BPH and intimacy

Understand. Communicate. Become a team.

Closeness and sexuality are important at any age

In addition to other sex-related issues that men may face as they grow older, research shows that common symptoms of BPH can also interfere with sexual function and desire.12 Many treatments for BPH, particularly surgical procedures and medications, can also cause changes in men’s sexual function.13 So these changes can affect you and your sexual relationship with your partner.

Both BPH and problems with sexual function become more and more common as men get older. So it is not surprising that many men with BPH have problems with sexual function as well. These problems include lower sexual desire (libido), ejaculation problems, and erectile dysfunction. But most studies don’t show a direct link between BPH symptoms and sexual dysfunction. It is well known that treatments for BPH have an impact on sexual function, so it is important for you and your partner to understand how these treatments can affect your sex life.

Sexual function after minimally invasive procedures or surgery for BPH

It may take up to a year for sexual function to return to normal after surgery but the good news is that with time, most men will be able to enjoy sex again.2 The effect of BPH surgery on sexual function varies depending on the type of procedure. Minimally invasive procedures such as TUMT and TUNA do not appear to have an effect on a man’s ability to withhold urine or have erections. During surgical procedures such as TURP and open surgery, the muscle that normally closes off the entrance to the bladder during ejaculation is cut. This can lead to a condition called retrograde ejaculation, or dry climax. This condition is not harmful to a man’s health. It means that during ejaculation, the sperm do not exit through the penis but instead enter the bladder and are flushed out in the urine.2 Although this "dry climax" may feel different, most men find they can enjoy sex as much as they did before surgery.2

Sexual side effects of BPH medication

Selective alpha-blockers work by relaxing the smooth muscle in the prostate and the bladder neck. But they may also relax the muscles in the vas deferens, the part of the male reproductive system that helps propel the sperm out into the urethra and penis.8This means that ejaculation may occur with little or no semen. As with retrograde ejaculation after surgery, this change in climax is not harmful to a man’s health. Also, this side effect will stop if medication is discontinued. Alpha-blockers do not affect a man’s ability to have erections or achieve orgasm.

The most common side effects of 5-alpha-reductase inhibitors are related to sexual function. The 5-ARIs interfere with the body’s production of dihydrotestosterone, a male hormone. Sexual side effects include impotence, decreased sexual desire, reduced semen with ejaculation, and other ejaculation problems.5

In other studies of men with health problems, spouses were more likely to start the process of getting medical help than the men themselves. 11

There’s no need to give up on sexual intimacy with your partner. Here are some steps you can take:

• Encourage your partner to talk with his doctor about any and all issues that may be embarrassing, such as lower urinary tract symptoms and anything else that interferes with his health or intimacy
• You and your partner should ask the doctor about the effects of BPH symptoms, medication, or procedures on sexual function. Most healthcare professionals understand the importance of sexuality in later life and are trained to help
• Talk to each other — before and after diagnosis and treatment.
  As awkward as it might seem, talking about sexual difficulties is a critical part of finding a solution. Good communication between partners can help with the adjustment to changes in sexual function after BPH treatment

Learn how you can help him start the conversation with his doctor
Learn about treatment options for BPH