An enlarged prostate is a treatable condition. Unfortunately, the standard treatments for benign prostatic hyperplasia often lead to various sexual problems. When you are being treated for BPH, you may experience decreased libido and less sexual satisfaction. You may also develop impotence.
The link between BPH and erectile dysfunction is quite complex. Men who have erectile dysfunction often also develop an enlarged prostate. And most men who have BPH end up developing erectile dysfunction.
BPH medications either stop the production of testosterone or block the hormone’s actions. This is because testosterone, when broken down to its byproduct, can stimulate the prostate gland to further grow in size.
Two types of medications are typically prescribed to treat an enlarged prostate. The first type of medication is called alpha-blockers. Also referred to as alpha-adrenergic antagonists, alpha-blockers work by helping your small arteries and veins dilated.
By preventing norepinephrine from making your blood vessel walls tight, alpha-blockers enable your blood vessels to remain relaxed and open. This then results in better blood circulation and improved blood pressure. This is also one of the reasons why alpha-blockers are often prescribed for patients with high blood pressure.
In men with BPH, alpha-blockers work by improving urine flow. The main focus of alpha-blocker therapy for BPH is to help reduce the symptoms of the disease. Men with BPH often experience lower urinary tract symptoms or LUTS. This means that when you have an enlarged prostate, you will most likely experience a host of urinary problems.
Although alpha-blockers are great for reducing urinary symptoms of BPH, the problem is that there are alpha-blockers that cause sexual problems as a side effect. You may experience ejaculatory problems like delayed ejaculation or premature ejaculation if you’re taking alpha-blockers.
The second type of BPH medication is called 5-alpha reductase inhibitor. These medications work differently compared to alpha-blockers. While alpha-blockers improve the patient’s convenience by reducing urinary symptoms, 5-alpha reductase inhibitors, on the other hand, prevent further enlargement of the prostate.
The functions and normal growth of your prostate gland are basically dependent on the conversion of testosterone to dihydrotestosterone (DHT). The conversion happens through a reduction process facilitated by enzymes called 5-alpha reductase. When your DHT levels are too high, you are at risk of developing an enlarged prostate or even prostate cancer.
Medications that inhibit the actions of 5-alpha reductase prevent testosterone from being broken down to DHT. This then helps suppress the actions of DHT on your prostate cells and controls your DHT levels so that your prostate cells do not become stimulated to grow and multiply.
Dutasteride and finasteride are the two types of 5-alpha reductase inhibitors that are currently available on the market. Unfortunately, both these drugs are associated with adverse sexual effects.
According to one study, the prevalence of adverse sexual effects on men taking 5-alpha reductase inhibitors ranges from 2% to as high as 38%. Erectile dysfunction is the most common sexual problem encountered by men taking 5-alpha reductase inhibitors, followed by ejaculatory disorders and reduced sex drive.
Another study reported that due to these adverse sexual effects, various psychological problems often follow. Your self-esteem may be negatively affected, your quality of life may take a turn for the worse, and your ability to engage in and maintain intimate relationships may also be impaired.
Not only that, the actions of 5-alpha reductase inhibitors can also influence your deoxycorticosterone and progesterone levels, which can lead to altered psychologic functions. For instance, depression and melancholy are often experienced by men taking 5-alpha reductase inhibitors.
Surgical Treatment of BPH
There are cases wherein an enlarged prostate is treated through surgery. However, prostate surgeries often lead to long-term sexual problems. For instance, when a transurethral resection surgery (TURP) is performed on your prostate, it may lead to erectile dysfunction and other ejaculatory problems.
When a transurethral resection of the prostate surgery is performed, a resectoscope is inserted through your penis to your urethra. Through the use of the resectoscope, excess prostate tissues that are blocking your urine flow are removed.
A TURP is performed when the patient is not receptive to BPH medications and is experiencing severe BPH-related urinary problems. Aside from treating an enlarged prostate, a TURP may also be performed to remove blockages to the urine flow such as bladder stones.
Even minimally invasive surgeries such as a prostatic urethral lift, laser treatments, and heat or microwave treatments may also lead to sexual problems like retrograde ejaculation. When you suffer from retrograde ejaculation, it means that your semen goes back to your bladder instead of coming out of your penis when you ejaculate.
Another type of surgery called the transurethral incision of the prostate or TUIP may also result in erectile dysfunction. This type of surgery is performed to allow urine to flow more freely from the bladder to the urethra, thereby reducing urinary problems caused by BPH.
Compared to TURP, TUIP is considered more advantageous since the risks of bleeding are lower. Hence, TUIP is recommended for men who are taking blood thinners or who have bleeding disorders.
In addition, TUIP presents lower risks of retrograde ejaculation or dry ejaculation. This is important for men who are trying to conceive with their partner. Since your semen goes back to your bladder when you have retrograde ejaculation, you may be at risk of developing infertility.
Erectile Dysfunction Medications
Prescribed medications for erectile dysfunction such as sildenafil, tadalafil, and vardenafil work by preventing the breaking down of cyclic guanosine monophospate or cGMP. This chemical promotes the relaxation of your smooth muscles in your penis. This then results in an inflow of blood to your sex organ, causing an erection.
Although these drugs are approved for the treatment of erectile dysfunction, they are not approved for BPH treatment, despite the fact that several studies showed that these erectile dysfunction medications were also able to relieve various BPH urinary symptoms.
For instance, in one study, the effects of tadalafil on both BPH and erectile dysfunction were investigated. The study involved men who were suffering from erectile dysfunction for more than three months and, at the same time, experienced lower urinary tract symptoms due to BPH.
The results showed that 5 mg of tadalafil taken daily for a total of twelve weeks resulted in improved erectile function and in the reduction of the urinary symptoms associated with benign prostatic hyperplasia.