BPH and ED

May 9, 2023
Some men might worry that benign prostatic hyperplasia, or BPH, and erectile dysfunction, or ED, run together in the same crowd, but there isn’t yet enough evidence to suggest this is the case. However, erectile dysfunction can occur in some men because of certain treatment options for BPH.1 Benign prostatic hyperplasia or prostatic hyperplasia is the non-cancerous enlargement of the prostate in men as they get older. BPH doesn’t cause prostate cancer, but it is typical for most men to experience an enlarged prostate or BPH if they live long enough. Erectile Dysfunction or ED is the lack of sexual function to the point where erectile function is impaired and an erection can’t be attained or kept long enough to afford a man enough penile firmness to successfully engage in sex. BPH is typically characterized by a host of lower urinary tract symptoms or LUTS and these symptoms are usually the first warning signs that BPH is present. ED is usually brought on by the decrease in blood flow to the penis due to the narrowing of blood vessels in the area. The prostate is a walnut-shaped and sized male reproductive gland that grows in size as most men age and becomes large enough, due to BPH, to become bothersome as men grow older. Unfortunately, BPH can create lower urinary tract symptoms that lead to difficulties urinating. The function of the prostate gland is to help supply about a quarter of the vital fluid (seminal fluid) that nourishes sperm and allows them to more easily travel to their eventual destination. It works in conjunction with the Cowper’s gland and seminal vesicles to provide the perfect nourishment and transport mechanism for sperm to exist within and outside of a man’s body. In addition, the prostate works to help propel sperm out of the urethra in a forceful manner during ejaculation.  

Who Gets BPH?

The more appropriate question might be: Who doesn’t get BPH? A few fortunate men (maybe up to 20%), for some reason, don’t succumb to an enlarged prostate because of genetics, their environment, good health practices, luck, or all of the above. Approximately 50% of men between the age of 51 and 60 have BPH, but that number jumps to about 80% for men aged 70 and older.2 However, not all men who get benign prostatic hyperplasia will experience lower urinary tract symptoms or LUTS brought on by BPH. Some men will simply get an enlarged prostate and not necessarily have any urinary symptoms. But many men will develop LUTS brought on by BPH and they will need to take medication or undergo therapy to minimize or hopefully eliminate the symptoms of LUTS. Most men from about the age of 40 have an ever-increasing chance of developing BPH as they age further, and many of those men will end up experiencing some urinary symptoms because of their enlarged prostate.  

Can an Enlarged Prostate Affect a Man Sexually?

An enlarged prostate, or a prostate suffering from benign prostatic hyperplasia, can certainly cause interruptions in urination via lower urinary tract symptoms such as a weakened urine stream, starting and stopping, urinary urgency and frequency, straining, or other LUTS-related symptoms, but an enlarged prostate alone doesn’t typically cause sexual dysfunction.1 Men who have BPH and suffer sexual side effects are usually suffering from other illnesses such as diabetes, obesity, heart disease, kidney disease, hypertension, atherosclerosis, multiple sclerosis, alcoholism, or high cholesterol. In addition, some types of prostate disease, prostate cancer treatments, or BPH medications such as 5-alpha reductase inhibitors that effectively treat (by shrinking) an enlarged prostate, can affect a man sexually via decreased sexual desire, ejaculatory disorders, or impotence.1  

What Causes ED and Who is Affected?

Erectile dysfunction can happen to a man at any age because it can be caused by many things, but it becomes more prevalent the older a man gets. Once a man reaches 75 years of age, the odds of experiencing ED go up even more. Good blood flow to the penis is important for maintaining sexual function and an erection sufficient enough to have sex. However, numerous potential roadblocks can impair a man’s ability to maintain proper erectile function. Erectile dysfunction or ED most often occurs because of limited blood flow to the penis or nerve damage to the area and can be brought on by a health condition, medication, prostate surgery, prostate cancer treatment, or psychological conditions. However, BPH isn’t to blame for erectile dysfunction, as far as scientists know thus far. Therefore, it’s important to get a proper diagnosis from a medical professional before any treatment regimen is finalized. Some of the more common physical and psychological causes of erectile dysfunction according to the Mayo Clinic are listed below.

Physical causes of erectile dysfunction

In many cases, erectile dysfunction is caused by something physical. Common causes include:
  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist, and high cholesterol
  • Parkinson’s disease
  • Multiple sclerosis
  • Certain prescription medications
  • Tobacco use
  • Peyronie’s disease — development of scar tissue inside the penis
  • Alcoholism and other forms of substance abuse
  • Sleep disorders
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Low testosterone3

Psychological causes of erectile dysfunction

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. Many things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:
  • Depression, anxiety, or other mental health conditions
  • Stress
  • Relationship problems due to stress, poor communication, or other concerns3

Can an Enlarged or Swollen Prostate Cause Erectile Dysfunction?

Erectile dysfunction or ED, according to its dictionary description, is the “inability of a man to maintain an erection sufficient for satisfying sexual activity”. As mentioned above, erectile dysfunction is primarily brought about because of a decrease in blood flow to the penis or because of nerve damage to important sexual structures. Men who are experiencing a swollen or enlarged prostate due to BPH can often have erectile dysfunction and ejaculatory problems, but BPH itself isn’t to blame. Although BPH does not cause these problems, some of the treatments used for BPH can. For example, finasteride (Proscar), an anti-testosterone drug prescribed for BPH, has been linked to erectile dysfunction in 3.7% of men who use it and to diminished libido in 3.3%. But alpha-blockers such as tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo) can improve the symptoms of BPH with a lower risk of sexual side effects. Transurethral resection of the prostate (TURP), a surgical technique often used when medication fails, also causes erectile dysfunction in a small percentage of men.1 Benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) can impact a man concurrently and can also coexist together, but research doesn’t yet show that either is caused by the other. ED has many potential physical causes and some psychological causes, including often prescribed 5-alpha reductase inhibitor medication used for treating BPH by shrinking the prostate. It’s important to determine the benefits and risks of certain medications and lifestyle choices that could cause abnormal sexual function and ED when deciding on the right approach to treating an enlarged prostate. There are many solutions for addressing BPH and ED doesn’t have to enter the equation if the right approach is taken that results in the most desired outcome.   References:
  1. https://www.health.harvard.edu/blog/sex-and-the-prostate-overcoming-erectile-dysfunction-when-you-have-prostate-disease-20090331100#:~:text=Men%20who%20have%20benign%20prostatic,erectile%20dysfunction%20and%20ejaculatory%20problems.
  2. https://www.yalemedicine.org/conditions/enlarged-prostate-benign-prostatic-hyperplasia-bph#:~:text=But%20because%20enlarged%20prostate%2C%20or,over%2070%20years%20of%20age.
  3. https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776#:~:text=Physical%20issues%20like%20heart%20disease,also%20interfere%20with%20sexual%20feelings.

All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.

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