Erectile dysfunction(ED),  formerly known as impotence, is a condition that affects millions of men worldwide, often causing stress, anxiety, and relationship difficulties. While many factors, such as age, stress, and lifestyle, can contribute to this issue, there’s another possible contributor that’s frequently overlooked: prostate health.

So, can a swollen prostate, also known as benign prostatic hyperplasia (BPH), cause or worsen ED?

Here, we will talk about the connection between a swollen prostate and erectile dysfunction, dive into the underlying mechanisms, and look at what treatment options are available for men experiencing both conditions.

What Does The Prostate Do For A Man?

The prostate is defined as a gland that produces some of the fluids that carry sperm during ejaculation.  It surrounds the urethra, the tube through which urine passes out of the body.

Swollen Prostate

A swollen prostate, also known as an enlarged prostate or benign prostatic hyperplasia (BPH), means the gland has become bigger. It can happen to any man as they get older [1].

What Is The Main Cause Of Prostate Enlargement?

For many men, a swollen prostate is a natural part of aging. The exact cause of an enlarged prostate is still unclear. It might be associated with changes in the balance of sex hormones as men age. There is also some research about the role of the male hormone DHT (dihydrotestosterone) that helps the prostate grow. Older populations appear to have higher levels of DHT, and the excess DHT may be a contributing factor to prostate cell growth [2].

While aging is a significant contributor, lifestyle choices such as diet, exercise, and weight management can also influence the development and progression of a swollen prostate.

To know which foods should be avoided for your prostate health, you can check our blog page “Ten Worst Foods For Prostate Health”.

Some essential facts about a swollen prostate:

• A small amount of prostate enlargement is present in most men over age 40. More than 90% of men develop the condition after the age of 80.
• The risk of developing a swollen prostate increases with age.
• BPH is very common.  It has been said that all men will have a swollen prostate if they live long enough.

What are the Symptoms of Prostate Enlargement?

Common symptoms of BPH (Benign Prostatic Hyperplasia) include [3]:

• A frequent or urgent need to urinate
• Increased urination at night (nocturia)
• Difficulty starting urination
• A weak or interrupted urine stream
• Dribbling at the end of urination
• A feeling that the bladder isn’t completely emptied

Enlarged prostate symptoms usually worsen gradually over time. However, in some cases, they may remain stable or even improve on their own.

Importantly, the size of the prostate does not always reflect the severity of symptoms. Some individuals with only slight enlargement may have significant issues, while others with a significantly enlarged prostate may experience few or no symptoms.

The basics: How an erection occurs

An erection starts with sensory and mental stimulation in the brain. Your brain sends messages to your penis through your nerves.

These messages instruct the muscles of your corpora cavernosa to relax, allowing blood to flow in and fill the open spaces. When the blood vessels of the corpora cavernosa relax and open up, blood rushes in to fill them. The blood under high pressure gets trapped by a series of valves, resulting in an erection.

A membrane surrounding the corpora cavernosa (tunica albuginea) helps to trap the blood in the corpora cavernosa, which enables you to stay hard.

Erectile dysfunction (ED) occurs when there is a disruption in any part of this process, whether due to poor blood flow, nerve damage, hormonal imbalance, or psychological factors, making it difficult to achieve or maintain an erection [4].

Can BPH Cause ED?

Whether or not a swollen prostate might cause erectile dysfunction can depend on what’s causing the enlarged prostate in the first place.

A study by Hao Su et al. suggests that BPH and lower urinary tract symptoms are closely linked to the decline of erectile function. While this does not mean BPH directly causes ED, it’s worth mentioning that both conditions share similar risk factors, such as age. As you get older, you are more likely to suffer from ED as well as BPH.

It’s also possible that several medications that are prescribed to treat BPH, such as 5-alpha-reductase (5-AR) inhibitors, can also be responsible for sexual dysfunction. For example, Proscar is a type of 5-AR inhibitor often prescribed for BPH. The prescribing information for this medicine lists ” trouble attaining and sustaining an erection” as a possible adverse effect. Additionally, numerous studies have found ED to be a possible adverse effect of 5-AR inhibitors at varying percentages.

Surgery, be it for BPH or prostate cancer, might also be what’s behind any sexual dysfunction. The procedural treatment for BPH is known as transurethral resection of the prostate (TURP), which is essentially a fancy name for removing a section of the prostate. TURP has been linked to an increased probability of sexual problems, including ED. And the same can be said of a prostatectomy, which involves removing part or all of the gland. According to a review published in 2016, up to 85% of male who have had their entire prostate removed experience issues with erections post-surgery.

While a swollen prostate does not cause ED, some BPH treatments may affect the ability to sustain an erection. Therefore, it is essential to consult with your healthcare provider to understand the possible side effects of BPH treatment.

Diagnosing Erectile Dysfunction

Diagnosing erectile dysfunction involves having a physical exam and answering questions about your sexual and medical history. If you have an existing health condition that may be involved, you may need additional tests [5].

Tests for pre-existing conditions might include:

• Blood tests: A blood test can help check for signs of diabetes, heart disease, low testosterone levels, and other health issues.
• Physical tests: This might involve an exam of your testicles and penis, checking for nerve damage. Ultrasound: This test uses sound waves to look at the blood vessels that supply blood to the penis. It involves using a wand-like device called a transducer, which is held over the blood vessels. It features a video image that can help identify any blood flow issues.
• Urine tests, like blood tests, can detect signs of various health conditions, including diabetes.

Treating Erectile Dysfunction

Approved by the FDA in 1998, Sildenafil (Viagra) changed the way erectile dysfunction is treated, mainly because of how easy it is to use and how well it works.

Since then, the FDA has approved other related drugs, such as Vardenafil (Levitra) and Tadalafil (Cialis).

All these drugs work similarly by improving blood flow to the penis. But it is essential to know that you have to be sexually stimulated for them to work.

The primary distinctions between these medications pertain to timing: how quickly they take effect and how long their effects last.

However, some medicines used to treat erectile dysfunction can help improve symptoms of a swollen prostate.

Although no drug prescribed for ED has been approved to address an enlarged prostate, early studies suggest that men who take ED  medications may find some relief from their prostate symptoms.

Several erectile dysfunction medications have shown success to some degree in treating enlarged prostates. These include Vardenafil, Tadalafil, and Sildenafil.

For example, one study showed that men who took 10 mg of Vardenafil twice a day for 2 months experienced improvements in their prostate symptoms, compared to a similar group who received a placebo [6].

Another research study found that men who took up to 5 mg of Tadalafil daily saw improvements in both their prostate and ED symptoms [7].

However, before taking ED medication to treat symptoms of a swollen prostate, speak to a healthcare provider. ED medications cause diverse effects that can make them unsafe for some men, especially those with a history of stroke, heart attack, high blood pressure, and unstable angina [8].

Can You Get An Erection Without A Prostate?

Yes, you can get an erection without a prostate. At the same time, the prostate plays a role in sexual function, but it’s not essential for erections. Many men suffer from erectile dysfunction after prostatectomy (removal of the prostate) due to nerve damage during surgery, but this is often temporary, and nerve function can recover, or treatments like penile implants and medications can help restore erections [9].

Conclusion

If you have a swollen prostate, you may be worried about how it will affect your intimate life. The good news is that it won’t, on its own. Having an enlarged prostate does not directly cause erection problems such as ED. But treatments for a swollen prostate, such as medications and surgeries, can impact your sexual function and increase your risk of ED. That’s why, if you are being treated for a swollen prostate, it’s a great idea to talk to a healthcare provider about your intimate health concerns.