’re effective but come with more significant sexual side effects:
- Erectile problems affect about 5-8% of men taking these
- Decreased libido happens in about 3-6% of guys
- Some men report ejaculation problems too
What’s particularly frustrating is that these side effects sometimes continue even after stopping the medication. Not always, but it happens.
Surgical Options and Your Sex Life
The Traditional Approach: TURP
Transurethral resection of the prostate (TURP) has been the gold standard surgical treatment for decades. It works well for urinary symptoms, but here’s what you should know about sex afterward:
About 65-75% of men experience retrograde ejaculation after this procedure. That’s a pretty high number. The good news is that erectile function is usually preserved if the surgery is done properly.
Newer, Less Invasive Options
Procedures like UroLift and Rezūm are gaining popularity, and for good reason. They tend to have fewer sexual side effects while still effectively treating BPH symptoms.
The 5-year study on UroLift showed it preserved sexual function better than traditional options. One of my patients described his experience: “It’s like I got my bathroom habits fixed without sacrificing my bedroom habits.”
Practical Advice: Managing Your Sex Life With BPH
Enough with the problems – let’s talk solutions. Here’s my real-world advice after helping countless men navigate this issue:
Have That Awkward Conversation
Listen, I know it’s not easy to bring up ejaculation problems with your doctor. But trust me, we’ve heard it all, and we can’t help if you don’t tell us what’s happening. The men who have the best outcomes are invariably those who speak up early and honestly.
Choose Your Treatment With Sex in Mind
When discussing treatment options with your urologist, be upfront about how important sexual function is to you. Different treatments have different risk profiles for sexual side effects. There’s often a way to balance improved urinary symptoms with preserved sexual function.
As one of my patients wisely said, “I’d rather get up once more at night than give up what happens in that bed.”
Lifestyle Changes That Actually Help
Some simple changes to your daily routine can improve both BPH symptoms and sexual function:
- Get moving: Regular exercise improves blood flow everywhere, including the places that matter for sexual function
- Watch the scale: Extra weight puts pressure on your bladder and can make BPH symptoms worse
- Kegel exercises aren’t just for women: Strengthening your pelvic floor muscles can improve both urinary control and sexual function
- Easy on the evening drinks: Cutting back on alcohol and caffeine, especially in the evening, can reduce those nighttime bathroom trips
When Sexual Side Effects Happen
If you do experience sexual side effects from BPH treatment, don’t just suffer in silence. There are usually ways to address them:
- Changing medication timing or dosage often helps
- Switching to a different medication might solve the problem
- Adding an ED medication might counter some side effects
- Seeing a sexual health specialist can provide additional options
As Dr. Kevin McVary, a leading specialist in this field, explains: “There’s rarely a situation where a man has to choose between treating his BPH and having a satisfying sex life. With the right approach, most men can have both.”
Answering Your Burning Questions
Does an enlarged prostate directly cause ED?
Not exactly. Think of them more like cousins than parent and child. They don’t directly cause each other, but they share family traits and often show up at family gatherings together. They have common underlying causes, especially as men age.
Will sex get better after my BPH is treated?
Many men report better sexual satisfaction after treatment, mainly because they’re not getting up three times a night to pee, they’re sleeping better, and they’re not constantly worried about urinary symptoms. But your results will depend on which treatment you choose and your individual response.
Can I still father children if I have BPH?
BPH itself doesn’t usually affect fertility. However, some treatments (especially those causing retrograde ejaculation) can make it difficult or impossible to father children naturally. If you’re still planning on having kids, make sure to mention this to your doctor before deciding on treatment.
Can I take Viagra if I’m on BPH medication?
Often yes, but proceed with caution. Some combinations (particularly alpha-blockers with ED medications) can cause dangerous drops in blood pressure. Never start taking ED medication without discussing it with your doctor first.
Will having more or less sex affect my BPH?
Despite what you might have heard, no solid evidence shows that sexual activity makes BPH better or worse. Some studies suggest regular ejaculation might have slight benefits for prostate health, but it’s not proven as a treatment. I tell my patients: “Do what feels right for you and your partner.”
The Bottom Line
Here’s what I want you to take away from all this: Yes, an enlarged prostate can affect your sex life – through direct physical effects, treatment side effects, and the psychological impact of dealing with the condition.
But having BPH doesn’t mean your sex life is over. Far from it. With the right treatment approach, open communication with healthcare providers and your partner, and some lifestyle adjustments, most men can successfully manage both their urinary symptoms and maintain a satisfying sex life.
The key is being honest about what matters most to you and finding the right balance of treatments to address your unique situation. Don’t settle for “just living with it” when it comes to either urinary symptoms or sexual side effects – because you probably don’t have to.