Benign Prostatic Hyperplasia (BPH), a common condition in aging men, often raises concerns about its impact on daily life, particularly regarding urinary function. Many individuals also wonder about its potential effects on sexual health, specifically ejaculation. This article explores how BPH can influence ejaculatory function and examines the effects of its various treatments.
Understanding Benign Prostatic Hyperplasia
Benign Prostatic Hyperplasia refers to a non-cancerous enlargement of the prostate gland. The prostate, a walnut-sized gland, is located below the bladder and surrounds the urethra, which carries urine and semen. Its function involves producing fluid for semen, contributing to sperm health and mobility.
As men age, the prostate can gradually enlarge. This enlargement, if significant, can compress the urethra. The compression obstructs urine flow from the bladder, leading to lower urinary tract symptoms such as frequent urination, urgency, a weak stream, and incomplete bladder emptying.
Direct Impact of BPH on Ejaculation
While BPH primarily affects urinary function, the enlarged prostate can also interfere with ejaculation. The prostate plays a role in propelling semen through the urethra during ejaculation. An enlarged gland can hinder this due to increased tissue volume around the urethra.
Some men with BPH report reduced ejaculate volume, possibly due to obstruction from the enlarged prostate. Painful ejaculation (dysorgasmia) can also occur. About 20% of sexually active men with BPH symptoms experience pain or discomfort during ejaculation.
Retrograde ejaculation, where semen flows backward into the bladder, is another potential impact. While BPH itself does not cause dry ejaculation, physical changes within the prostate can contribute to it by altering the semen pathway. This can occur if the enlarged prostate affects the bladder neck’s closing mechanism during ejaculation.
Treatment Effects on Ejaculatory Function
Treatments for BPH, both medical and surgical, can influence ejaculatory function. Alpha-blockers, common BPH medications, relax smooth muscles in the prostate and bladder neck, improving urine flow. While effective for urinary symptoms, they can lead to ejaculatory dysfunction, most notably retrograde ejaculation.
Alpha-blockers like tamsulosin and silodosin are associated with a higher incidence of ejaculatory disorders, including retrograde ejaculation. Alfuzosin may have a lower rate of sexual side effects compared to other alpha-blockers.
Another class, 5-alpha reductase inhibitors (5-ARIs) like finasteride and dutasteride, shrink the prostate by preventing hormone-related growth. These medications can reduce ejaculate volume and may decrease libido. They can also lead to ejaculatory disorder, though this side effect is less studied than their impact on erectile function and libido.
Surgical procedures like Transurethral Resection of the Prostate (TURP) effectively relieve urinary obstruction but carry a significant risk of ejaculatory changes. Retrograde ejaculation is a common side effect of TURP, occurring in 65% to 75% of men. This happens because the procedure alters the bladder neck, allowing semen to flow backward.
Minimally invasive procedures, such as prostatic urethral lift (UroLift) and Rezūm water vapor therapy, aim to preserve ejaculatory function while treating BPH. These newer techniques often have a lower incidence of ejaculatory dysfunction compared to traditional surgery, with some patients even reporting improved ejaculation after certain procedures.