Many men delay treatment for an enlarged prostate because they worry about erections or fertility. In fact the enlargement itself is rarely the direct cause, but some medicines and some operations can affect ejaculation or desire. Knowing this before choosing treatment helps you pick what suits your life.
Medically reviewed by Prof. Dr. Samir Ahmed Al-Samarrai, consultant urologist. Last reviewed:
Does enlargement itself affect erections?
Erectile dysfunction and prostate symptoms often occur together after 50 because they share risk factors such as diabetes, high blood pressure, heart disease, obesity and inactivity. So when a man reports one, the doctor asks about the other, and treating the risk factors helps both. Read about erectile dysfunction treatment.
Effects of BPH medicines
| Medicine | Possible effect | Notes |
|---|---|---|
| Alpha-blockers (tamsulosin, silodosin, alfuzosin, doxazosin) | Less semen, or none, at ejaculation | More common with silodosin and tamsulosin; usually goes after stopping |
| 5-alpha reductase inhibitors (finasteride, dutasteride) | Lower desire or erections and less semen in some men | Can affect semen analysis; discuss with your doctor if you plan a family |
| Daily tadalafil | Improves erections and urinary symptoms | Not taken with nitrate medicines |
Do not stop your medicine on your own. If you notice an effect on sex or ejaculation, tell your doctor; there is usually an alternative. Read BPH medicines and their side effects.
Effects of surgery
- Transurethral resection and laser enucleation: many men have retrograde ejaculation afterwards, with semen going back into the bladder. Orgasm usually remains, but natural conception is affected.
- Ejaculation-preserving techniques such as water vapour therapy (Rezum) and prostatic urethral lift suit selected cases, depending on prostate size and shape.
- Erections are usually not affected by BPH surgery, unlike radical prostatectomy for cancer.
If you plan to have children, tell your doctor before surgery; another technique or storing a semen sample may be suggested. Read prostate surgery types compared.
Does it affect your partner?
Benign enlargement is not an infection and cannot pass to a partner. Bacterial prostatitis is sometimes caused by a sexually transmitted infection, which is a different condition. Read about prostatitis.
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Frequently asked questions
Does an enlarged prostate cause erectile dysfunction?
Enlargement itself does not directly cause erectile dysfunction, but the two often occur together with age because they share risk factors such as diabetes, heart disease and obesity. The worse the urinary symptoms, the more likely erectile problems are present too.
Does an enlarged prostate stop you having children?
Enlargement alone does not usually affect fertility. Some medicines and operations affect ejaculation, so tell your doctor if you plan to have children before choosing treatment.
How do prostate medicines affect ejaculation?
Alpha-blockers, especially silodosin and tamsulosin, can reduce the volume of semen or stop it coming out in some men. The effect usually goes after stopping the medicine.
Is there a treatment for both BPH and erectile dysfunction?
Yes. Low-dose daily tadalafil improves both urinary symptoms and erections in some men, prescribed after checking there are no contraindications such as nitrate medicines.
Does prostate surgery affect sex life?
After many transurethral prostate operations, retrograde ejaculation occurs: semen goes back into the bladder instead of coming out. It usually does not affect sensation or erections, but it does affect fertility. Some techniques preserve ejaculation better.
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Book a consultation
Prof. Al-Samarrai and Dr. Amer Mousa assess prostate symptoms and their effect on erections and fertility at Prof. Al-Samarrai Medical Center, Dubai Healthcare City, and discuss the options that suit your case. Medical consultations are confidential.
This information is for health education and does not replace a medical examination. See our medical content policy.