If you have a common aging-related enlargement of the prostate, a condition called BPH, you may have some of the problems that come with it. These are problems like more frequent nighttime peeing, more urge to pee during the day, difficulty starting urine flow, inability to completely empty your bladder, even urinary tract infections that you never had before. All of these are linked with BPH, which stands for benign prostatic hyperplasia.
As if all those symptoms aren’t bad enough, a breakthrough presentation at a 2024 medical meeting has linked BPH with erectile dysfunction (ED). ED means the inability to achieve or maintain an erection sufficient for penetration during sex.
The talk, “BPH is linked with erectile dysfunction in US men,” was given before members of the Sexual Medicine Society of North America (SMSNA) during their 2024 Annual Fall Scientific Meeting (Oct. 17-20, Scottsdale, AZ).[i] In a noteworthy analysis of data based on 6,089,425 men, over 700,000 (12%) were found to have BPH according to their questionnaire answers for the National Health and Nutrition Examination Survey (2003-2004).
According to a new report, most of them were White non-Hispanic men between the ages of 40-59, and “… nearly 50% of men with BPH reported sometimes or never being able to hold an erection, compared with approximately 30% of men without BPH.”[ii] This is quite a compelling statistic.
Unfortunately, the presentation did not include information on the biological connection between prostate enlargement and sexual function. Does the gland’s growth somehow strain the nerves that control erectile response, where they “hug” the outside of the gland? A very technical 2013 journal article summarized several theories on interconnected biological and hormonal mechanisms that might explain the connection between BPH, lower urinary tract symptoms, and ED—but all hypotheses were the result of experiments with lab animals.[iii] Interested readers can click here for the entire article.
Need for early diagnosis and treatment
While the presentation’s authors don’t directly address the possible causal interactions between BPH and ED, they do point out the necessity of diagnosing both BPH and ED as early as possible in order to establish a treatment plan. For example, one way to rule out if BPH is the cause of ED would be to see if ED responds to medications like Viagra, Cialis, etc. If so, the BPH can be addressed separately.
For BPH, the first line treatment is medication to relax the muscles in the bladder neck and prostate to help ease urination. You may have heard of brand names like Flomax, Avodart and Proscar. While effective for most patients, long-term use of these medications has been found to have side effects such neurocognitive or psychological problems,[iv] and even heart failure.
Other solutions include procedures such as TURP (“reaming out” with surgical instruments) or alternatives to surgery using minimally invasive energy sources to widen the urethral passage through the prostate by destroying the lining. Additional methods use some type of implant to widen it.
At the Sperling Prostate Center, we offer MRI-guided focal laser treatment to destroy a focally enlarged area outside of the urethra that is creating a urinary blockage. Instead of destroying the urethra lining, this method shrinks the blockage by turning it into a reduced area of harmless scar tissue—which unblocks the urethra. This outpatient procedure results in successful urinary control, though if improved sexual function also occurred, it would be a secondary result, as it is not the intended purpose of the treatment.
Our recommendation for those men whose urinary function is diminished as a result of BPH is to see a doctor for diagnosis. The same is true for ED, whether or not it seems connected with BPH. Overlooking, ignoring, or neglecting your pelvic anatomy will not make problems go away. Don’t try to self-diagnose and self-treat. If either or both of these problems are short-circuiting your quality of life, don’t wait. See a doctor at your earliest convenience.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
References
[i] Paulsen O, Wu E, Demario V, et al. Benign prostatic enlargement is associated with erectile dysfunction in United States. Presented at: 2024 Sexual Medicine Society of North America Fall Scientific Meeting. October 17-20, 2024. Scottsdale, Arizona. Abstract 216.
[ii] Saylor, Benjamin. “BPH is linked with erectile dysfunction in US men.” Urology Times, Oct. 29, 2024. https://www.urologytimes.com/view/bph-is-linked-with-erectile-dysfunction-in-us-men
[iii] Glina S, Glina FP. Pathogenic mechanisms linking benign prostatic hyperplasia, lower urinary tract symptoms and erectile dysfunction. Ther Adv Urol. 2013 Aug;5(4):211-8.
[iv] Bortnick EM, Simma-Chiang V, Kaplan SA. Long-term Consequences of Medical Therapy for Benign Prostatic Hyperplasia. Rev Urol. 2019;21(4):154-157.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
