Can an Enlarged Prostate Cause Erectile Dysfunction? The Link, the Medicines and What Helps Both
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It can be part of the picture: the NIDDK lists an enlarged prostate among the conditions that can cause erectile dysfunction.2 In a survey of 12,815 men aged 50 to 80, urinary symptoms were an independent risk factor for sexual problems.1 Some prostate medicines affect sex too, and daily tadalafil is FDA-approved for both conditions.6
Men rarely bring this up at the same appointment, but the two problems often arrive together, and the treatment for one can affect the other. This guide covers what the research shows about the link, which prostate medicines affect erections, ejaculation or libido and by how much, the one drug approved for both conditions, and the common question of whether ejaculating more often helps the prostate. For the urinary side on its own, start with our guide to enlarged prostate symptoms.
Key takeaways
- In the MSAM-7 survey of 12,815 men aged 50 to 80 in the U.S. and six European countries, urinary symptoms were an independent risk factor for sexual dysfunction, even after accounting for diabetes, high blood pressure and heart disease.1
- In the same survey, 83 percent of the men reported sexual activity, but only 19 percent had sought medical help for urinary problems.1
- Ejaculation problems were reported by 7.7 percent of men on alpha blockers versus 1.1 percent on placebo, with tamsulosin and silodosin at the high end.4
- In the first year of a 4-year finasteride trial, impotence was reported by 8.1 percent on the drug versus 3.7 percent on placebo; in years two to four the rates were equal.8
- Tadalafil 5 mg daily is FDA-approved to treat BPH symptoms, erectile dysfunction, or both together.6,7
Can an enlarged prostate cause erectile dysfunction?
The NIDDK names it as one possible cause. Its list of conditions that can lead to erectile dysfunction (ED) includes diabetes, heart and blood vessel disease, high blood pressure, low testosterone, nerve damage and "enlarged prostate."2 That does not mean every man with benign prostatic hyperplasia (BPH) will have erection problems, or that the prostate is the only cause when he does. It means the two belong in the same conversation.
The NIDDK's list also shows why they overlap so often. The same things raise the risk of both: age, and many of the same health conditions and habits. For ED, the NIDDK lists not getting enough physical activity, drinking too much alcohol and smoking among the lifestyle causes, and antihistamines, blood pressure medicines and diuretics, antidepressants and sedatives among the medicines that can contribute.2 Several of those medicines can also worsen urinary symptoms, which our guide to cold and sleep medicine with an enlarged prostate covers.
What the largest survey found
The Multinational Survey of the Aging Male (MSAM-7) mailed detailed questionnaires to a representative sample of men aged 50 to 80 in the United States and six European countries. Of 34,800 surveys sent, 12,815 were included in the analysis. Men scored their urinary symptoms with the International Prostate Symptom Score and their erections with the International Index of Erectile Function.1
Three findings matter for a man reading this:
- Sex was common. 83 percent of the men reported sexual activity, and 71 percent had been sexually active in the previous four weeks.1
- Worse urinary symptoms went with worse sexual function. Sexual problems and how much they bothered men were "strongly related to both age and severity of LUTS," and the link held after accounting for diabetes, high blood pressure, heart disease and high cholesterol.1
- Few men got help. Only 19 percent had sought medical help for urinary problems, and 11 percent were treated.1
The authors concluded that urinary symptoms are "independent risk factors for sexual dysfunction in older men."1 A survey cannot prove that one causes the other, but it does show that a man with a bothersome stream or night trips is more likely to have erection or ejaculation problems too, and that asking about both is worth it. You can score the urinary side in two minutes with our IPSS score calculator.
Prostate medicines and your sex life
This is the part most pages skip, and it is often the real reason a man notices a change after starting treatment. The previous American Urological Association (AUA) guideline lays out the numbers.4
| Medicine | Erections | Ejaculation | Libido |
|---|---|---|---|
| Alpha blockers: tamsulosin, silodosin4 | Not the main issue in the guideline | Ejaculatory problems more likely than placebo; highest with silodosin | Not the main issue in the guideline |
| Alpha blockers: doxazosin, terazosin4 | Not the main issue in the guideline | Low risk, similar to placebo | Not the main issue in the guideline |
| Finasteride (5-ARI)8 | Impotence 8.1% vs 3.7% in year 1; equal in years 2 to 4 | Lower ejaculate volume 3.7% vs 0.8% in year 1 | Decreased 6.4% vs 3.4% in year 1; equal in years 2 to 4 |
| Dutasteride (5-ARI)4 | ED 9% vs 5.7% in the REDUCE trial | Lower semen volume reported | Decreased libido reported |
| Tadalafil 5 mg daily4,6 | Improves erectile function | Not reported in these sources | Not reported in these sources |
Alpha blockers and ejaculation (including Flomax)
When the AUA tells doctors how to choose among alpha blockers, it names ejaculatory dysfunction and blood pressure changes as the side effects to weigh. In the meta-analysis it cites, ejaculation problems occurred in 7.7 percent of men on alpha blockers versus 1.1 percent on placebo. They were more common with tamsulosin (sold as Flomax) and silodosin, while doxazosin and terazosin were close to placebo.4
The effect is usually a reduced or absent ejaculate, not a weaker erection. The guideline explains it is mostly "anejaculation," with tamsulosin reducing ejaculate volume by an average of 2.4 mL in one study, rather than semen flowing backward into the bladder. Age changes the picture: in the silodosin trials, ejaculation problems were reported by 46 percent of men in their 50s and 11 percent of men in their 70s.4 If this bothers you, it is a reason to talk to your doctor about a different drug, not to stop on your own. Our guide to natural alternatives to Flomax explains the options.
5-alpha reductase inhibitors: the first year matters most
Finasteride and dutasteride shrink the prostate, as our guide on whether an enlarged prostate can shrink explains, and they carry sexual side effects. MedlinePlus lists "decreased sex drive and impotence."3 In the 4-year PLESS trial, impotence was reported by 8.1 percent on finasteride versus 3.7 percent on placebo in year one, and decreased libido by 6.4 versus 3.4 percent; in years two to four, the rates were the same in both groups.8 The AUA reads this pattern as side effects concentrated in the first 6 to 12 months, after which age-related changes dominate. In MTOPS, men on finasteride plus doxazosin had a significant worsening in erectile function, and the AUA says men should hear about sexual side effects before starting a 5-ARI.4
The one drug approved for both: daily tadalafil
On October 6, 2011, the FDA approved tadalafil to treat the signs and symptoms of BPH, and BPH and ED when they occur together. It had been approved for ED since 2003.7 The current label lists three uses: ED, the signs and symptoms of BPH, and both together, at 5 mg once a day for BPH or BPH with ED.6
What to expect, in numbers: across 10 trials reviewed by the previous AUA guideline, the urinary symptom score fell 5.4 points on tadalafil versus 3.6 on placebo, a difference the panel called "little to no difference" because it fell short of the 3-point mark it uses. In one trial, after 6 weeks on 5 mg, 49 percent of men had at least a 3-point improvement versus 36 percent on placebo. The guideline also says men "should be made aware that tadalafil improves EF in men with LUTS/BPH with and without co-morbid ED," and recommended that 5 mg daily "should be discussed as a treatment option."4 The 2026 guideline adds that daily 5 mg tadalafil combined with a 5-ARI "may be considered for select patients."5
Important limits, from the label: tadalafil must not be taken with any form of nitrate, and it is not recommended with alpha blockers for treating BPH because the combination was not studied well enough and can lower blood pressure.6 Tadalafil is a prescription drug; any choice between it and other options is one to make with your doctor.
Procedures and sex
If medicines are not enough, the choice of procedure matters for sexual function. The 2026 AUA guideline says men considering a procedure "should be counseled on progressive bladder functional changes, possible effects on sexual function, retreatment rates, and the need for re-evaluation."5 A 2021 review reported that retrograde ejaculation follows 50 to 70 percent of standard transurethral resections (TURP).9 The previous AUA guideline says the prostatic urethral lift and water vapor therapy may be offered to eligible men "who desire preservation of erectile and ejaculatory function."4 Ask about both erections and ejaculation before you choose.
Does ejaculation help an enlarged prostate?
There is no good evidence that it does. We did not find a trial showing that ejaculating more often improves BPH symptoms or prostate size. The study usually quoted on this is about cancer, not BPH: in the Health Professionals Follow-up Study of 31,925 men, those who reported 21 or more ejaculations a month at ages 40 to 49 had a lower risk of later prostate cancer diagnosis than men reporting 4 to 7 (hazard ratio 0.78), driven mainly by low-risk disease.10 That is an observational link with cancer, not a treatment for an enlarged prostate.
What is clear is that ejaculation itself is often affected. A 2021 review found that 46 percent of men presenting with BPH-related urinary symptoms reported ejaculation problems, and that studies of medicines reported absent ejaculation in 4 to 30 percent of men on alpha blockers and 4 to 18 percent on 5-ARIs.9 If ejaculation has changed, say so at your visit; it can change which treatment fits.
Habits that help both
The overlap works in your favor here. The 2026 AUA guideline says "Behavioral and lifestyle interventions should be explored before or alongside pharmacologic treatment" for urinary symptoms.5 On the ED side, the NIDDK lists too little physical activity, too much alcohol and smoking among the causes.2 Regular walking, less alcohol (especially in the evening, when it also drives night trips) and not smoking address both lists at once. Our guide to walking for prostate health covers the urinary side in detail.
When to see a doctor
See a doctor about ED in any case, because the NIDDK lists diabetes, heart and blood vessel disease and high blood pressure among its causes, and those are worth finding early.2 Bring your symptom score, your full medicine list including anything bought over the counter or online, and the date any change began. Do not stop or change a prescribed medicine without your doctor. New back or bone pain along with urinary symptoms deserves its own look; see enlarged prostate and back pain.
Where a supplement fits
Many formulas now combine prostate herbs with herbs sold for male vitality, such as ginseng, epimedium or tribulus. Be realistic about what is known. The 2021 Cochrane review of ginseng for ED, nine trials with 587 men, concluded that ginseng "may only have trivial effects on erectile function" on validated scales, though men did report a better self-rated ability to have intercourse, with mostly low-certainty evidence.11 We did not find comparable reviews for the other vitality herbs in this round of research. And the FDA warns that many products sold for sexual enhancement "are likely to be contaminated with dangerous hidden ingredients," so buy only products that list every ingredient and amount, and tell your doctor, especially if you take nitrates or blood pressure medicine.12
A supplement is not a substitute for the checkup, and no supplement treats, cures or prevents BPH or ED. If you are weighing one, read the label against the evidence: our guide on how to read a prostate supplement label shows how, our comparison of prostate supplements vs medication lays out the trade-offs, and our article on saw palmetto drug interactions covers what to check if you take prescription drugs.
ProtoFlow pairs one prostate herb, saw palmetto at 84.5 mg a day, with herbs sold for male vitality: epimedium, damiana, muira puama, tribulus, catuaba, ginseng and ginkgo. Its maker says it "supports the normal functions of the bladder, prostate and reproductive system".
Of those, only ginseng has a Cochrane review for erectile dysfunction, and it found only trivial effects. The label also has 120 mg of ginkgo, worth raising with your doctor if you take blood thinners.
Our review checks that claim against the full label, the published research and the refund terms.
A practical plan for this week
- Score both sides: take the IPSS for urinary symptoms and note any changes in erections, ejaculation or desire, and when they started.
- Line up the dates: did anything change after starting a new prostate, blood pressure or sleep medicine?
- Book one visit for both problems and say so when you book.
- Ask specifically whether daily tadalafil, a different alpha blocker, or a different procedure fits your situation.
- Start the shared habits: a daily walk, less evening alcohol, and no smoking.
Frequently asked questions
Can an enlarged prostate cause erectile dysfunction?
It can contribute. The NIDDK lists an enlarged prostate among the conditions that can cause erectile dysfunction. In a survey of 12,815 men aged 50 to 80, urinary symptoms were an independent risk factor for sexual problems even after accounting for diabetes, high blood pressure and heart disease. Age, other health conditions and some medicines also play a large part.
Does Flomax cause erectile dysfunction?
The main sexual side effect of tamsulosin, sold as Flomax, is on ejaculation rather than erections. In the meta-analysis cited by the American Urological Association, ejaculation problems occurred in 7.7 percent of men on alpha blockers versus 1.1 percent on placebo, more often with tamsulosin and silodosin. Talk to your doctor before stopping or switching.
Does ejaculation help an enlarged prostate?
There is no good evidence that it does. We found no trial showing that ejaculating more often improves BPH symptoms or prostate size. The study often quoted found that men reporting 21 or more ejaculations a month had a lower risk of later prostate cancer diagnosis, which is a different condition and an observational link, not a treatment for an enlarged prostate.
Is there a medicine that treats both an enlarged prostate and ED?
Yes. Tadalafil 5 mg taken once daily is FDA-approved for the signs and symptoms of BPH, for erectile dysfunction, and for both together. It must not be taken with nitrates, and its label does not recommend combining it with alpha blockers for BPH because of the risk of low blood pressure. It requires a prescription.
Do finasteride and dutasteride cause erectile dysfunction?
They can. In the first year of a 4-year trial, impotence was reported by 8.1 percent of men on finasteride versus 3.7 percent on placebo, and decreased libido by 6.4 versus 3.4 percent. In years two to four, the rates were the same in both groups. For dutasteride, one large trial reported erectile dysfunction in 9 percent versus 5.7 percent on placebo.
Can an enlarged prostate affect ejaculation?
Often. A 2021 review found that 46 percent of men with urinary symptoms from BPH reported ejaculation problems. Some treatments add to this: alpha blockers can reduce or stop ejaculation, and standard prostate surgery is followed by retrograde ejaculation in about 50 to 70 percent of men. Newer procedures aim to preserve ejaculation.
Do supplements for male vitality help with ED?
The evidence is weak. A 2021 Cochrane review of ginseng found only trivial effects on erectile function on validated scales, with mostly low-certainty evidence. The FDA warns that many products sold for sexual enhancement are likely to be contaminated with hidden drug ingredients, so choose products that list every ingredient and tell your doctor.
Sources
- Rosen R, Altwein J, Boyle P, et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). European Urology. 2003;44(6):637-649. https://pubmed.ncbi.nlm.nih.gov/14644114/
- National Institute of Diabetes and Digestive and Kidney Diseases (NIH). Symptoms and Causes of Erectile Dysfunction. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes
- MedlinePlus Medical Encyclopedia (NIH National Library of Medicine). Enlarged prostate. Reviewed July 1, 2025. https://medlineplus.gov/ency/article/000381.htm
- American Urological Association. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (2021, amended 2023), unabridged. Previous version, replaced on May 7, 2026. https://www.auanet.org/documents/Guidelines/PDF/2023%20Guidelines/BPH%20Unabridged%2002-20-24%20Final.pdf
- American Urological Association. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (2026). Released May 7, 2026; key statements as published by Guideline Central. https://www.guidelinecentral.com/insights/may-2026-aua-lowerurinarytractsymptoms-guideline-video/
- Cialis (tadalafil) tablets, prescribing information, sections 1, 2 and 4. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895
- U.S. Food and Drug Administration. FDA approves Cialis to treat benign prostatic hyperplasia. News release, October 6, 2011. https://www.prnewswire.com/news-releases/fda-approves-cialis-to-treat-benign-prostatic-hyperplasia-131283364.html
- Proscar (finasteride) tablets, prescribing information, section 6.1. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6f988153-fc74-4ca4-b29a-111f750c4a4b
- Couteau N, Duquesne I, Frédéric P, et al. Ejaculations and benign prostatic hyperplasia: an impossible compromise? A comprehensive review. Journal of Clinical Medicine. 2021;10(24):5788. https://pmc.ncbi.nlm.nih.gov/articles/PMC8704358/
- Rider JR, Wilson KM, Sinnott JA, et al. Ejaculation frequency and risk of prostate cancer: updated results with an additional decade of follow-up. European Urology. 2016;70(6):974-982. https://pubmed.ncbi.nlm.nih.gov/27033442/
- Lee HW, Lee MS, Kim TH, et al. Ginseng for erectile dysfunction. Cochrane Database of Systematic Reviews. 2021;4(4):CD012654. https://pubmed.ncbi.nlm.nih.gov/33871063/
- U.S. Food and Drug Administration. Sexual Enhancement and Energy Product Notifications. Updated September 25, 2026. https://www.fda.gov/drugs/medication-health-fraud-notifications/sexual-enhancement-and-energy-product-notifications
About the author
Alice Hess is a health researcher and wellness writer at ProstateClarity. She is not a doctor, a nurse, a nutritionist or any kind of licensed clinician, and nothing here is medical advice. She started this work because of her father: at 76 he was getting up several times a night, and the research she did for him helped him get back to sleeping through the night. One man's story is not evidence, which is why every guide here is built on published research. She reads labels, primary research and regulatory limits, and publishes the numbers manufacturers leave out. More about her work and how these articles are researched.
Found an error? Write to contact@prostateclarity.com with the sentence and the source that contradicts it. Corrections are made in the article with the date noted.