Is BPH the cause of your ED and Ejaculation Issues? What to know about it and treatment options.

By: Mark Pressprich, M.D.

An enlarged prostate, also known as benign prostatic hyperplasia, or BPH, is a health condition in which the prostate gland grows larger than normal, largely driven by age and genetics. This non-cancerous growth does cause problems, most often because the growth squeezes the urethra, making it difficult to urinate.

According to 2025 research from the National Library of Medicine, men with erectile dysfunction are 1.3 to 6.2 times more likely to have an enlarged prostate than the general population. Moreover, recent international studies show that men with enlarged prostates are also more likely to experience ejaculation dysfunction.

BPH on its own is rarely a cause of sexual performance issues, but because they often occur together, it’s important to understand the ways that treatments for BPH might affect sexual performance.

Take our BPH symptom quiz here.

Read about men’s prostate health and conditions here.

If you, or someone you love, is experiencing these symptoms, you can do something about it. Understanding what causes BPH and what treatment options exist is the first step.

BPH in a nutshell: why it happens and who is at risk

The prostate is a small gland located just below the bladder and above the rectum. The urethra runs through its center to the penis. About 70% of the prostate is glandular tissue.

As men approach their 40s and 50s, a portion of this tissue surrounding the urethra begins to grow. Researchers believe this might be due to shifts in the balance of sex hormones that occur with age.

This is a natural occurrence, but because the tissue often compresses the urethra, blocking the passage of urine, it can lead to complications of the bladder, kidney, and urinary tract.

Typical BPH symptoms include:

• Straining, or difficulty starting to urinate
• Sudden, strong urges to urinate
• An inability to completely empty the bladder
• Peeing more frequently, especially at night (also known as nocturia)
• Having a weaker urine stream
• Leakage

How BPH can interfere with a man’s sex life

The prostate’s primary role is to produce part of the seminal fluid, the liquid component of semen, making it essential for both ejaculation and reproduction. The prostate also sits close to nerves and blood vessels that supply the penis. As a result, some BPH treatments can affect them and potentially cause erectile dysfunction.

Furthermore, certain BPH treatments affect the junction between the prostate and the bladder called the bladder neck. If the bladder neck is compromised, semen flows backwards into the bladder at the time of ejaculation, which is called retrograde ejaculation. Men with this symptom will still experience orgasm but will not see semen come out, which can be distressing and can adversely affect fertility.

Health conditions like cardiovascular disease, smoking, and diabetes can cause nerve and blood vessel damage and so can contribute to erectile disorders. This same damage can also affect bladder function and so exacerbate BPH symptoms.

What you can do about BPH and sexual issues

If you are properly diagnosed with BPH, lifestyle changes may ease your symptoms. These practices can be combined with medications.

Some lifestyle modifications and medications for BPH:

• Control your urination schedule – Known as timed voiding, make a routine of urinating on a regular basis rather than when the need strikes. Aim for every two hours. When finished, wait 10 seconds and try to urinate again to ensure your bladder is empty (double voiding).
• Dial back on caffeine and alcohol – These diuretics will cause you to urinate more and make it difficult to stick to timed voiding. Further, they irritate the bladder lining.
• Stop drinking and eating three hours before sleep – Cutting off fluids will reduce the risk of having to get up a few hours later. This applies to foods because many contain liquid and/or bladder irritants.
• Perform Kegel exercises – Yes, these pelvic-strengthening squeezes benefit men as well. Tighten your pelvic muscles for 5 seconds, as if you’re holding in urine, then relax. Repeat 10 times daily. This tutorial on male Kegel exercises can help.
• Medications – Alpha-blockers such as tamsulosin or PDE5 inhibitors such as tadalafil (Cialis) relax the urethra and bladder neck, so urine passes more easily. A common side effect of tamsulosin is retrograde ejaculation as discussed above.

Cialis also improves penile blood flow, making it effective for both ED and BPH, especially when taken daily. However, drugs designed to shrink the prostate (5-alpha reductase inhibitors) have been linked to ED, ejaculatory dysfunction, and reduced libido.

Sex-Friendly Pathways for Treating BPH

If your BPH persists, your doctor will recommend a menu of options and can tailor your treatment plan to minimize sexual side effects if desired.

BPH treatments with the least chances of sexual side effects include:

• Prostate artery embolization (PAE) – In this revolutionary, minimally invasive procedure, blood flow to the enlarged prostate tissue is blocked through the arteries, so the tissue shrinks. We perform PAE at our Interventional Radiology Center. Click here to learn more about the PAE approach.
• Urethral expansion devices – These minimally invasive procedures expand the urethra by inserting a temporary instrument into it. We offer two options:
  • The iTind approach involves a small, collapsed device that gently expands the urethra over five to seven days and is then removed.
  • TheOptilume BPH procedure, wherein the doctor inserts a drug-coated balloon that dilates the space between the prostate’s lobes. The drug prevents the lobes from fusing, so urine can pass.
• UroLift – This unique approach involves no cutting whatsoever. Instead, tissue blocking the urethra is pulled back by small implants inserted through a urethral scope into each side of the prostate.
• Rezūm Water Vapor Therapy – Designed to reduce prostate size while preserving sexual function, Rezūm relies on highly targeted, controlled steam to remove enlarged prostate tissue without an incision.
• Aquablation – This robotic-surgery procedure is incision-free and carries lower risks of ED than other surgeries. Aquablation precisely cuts away enlarged tissue with high-pressure, heat-free water jets delivered through a thin scope in the urethra.
• GreenLight Therapy – While this minimally invasive procedure carries lower risks of sexual side effects, they can occur. It vaporizes the enlarged tissue with directed lasers.

If your BPH is severe enough to require robotic or open surgery to remove the tissue, you might be more vulnerable to sexual side effects. Talk to your doctor about potential links between medical and surgical treatments for BPH and sexual dysfunction in the early stages of seeking treatment.

Together, you can choose a treatment pathway that will relieve your urinary symptoms while considering your age, lifestyle, and sexual activity.

You don’t have to just live with BPH. Click here to review our downloadable BPH Treatment Pathways chart. If you are interested in participating in new BPH treatments, click here to see which clinical trials are available at Michigan Institute of Urology.