BPH and erectile dysfunction can occur together, and their treatments can overlap. Tadalafil may help both urinary symptoms and erections in suitable men, but it is not safe with nitrates. Other medicines and BPH procedures have different effects on erections and ejaculation. Start by identifying which symptom matters most and reviewing your medicines, cardiovascular health and treatment goals with a clinician.
Understanding the Link Between BPH and Erectile Dysfunction
Research shows that men with BPH are more likely to experience erectile dysfunction compared to those without prostate issues. Several factors contribute to this relationship. First, both conditions share risk factors and underlying mechanisms, including aging, vascular disease, and changes in smooth muscle and nerve function in the pelvis. Second, the discomfort, stress, and sleep disturbances associated with BPH may contribute to ED indirectly. Finally, some medications used to treat BPH have been linked to sexual side effects: 5-alpha reductase inhibitors can reduce libido and erectile function, while alpha blockers mainly affect ejaculation.
Recognizing these connections is important because treatment for one condition may worsen or improve the other. For example, certain therapies can address urinary symptoms while also supporting erectile function. Patients should always discuss with their doctors the impact of BPH treatments on sexual health, ensuring a holistic approach to care.
To discuss your symptoms and care options, request a consultation with the 1Prostate team.
Medication-Based Approaches
Phosphodiesterase-5 (PDE5) inhibitors, such as tadalafil, are commonly used to treat erectile dysfunction. Interestingly, tadalafil has also been approved for managing lower urinary tract symptoms related to BPH. This dual benefit makes it an appealing choice for men experiencing both conditions. By improving blood flow to the penis, PDE5 inhibitors support erections, and they also relax smooth muscle in the prostate and bladder, which can ease urinary symptoms even though urine flow rate usually does not change much. PDE5 inhibitors must never be taken with nitrate medications and should be combined with alpha blockers only under medical supervision because of the risk of low blood pressure.
Other medications, such as alpha blockers, focus primarily on improving urinary flow but may have mixed effects on sexual function. Some men find their erections improve slightly, while others notice decreased ejaculation or reduced sexual satisfaction. On the other hand, 5-alpha reductase inhibitors can shrink the prostate over time but are more commonly associated with side effects like reduced libido and erectile problems. For men concerned about sexual health, it is crucial to weigh these risks and benefits carefully with their healthcare provider.
Minimally Invasive Procedures and Their Effects
When medications are not effective, procedures may be considered for BPH. Prostatic artery embolization (PAE), Dr. Shusterman's first-line procedure, and water vapor thermal therapy (Rezūm), his alternative, relieve urinary symptoms with minimal impact on sexual health; transurethral microwave therapy is an older in-office heat option. Laser surgery and TURP are invasive surgery that commonly cause retrograde ejaculation and carry a small risk of worsening erectile function.
Prostatic urethral lift (UroLift) uses implants to hold prostate tissue away from the urethra and can preserve sexual function. Suitability depends on prostate size and anatomy, symptoms and treatment goals; some men need further treatment later. In Dr. Shusterman’s practice, PAE is usually discussed first, with alternatives considered after an individual evaluation.
Lifestyle Modifications and Supportive Care
Beyond medical and procedural treatments, lifestyle adjustments play an important role in managing both ED and BPH. Men are encouraged to maintain a healthy weight, exercise regularly, and adopt a diet rich in fruits, vegetables, and whole grains. These habits improve blood flow, hormone balance, and energy levels, all of which contribute to better urinary and sexual function.
Stress management is equally important. Anxiety about urinary symptoms or sexual performance can worsen ED, creating a cycle that impacts mental and physical health. Techniques such as mindfulness, therapy, and open communication with a partner can help reduce stress and improve outcomes. Hydration habits should also be adjusted to reduce nighttime urination without compromising overall prostate health.
Talking With Your Doctor About Treatment Options
Because both ED and BPH affect quality of life, men should not hesitate to bring up concerns with their doctors. Preparing questions about how treatments will affect sexual health, what side effects to expect, and whether combination therapies are available ensures patients receive personalized guidance. Dr. David Shusterman encourages patients to see these discussions as essential to long-term well-being, not as uncomfortable conversations to avoid.
By understanding the full range of treatment options—from medications to lifestyle changes—patients can work with their doctors to create a plan that addresses both urinary symptoms and erectile function. Each man’s situation is unique, and tailored care is key to balancing effective management with quality of life.
Taking Control of Health in Manhattan and Queens
Erectile dysfunction and benign prostatic hyperplasia are conditions that often occur together, and understanding how treatments overlap is critical. Medications like tadalafil, minimally invasive procedures, and lifestyle changes all provide avenues to improve both urinary and sexual health. At 1Prostate Center, serving Manhattan and Queens, Dr. David Shusterman emphasizes that men do not have to choose between managing one condition at the expense of the other. With informed decision-making and open communication, men can find treatment strategies that protect both prostate function and sexual well-being.
Questions patients ask
Does treating BPH cure erectile dysfunction?
Not necessarily. ED may also involve blood vessel disease, diabetes, medicine effects or emotional factors. Improving urination does not guarantee restored erections; an ED assessment may still be needed.
Are ejaculation and erections the same outcome?
No. A treatment may preserve erections yet change the amount or direction of semen released. Ask separately about erectile function, ejaculation and fertility before choosing a BPH procedure.
Sources
- Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (2026). American Urological Association, 2026.
- Erectile Dysfunction (ED) Guideline. American Urological Association, 2018.
- Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol, 2003.
- Tadalafil relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol, 2007.
- A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with α-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol, 2012.
- Impact of medical treatments for male lower urinary tract symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review and meta-analysis. J Sex Med, 2014.
- Treatment of LUTS secondary to BPH while preserving sexual function: randomized controlled study of prostatic urethral lift. J Sex Med, 2014.
- Erectile and Ejaculatory Function Preserved With Convective Water Vapor Energy Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Randomized Controlled Study. J Sex Med, 2016.
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