Many men approaching their late-forties and fifties will suffer from an enlarged prostate and/or erection problems. Since the prostrate is part of the male reproductive system, it is natural for many men to fear a connection between an enlarged prostate and erection problems. Most commonly this is the response of the individual first diagnosed for an enlarged prostate or benign prostate hyperplasia (BHP). There is no doubt that the symptoms of an enlarged prostate gland can affect attaining erection as a “nuisance” or psychologically. The more important question is whether there is a physiological connection.
Prostate and the Reproductive System
The prostate gland secretes the “seminal” fluid that transports sperm and provides the male ejaculate during sexual intercourse. An enlarged prostate or prostatitis can affect ejaculate volume by a decrease in prostate secretion. An enlarged prostate can also result in retrograde ejaculation. Retrograde ejaculation occurs when the semen travels backwards through the urethra towards the bladder because the enlarged prostate prevents ejaculation.
Prostate, Urination, and Erection Problems
Surrounding the urethra through which urine passes from the bladder for excretion, an enlarged prostate can significantly affect urine flow. Acting like a clamp, an enlarged prostate produces the most common symptoms of BPH. These prostatitis symptoms involve sometimes painful and often embarrassing problems with urination as evidenced by hesitance, an interrupted or weak stream, frequent urination, and a sense of urgency, leakage, or incontinence.
Once considered a coincidence of age, there is a statistical association between the rate of erection problems and moderate to severe symptoms of BPH. More recently, studies indicate that prostate problems and erection problems may be related from an affect of an enlarged prostate on penile blood supply.
Most BPH medications (alpha-blockers) block the receptors for contraction thus allowing relaxation of the muscles where the bladder opens to the urethra. The totally unrelated 5-alpha reductase inhibitors serve to shrink the prostate gland but may take months to be effective and only show noticeable improvement in cases of significantly enlarged prostates. Anticholinergics can increase the bladder’s capacity and inhibit involuntary bladder contractions and urination urges. Finally, surgical procedures may be required and erection problems after prostate surgery may result.
Erection Problems and ED
Erection problems present a confusing and complicated condition to both the patient/sufferer and the physician. Erection problems are a symptom more commonly termed erectile dysfunction (ED) and is a medical diagnosis based on physical causes, psychological factors, or a combination of both.
In normal erectile function, an erection results from the trapping of blood flow in the penis. When a male is sexually stimulated, a signal sent to the penis releases nitric oxide that causes smooth muscle relaxation and increased penile blood flow. However, blood flow out is restricted. This trapped blood swells the penis making it rigid.
For many years, erection problems were attributed to psychological factors because the physiological processes were not understood. Research now estimates that three quarters of ED cases result from medical problems affecting penile blood supply. High cholesterol, diabetes, smoking, surgery, or medications topped the list of contributors to the vascular problems that cause ED; however, now an enlarged prostate must be included as studies indicate that prostate problems can affect nitric oxide release.
Treatment of ED today is dominated by phosphodiesterase type 5 (PDE-5) inhibitors. PDE-5 inhibitors prevent this enzyme’s metabolic effect that decreases nitric oxide and cyclic GMP concentration below that needed for the smooth muscle relaxation and trapping of blood in the penis. These oral medications, pills to make a penis hard, include Viagra®, Levitra®, and Cialis®. Alternative treatments are more drastic including penile injections and penile implants for an artificial erection.
The vast majority of men with both BPH and ED tolerate the use of alpha-blockers, PDE-5 medications and herbal prostate health supplements without any side effects provided they follow the precautions indicated by their doctor(s).
More importantly, recent clinical studies strengthen the concept of a link between ED and BPH showing a beneficial effect of alpha-receptor drugs on ED symptoms and reports that the PDE-5 inhibitor (Cialis®) eases urinary symptoms of BPH. Such cross drug reactions are often evidence of a physiological connection.