Can an enlarged prostate keep you from ejaculating?

Enlarged prostate, or BPH, is one of the most common urological conditions that a man can encounter as he gets older. It can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder and other urinary tract, bladder, or kidney problems. Statistics show that 50% of men over the age of 50 will have BPH, then 60% over 60, and so forth, increasing by 10% with every decade of life. Accordingly, as men get older, they're also more prone to have sexual dysfunction.

There is no evidence that having BPH leads immediately to erectile dysfunction, yet there are relationships between BPH and erectile dysfunction. In general, these relationships are due to patients with BPH who may have other numerous medical conditions that are also associated with erectile dysfunction like hypertension, lipid abnormalities, diabetes, heart disease, etc.

An enlarged prostate does not impair the ability to ejaculate. However, some of the therapies used for management of urinary symptoms may cause ejaculatory dysfunction. Historically, BPH treatment starts with medications, including pills: Flomax, finasteride, dutasteride, Proscar, Avodart, etc. Many men have tried these medications and have side effects, including inability to ejaculate or retrograde ejaculation (which means what at the time of an orgasm, there is no ejaculate to the outside; rather, the ejaculate goes to the inside). These treatments can cause sexual issues in terms of the inability to get and keep an erection, particularly with some medications that have a few hormonal effects. And more importantly, they can drop blood pressure. Certainly, in certain patients who are a little bit older, that drop in blood pressure can cause falls and sometimes injuries. These side effects are temporary and resolve with cessation of pills.

When the pills don't work, treatments go to surgery such as TURP, where you basically carve out a part of the prostate to make the passageway of the urine bigger. These surgeries may have irreversible side effects that cause erectile dysfunction as well as ejaculatory dysfunction after surgery, retrograde ejaculation, sexual issues, bleeding, and can sometimes require catheters to be placed again. Additionally, they can cause incontinence in up to 1% of people, which can be quite disconcerting to a lot of patients.