Men's Health

Can A Swollen Prostate Cause Erectile Dysfunction?

Fact Checked

As men get older, it's normal for the prostate to grow and become enlarged but can it cause erectile dysfunction?

Last Updated: 05/02/2022

Written by

Warren Dutton

Medically Reviewed by

Dr. Paul Thompson

Almost every man has had the occasional issue getting an erection. Those one-off instances often may happen due to stress, alcohol, nerves, or lifestyle habits. But what happens when erectile dysfunction won't go away?

Erectile dysfunction is the inability to maintain an erection during sex. When impotence is an ongoing issue it can affect sexual intercourse, self-esteem, and performance anxiety. Erectile dysfunction is nothing to be embarrassed about. About 30 million men in the United States experience erectile dysfunction, especially as they get older.

However, can a swollen prostate cause erectile dysfunction? That's what this article will explore in further detail. It's not a straight-shot answer. Sexual arousal is a sophisticated and complex process that involves several components of the body and mind.

Prostate disease, underlying conditions, or mental blocks can cause sexual dysfunction in the bedroom. Thankfully there are plenty of ways to treat erectile dysfunction and restore sexual function in your sex life.

Prostate diseases and erectile dysfunction

As men get older, it's normal for the prostate to grow and become enlarged. Men may encounter some of the following prostate diseases.

Three common forms of prostate disease:

  • Benign prostatic hyperplasia (non-cancerous)

  • Prostatitis (non-cancerous)

  • Prostate cancer (cancerous)

All of these conditions have symptoms that overlap. It's important to not self-diagnose and jump to conclusions. Instead, consult your doctor to schedule a physical exam and further discuss your symptoms. Your physician may also refer you to a urologist. A urologist specializes in urinary tract diseases and the male reproductive system.

An enlarged prostate can cause sexual dysfunction, low libido, and pain or discomfort when urinating. Below we'll explore the potential causes of an enlarged prostate and how they relate to healthy sexual function.

Can an enlarged prostate cause erectile dysfunction?

The prostate is a walnut-shaped gland that is a part of the male reproductive system. The prostate helps make a fluid that goes into semen and plays an integral role in male fertility.

The prostate's first growth spurt happens during puberty, the prostate doubles in size. The second growth phase happens around the mid-twenties and steadily continues throughout a male's lifespan.

An enlarged prostate may cause lower urinary tract symptoms that may be correlated to erectile dysfunction. Though true association has not been proven to be 100 percent confirmed. A study published in Mayo Clinic showed that men who were experiencing urinary tract symptoms caused by an enlarged prostate were also experiencing a decrease in sexual function.

In the study, men with urinary symptoms that included urgency, a weak urine stream, and frequent night urination, experienced sexual symptoms such as erectile dysfunction, sex drive, and general sexual satisfaction problems.

However, for men over 70, the association of urinary symptoms and sex function greatly diminished. Since both conditions generally affect men as they age, researchers suspect that there may be a correlation.

Possible causes of erectile dysfunction

Benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia also referred to as BPH, is a non-cancerous condition in men where the prostate gland is enlarged. BPH is also known as benign prostatic hypertrophy and benign prostatic obstruction.

An enlarged prostate starts to put pressure on the urethra, making it more narrow and "pinched". BPH may cause the bladder to weaken and the ability to completely "empty" itself. These two occurrences may cause many urinary tract symptoms in men.

Researchers and scientists are still trying to fully understand what causes benign prostatic hyperplasia. BPH mainly occurs in older men. As men get older their testosterone levels decrease, leaving a higher level of estrogen in the blood. Scientists theorize that benign prostatic hyperplasia may begin when higher estrogen levels in the prostate promote faster growth.

Symptoms of benign prostatic hyperplasia can start as early as 40. As of 2010, 14 million men in the United States experienced lower urinary tract symptoms that were correlative with BPH. Symptoms tend to become more noticeable for men aged 50 and over. If you're experiencing any of the symptoms below, you may have benign prostatic hyperplasia.

Symptoms of benign prostatic hyperplasia

  • Frequent urination

  • An "emergency" feeling or instant urgency to urinate

  • "Stop-and-start" peeing

  • Difficulty 'starting' to urinate

  • Incontinence (accidental leakage)

  • Urine retention

  • A weak urine stream

  • Frequently having to pee at night (nocturia)

Benign prostatic hyperplasia treatments and erectile dysfunction

Certain BPH treatments and medications can cause men to experience erectile dysfunction. Some pills used for benign prostatic hyperplasia can inhibit a man's sex drive and lower their libido. Alpha blockers (commonly used to treat BPH) have been linked to erectile dysfunction and ejaculation problems. Newer medications may have less severe sex side effects. Your doctor can help steer you in the right direction if you're looking to treat BPH and ED.

Low testosterone

Testosterone levels begin to decrease in men as they get older. Testosterone is the male hormone responsible for maintaining strong bones, muscles, and a healthy sex drive. Starting at the age of 30, most men begin to experience a gradual decrease in testosterone, an estimated 1% per year throughout the rest of the man's life.

The normal total testosterone range extends from 300 nanograms per deciliter to 800 nanograms per deciliter. A lower than normal score would be suggestive of low testosterone levels.

Though it's normal for testosterone to decrease with age, various conditions could also cause the decline, such as hormones, testicular injuries, testicular cancer, infection, AIDS, HIV, liver or kidney diseases, diabetes, and obesity. Genetics and certain medications may also cause lower testosterone levels.

Since testosterone is the sex hormone that fuel's a man's sex drive, lower levels could cause erectile dysfunction and make sexual intercourse more difficult. Other symptoms may include a low sex drive, depression, fatigue, irritability, mood swings, and decreased muscle mass.

Prostate cancer

Prostate cancer is the second leading cause of cancer deaths amongst men. There's benign growth in the prostate such as that with benign prostatic hyperplasia, and there's malignant growth, which is cancerous. BPH and prostate cancer share many symptoms such as frequent urination, a weak urine stream, and general trouble or discomfort urinating.

It's common for there to be no symptoms in the early stages of prostate cancer. Some forms of prostate cancer progress very slowly and others are more aggressive.

As prostate cancer progresses, men may experience some of the following symptoms:

  • Frequent urination

  • Trouble urinating

  • A weak urine stream

  • Blood in urine or semen

  • Painful ejaculation problems

  • Erectile dysfunction

  • Bone pain

  • Weight loss

The risk of prostate cancer rises exponentially for men aged 55 and over. There are several risk factors such as older age, family history, lifestyle habits, and diet.

Prostate cancer treatments and erectile dysfunction

Erectile dysfunction is a common physical side effect of prostate cancer treatment. After the cancer is treated, the signal process that needs to trigger sexual arousal may be weakened due to radiation, surgery, or chemotherapy. Since the nerves around the prostate gland may have been damaged, this makes it more difficult to get blood flow to the penis.

Overcoming erectile dysfunction after cancer is possible as long as the nerves were not destroyed during the treatment process. However, even though the process of recovery is possible, it may be slow. On average, it takes 4 to 24 months to reach a full erection during sexual intercourse.

There are several treatments for ED such as medicines, devices, penile injections and implants, suppositories, and pumps. Your doctor can run through the pros and cons of each treatment with you.

Prostatitis

Prostatitis is a condition where the prostate gland is inflamed and tender. Prostatitis is often very painful. Men may experience pain when peeing, pain in the groin, genitals, or pelvic area. Thankfully, prostatitis is a noncancerous condition that is treatable with certain medications.

There are four different types of prostatitis and each comes with its own set of symptoms.

Acute bacterial prostatitis

This is a prostate bacterial infection that often happens very quickly. Bacteria may have found its way to your prostate through your urinary tract. This form of prostatitis can be very severe and painful. If you are experiencing any of the symptoms below, it's best to immediately contact your doctor.

Symptoms may include an emergency sense of having to pee, but only a little bit of urine actually comes out. Additional symptoms include chills, high fever, difficulty peeing, cloudy urine, and pain behind the scrotum.

Chronic bacterial prostatitis

This form of prostatitis is a milder bacterial infection that can last for months. The symptoms may flow in the level of pain and severity. Chronic bacterial prostatitis may occur after acute bacterial prostatitis due to a urinary tract infection (UTI) or sexually transmitted infection (STI). It's more commonly found in older men but can affect younger men as well.

Symptoms may include nocturia (waking up and having to urgently pee in the middle of the night), blood in your semen or urine, painful urination or ejaculation, difficulty peeing, a weak flow of urine, lower back pain, and pee that has a foul-smelling odor.

Serious complications could arise if chronic bacterial prostatitis is left untreated. This degree of discomfort may also cause erectile dysfunction and affect your sex life.

Chronic prostatitis/Chronic pelvic pain syndrome

Chronic prostatitis, also known as chronic pelvic pain syndrome, is the most common type of prostatitis but also the least understood since doctors aren't sure of what causes it. Doctors suspect it may be linked to chronic fatigue syndrome, immune disorders, UTIs, chemicals found in urine, and irritable bowel syndrome.

This form of prostatitis affects 10 to 15 percent of men in the United States. Unlike acute and chronic bacterial prostatitis, this form is not a bacterial infection. However, many of the same symptoms are still shared.

Symptoms of chronic pelvic pain syndrome may include discomfort or pain lasting more than 3 months in the following areas: lower abdomen, penis, scrotum, anus, lower back, and pelvic area. There are also other symptoms such as painful ejaculation problems, frequent urination, urgency, stop-start urination, and weak urine flow.

A physical exam can help diagnose what type of prostatitis you may have since so many of the symptoms overlap.

Asymptomatic inflammatory prostatitis

Men with asymptomatic prostatitis have an enlarged prostate however they experience no symptoms. Since there are no symptoms or infection, most men don't know they have prostatitis until they get a blood test done. This type of prostatitis does not need treatment. However, asymptomatic inflammatory prostatitis may affect male fertility and affect sperm count.

Diagnosis

Whether you're having issues in the bedroom or the bathroom (or both), it's smart to talk to your doctor to find a proper diagnosis.

To find out if you have any of the prostate diseases mentioned, a urologist or doctor will need to perform exams and analyze your symptoms. There could be several reasons behind an enlarged prostate and erectile dysfunction. Below are some of the most common tests performed on men to access their reproductive health.

Medical history

You'll need to provide your complete medical history to your doctor. This helps your doctor see if certain conditions and illnesses run in your family. You'll be asked to provide your personal medical history, family health history, any history of substance or alcohol abuse, sexually transmitted diseases, diet and exercise habits, mental health symptoms such as depression and anxiety, allergies, and medications you're taking.

Your doctor may also ask you if you're experiencing any sexual problems such as a decreased libido, trouble reaching or sustaining erections, and how frequently you've been sexually active.

While many of these questions might feel invasive and embarrassing to answer, it's important to be transparent with your doctor and provide an accurate picture of your overall health. This information helps your doctor connect important insights and also have an idea of what your future health risks may be.

Physical exam

After accessing your medical and sexual history, the doctor will perform a physical exam. During this exam your doctor will check vital signs such as blood pressure, heart rate, respiration rate, and body temperature. Checking your vital signs will let the doctor know if you're at risk for hypertension (high blood pressure), have a heart murmur or an irregular heart beat, or if there's presence of lung disease.

Your physician will also assess your overall appearance, skin, eyes, teeth, and gums. Your doctor will also examine your abdomen (to check your liver) and test your reflexes and senses.

A physical exam for men commonly includes a testicular exam, to check for tenderness, lumps, or abnormal growth. Your hernia is also checked for any signs of weakness in the scrotum. This is where the doctor will have you 'turn and cough.' Your penis will also be surveyed for any signs of sexually transmitted infections or abnormalities.

Digital rectal exam

A digital rectal exam (DRE) is a specific test used to check the prostate. Since your doctor cannot visually access the health of your prostate, they'll need to feel it by inserting a lubricated and gloved finger into the rectum. The rectal exam checks for pain, swelling, size, and hard or lumpy abnormalities.

This exam helps doctors detect an enlarged prostate and signs of prostate cancer. Thankfully this procedure only takes a few minutes. You may experience some slight discomfort during the test, however it shouldn't be painful.

Urinalysis

A urinalysis is a test performed to check your urine for urinary tract infections, kidney disease, liver disease, and diabetes. Your urine is then examined for appearance, cloudiness, odor, and volume. Your urine is also dipstick tested for acidity, concentration, protein levels, sugar, ketones, bilirubin, and blood. Your health care provider will breakdown the results for you.

Blood test

A blood test measures protein levels of the prostate gland, provides complete blood count, glucose, cholesterol, and testosterone levels. Certain blood tests can also check the function of your thyroid. Your thyroid is a butterfly shaped gland found in your neck. Part of it is responsible for assisting with the flow of sex hormones.

Hormone test

If you're experiencing a decrease in sexual desire and struggling with erectile dysfunction, it may be because of your hormones. A hormone test will check your testosterone levels to see if they're in a healthy range. Low testosterone levels tend to cause a low libido. The American Urology Association considers low t-levels to be less than 300 nanograms per deciliter. Low testosterone levels can also be an indicator of congenital conditions, diabetes, and high blood pressure.

Mental health evaluation

Psychological issues can also hold you back from overcoming erectile dysfunction. Performance anxiety, chronic stress, depression, and general anxiety can strain your sex life. A lack of arousal could be related to a mental health condition. Going to therapy or meeting with a psychologist can help you address and overcome any issues you may be experiencing. Couples therapy can also bridge any distance between you and your partner and help restore sexual function in the bedroom.

Nocturnal penile tumescence test

Nocturnal penile tumescence (NPT) test is an overnight erection test. On average, men experience three to five erections during the night. To find out if you're getting nocturnal erections, your doctor may perform an overnight test. There are different at-home methods and devices that measure how many erections you're getting, how long they last, and how strong they are.

If you are getting nocturnal erections, your struggles with erectile dysfunction could be related to a mental or emotional block.

Treatment

Once a doctor has diagnosed the culprit of an enlarged prostate or erectile dysfunction, there are several treatments available. You and your doctor can discuss the best suitable treatment for your unique symptoms and needs. Common treatments include medication, surgery, and lifestyle changes.

Prostate Medications

There are several medications that can help treat an enlarged prostate. Below are common medications that are prescribed to treat a swollen prostate.

Alpha blockers help relax the muscles of the bladder, making it easier for urine to flow. Examples of alpha blockers include Flomax (tamsulosin ) and Hytrin (terazosin). Alpha blockers do not shrink the size of an enlarged prostate, but they do help with urination symptoms. They're also used to treat high blood pressure, a condition that could also affect erectile function.

Common medications include:

  • Avodart

  • Proscar

  • Cialis

  • Ditropan

  • Detrol

ED medications and treatment

There are various medications and treatments available to help with erectile dysfunction. Your doctor may recommend some of the following options below.

Medications such as:

  • Sildenafil

  • Vardenafil

  • Tadalafil

  • Avanafil

All of these medications help improve blood flow to the penis. Each medication has it's own chemical makeup, side effects, and how quickly it takes to go into effect. Your doctor may make recommendations based on your preferences, budget, and existing health conditions. Most men do not experience severe side effects with ED medications. However, side effects may include flushing, headache, indigestion, blurred vision, runny nose, or back pain.

Treatments

  • Injections

  • Penile bands

  • Vacuum pumps

  • Testosterone replacement therapy (for low testosterone levels)

Surgery

Enlarged prostate surgery may sound scary but it's not as invasive as you might think. Many doctors are using newer technologies and performing minimally invasive procedures. These procedures have a faster recovery time and are generally less risky. If your case is more severe, you may not be a candidate for a minimally invasive surgery. Your doctor will have to assess the size of your prostate and your overall health.

Since an enlarged prostate can cause erectile dysfunction, many of these surgeries that are designed to sooth benign prostatic hyperplasia symptoms may also help cure ED.

Types of minimally invasive surgeries include:

  • Transurethral microwave therapy (TUMT). An instrument called an antenna is inserted into the urethra to reach the prostate. A combination of microwave energy and cooling fluid is circulated through the antenna. The controlled high temps help kill excess prostate tissue. As the prostate heals and shrinks, there's less blockage. This process only requires one treatment.

  • Transurethral resection of the prostate (TURP). This is a surgical procedure that requires cutting away a portion of the prostate to reduce its overall size. This procedure is performed with a resectoscope, through the urethra. The loop of the wire on the resectoscope is then heated with a strong electric current to cut off part of the prostate. A catheter is then used to flush away the removed prostate pieces. You'll need to stay in the hospital for 1 to 3 days and full recovery usually takes two to four weeks.

  • Transurethral incision of the prostate (TUIP). For this procedure an instrument is inserted into the urethra that generates an electric current to make incisions where the prostate meets the bladder. Making muscle incisions in this area helps relax the bladder and release pressure, helping improve the flow of urine. No hospital stay is required for this procedure and recovery may take 1 to 2 weeks.

  • Laser surgery. Laser energy is used to kill off excess prostate tissue and shrink the enlarged prostate gland. Lasers use precise light and intense heat to deliver energy. There are different laser procedures such as PVP, HoLAP, and HoLEP. Recovery time usually takes 1 to 2 weeks.

  • Rezūm water vapor therapy. This non-surgical procedure uses natural energy stored in water vapor and steam to remove excess prostate tissue that is putting pressure on the urethra. This procedure is typically performed in a urologist's office and takes 9 seconds per treatment. The number of treatments depends on the size of your prostate.

  • UroLift system. This procedure uses tiny Urolift implants to lift and hold enlarged prostate tissue out of the way of the urethra, clearing up any blockages and improving urine flow. No prostate tissue is destroyed or removed for this process. Most patients take 1 to 2 weeks to recover after treatment.

Lifestyle changes

Positive lifestyle habits may help soothe erectile dysfunction and enlarged prostate symptoms. For a healthy prostate, it's best to make key changes to your lifestyle in order to restore your sexual health. Here are some ways to start improving your life.

  • Stop smoking. Research suggests that smoking may be a major culprit of erectile dysfunction as well as other male reproductive health issues. A recent survey revealed that men who smoke 20 plus cigarettes a day were 60% more likely to struggle with impotence.

  • Limit your alcohol intake. Booze is bad news for the bedroom. Chronic drinking can lead to long-term erectile dysfunction and decreased sexual desire. Alcohol is also a depressant that can negatively impact your mood and intimate relationships.

  • Exercise regularly. Regular exercise helps increase blood flow, cardiovascular endurance, and heart health. It can also address sexual problems in the bedroom and restore erectile function. Moderate exercise such as walking, cycling, dancing, and jogging are great ways to stay healthy.

  • Eat healthy. What you eat matters for your prostate and sexual health. There have been studies that show that the plant-based Mediterranean diet helps tremendously with ED, obesity, and cardiovascular disease.

Remember to also take inventory of the medications you're taking (and their side effects). Overcoming erectile dysfunction and having a healthier prostate is possible with mindful habits.

Summary

It is possible that prostate diseases such as prostatitis and benign prostatic hyperplasia, and prostate cancer may be causing erectile dysfunction. A swollen prostate is known to cause urinary tract symptoms and sexual symptoms. If you're struggling to maintain an erection or with any of the symptoms mentioned in this article, it's best to meet with your doctor for a thorough physical exam. Having a proper diagnosis will help you pursue the right treatment plan.