Benign Prostatic Hyperplasia (BPH) is the non-cancerous growth of the prostate gland, a common issue affecting aging men, with prevalence rising significantly after age 60. This condition, which involves the prostate surrounding the urethra, can impact a man’s sexual function, specifically ejaculation. Understanding the mechanisms of this effect, both from the enlarged gland and subsequent treatments, is important. This article explores how BPH and its common interventions influence the ejaculatory process.
Understanding Benign Prostatic Hyperplasia
The primary effect of an enlarged prostate is pressure on the urethra, the tube that carries urine from the bladder, leading to lower urinary tract symptoms (LUTS). These symptoms are often the first sign of BPH, prompting men to seek medical attention. The physical blockage at the bladder neck restricts urine flow, causing noticeable changes in voiding habits.
Common LUTS include an increased urge to urinate, frequent urination, and nocturia (waking up multiple times during the night to void). Men may also experience difficulty initiating the stream, a weak urinary flow, and a feeling that the bladder has not emptied completely. While these urinary issues are the most recognized clinical manifestations, they do not fully represent the condition’s potential influence on reproductive health.
How BPH Affects Ejaculation Mechanics
The enlarged prostate can mechanically interfere with ejaculation. During orgasm, the prostate and smooth muscles around the bladder neck contract to propel semen forward and prevent it from entering the bladder. The physical size and inflammation of the BPH tissue can disrupt this coordinated muscular action.
The compression exerted by the enlarged gland can reduce the volume of fluid expelled during climax. A decrease in ejaculate volume is a common ejaculatory disorder reported by men with BPH before intervention. Inflammation within the prostate tissue can sometimes lead to discomfort or pain during or immediately after ejaculation. This pain, although less common than reduced volume, can diminish sexual satisfaction.
Ejaculation Changes Caused by BPH Treatment
Changes in ejaculatory function are most frequently seen as a side effect of the common medical and surgical treatments for BPH, rather than the condition itself.
Medical Treatment: Alpha-Blockers
The most significant changes are often caused by alpha-blockers, a first-line treatment for BPH symptoms. These drugs, such as tamsulosin and silodosin, relax the smooth muscles in the prostate and the bladder neck, which reduces pressure on the urethra and improves urine flow.
This muscle relaxation interferes with ejaculation mechanics. The bladder neck sphincter, which normally closes during climax, remains relaxed. This allows semen to flow backward into the bladder, a common side effect known as retrograde ejaculation. Retrograde ejaculation results in a “dry orgasm,” meaning a reduced or absent amount of visible ejaculate, which is typically reversible once the medication is stopped.
Surgical Procedures
Surgical procedures for BPH, such as Transurethral Resection of the Prostate (TURP) or various laser surgeries, carry a high risk of causing permanent ejaculatory changes. These procedures involve removing or ablating obstructive prostate tissue near the bladder neck to create a wider channel for urine.
This physical alteration of the bladder neck anatomy eliminates the mechanism for the sphincter to close completely during orgasm. As a result, retrograde ejaculation is a frequent and long-term consequence of BPH surgery, affecting more than 80% of patients who undergo a TURP procedure. While retrograde ejaculation can affect fertility, it generally does not diminish the sensation of orgasm itself.