Can A Swollen Prostate Cause Erectile Dysfunction?

Mary Lucas, RN

Medically reviewed by Mary Lucas, RN

Written by Our Editorial Team

Last updated 2/05/2021

Erectile dysfunction can affect your ability to get and maintain an erection. 

It is a very common condition around 322 million men globally by 2025 are projected to experience persistent difficulty achieving and sustaining erections.

This condition may be caused by psychological factors like performance anxiety or stress. 

Likewise, your medication for managing high blood pressure or ulcers or other conditions could also affect erectile functioning. 

However, physical conditions like an enlarged prostate (also known as benign prostatic hyperplasia or BPH) and prostatitis may account for many cases of erectile dysfunction.

We’ll be examining how a swollen prostate can lead to ED. 

We’ll do this by looking through the links between benign prostatic hyperplasia, prostatitis and erectile dysfunction, their causes, as well as treatment options which may affect erectile abilities. 

What Is Benign Prostatic Hyperplasia?

We’ll get to that, but first — let’s explore the prostate to understand how this condition may affect its effectiveness.

Your prostate is a part of your reproductive system responsible for producing the fluid that goes into your semen. 

For a walnut-shaped gland, it's a big part of your fertility and does impact your chances of having children. 

The prostate surrounds the urethra at the neck of the bladder.

In cases of benign prostatic hyperplasia, the prostate becomes enlarged without being cancerous.

Because of the increase in size, the gland presses against and pinches the urethra, making it harder for urine to flow out. 

In response, the bladder walls become thicker, eventually weakening the bladder and making it unable to empty the urine in it completely. 

This may lead to complications like urinary tract infections, bladder damage and blood in the urine.

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What Causes Benign Prostatic Hyperplasia?

It’s a little hard to say for sure what causes BPH. 

What we do know for a fact is that men go through two main stages of prostate growth in their lives — first at puberty, where the prostate doubles in size, and then growth begins around the age of 25 and continues during most of a man’s life. 

BPH is known to surface in this second stage, and mostly affects men above the age of forty. Autopsy data has found evidence of the condition in about 90 percent of men above the age of eighty.

The growth of the prostate in this second stage may be linked to androgens in the body. Men produce testosterone throughout their lives. They also produce estrogen — the female hormone — but only in small amounts. 

When testosterone levels drop — as they inevitably do with age — a higher proportion of estrogen may remain. 

This increase in the ratio of Estrogen or its receptors to testosterone may directly and indirectly affect the growth of prostate cells.

Another possible cause is DHT or dihydrotestosterone. This male hormone is a bit of a villain. It is a major cause of alopecia in men, but is however useful for the development and maintenance of the prostate. 

Unfortunately, this role can be dangerous for the adult prostate, as DHT can cause excessive growth.

BPH may also result when there is an imbalance between the production and death of prostate cells. When the imbalance is in favor of cell proliferation, it can lead to BPH.

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What Is Prostatitis?

Prostatitis is an inflammation of the prostate which can often be as painful as it sounds. You may not hear about it a lot, but this condition is the most common urinary tract problem for men younger than fifty. It is also the third most common urinary tract condition for men above fifty.

There are four types of prostatitis:

  • Acute bacterial prostatitis: a bacterial infection of the prostate which lasts a short time.

  • Chronic bacterial prostatitis: a recurrent infection of the prostate that goes on for a long time.

  • Chronic pelvic pain syndrome/chronic prostatitis: pain in the lower back and pelvic area that may be caused by an infection, though not from bacteria. It may also be due to inflammation from other causes.

  • Asymptomatic inflammatory prostatitis: inflamed prostate with no symptoms.

Causes of Prostatitis

The type of prostatitis you experience may determine the cause of your condition.

Chronic pelvic pain syndrome can be caused by a number of infective and non-infective factors.

Local infections, chemical irritations, neuromuscular disturbances or an immunological process have been tapped as leading causes for the condition.

Acute bacterial prostatitis is caused by a bacterial infection of the prostate that causes pelvic pain and urinary tract issues like urinary frequency and urinary retention. 

This condition usually lasts for a short time. Chronic bacterial prostatitis is similarly caused by a bacterial infection, it develops slowly and lasts a long time. 

Asymptomatic inflammatory prostatitis may be caused by various things, including bacterial and viral infections, as well as estrogen-producing inflammatory cells.

How Can a Swollen Prostate Cause Erectile Dysfunction?

If you know anything about prostatic diseases, then you may be aware of how strongly they can affect the quality of life. 

A condition like benign prostatic hyperplasia may cause lower urinary tract symptoms (LUTS)

Urinary tract infections (UTIs), bladder damage, blood in the urine, as well as urinary retention are often complications that result from BPH. 

Additionally, benign prostatic hyperplasia is linked to pain during or after ejaculation, kidney damage and bladder stones. 

By itself, this condition may also affect sexual function, like your ability to get and keep an erection. Like BPH, erectile dysfunction is affected by age — a common link both conditions share.

In understanding how BPH may lead to ED, let's get familiar with a little something called the alpha 1-adrenergic (a1-adrenergic) receptor.

These receptors are responsible for mediating the tone of smooth muscle cells in tissue

In case you didn't know, your penis staying flaccid or achieving erection is heavily dependent on the contraction and relaxation of the corpus cavernosum smooth muscles, making a1-adrenergic receptors important for erectile function. 

In BPH, there is an imbalance in the autonomic control of smooth muscles, their contraction and relaxation. 

This leads to increased smooth muscle tone in the prostate. Increased smooth muscle tone is caused by the a1-adrenergic receptor. 

When this receptor is activated by noradrenaline (a neurotransmitter), the penile tissues are contracted. 

Erectile dysfunction favors the contraction of smooth muscles which encourages detumescence, and complicates the relaxation of these muscles, which is responsible for erections.

It is believed that 70 percent of men with BPH have an associated erectile dysfunction.

With prostatitis, erectile dysfunction may be induced by the pain caused from the condition. 

Depending on the type of prostatitis in question, pain may be experienced in the perineum, penis and areas above the pubic bone. 

If you suffer from chronic bacterial prostatitis for example, it isn’t uncommon to experience pain in the genital area and groin

This pain can last for three months and above.

Prostate Cancer and Erectile Dysfunction

And speaking of a swollen prostate causing ED — while prostate cancer may not always be a direct cause of sexual dysfunction, a growing prostate tumor could decrease sexual function by causing lower urinary tract symptoms. 

Additionally the psychological effects of the diagnosis itself and the treatments for the cancer can also cause erectile problems.

While these conditions are direct causes of erectile function, treatments to manage their effects may also lead to erectile dysfunction.

Swollen Prostate Treatments That May Lead to Erectile Dysfunction 

Managing a swollen prostate may require medication, or sometimes surgery to get it under control. 

These treatments can be effective in getting the prostate to an acceptable state, but may sometimes do so at the expense of causing serious side-effects, notable of which is erectile dysfunction.

Drugs to manage benign prostatic hyperplasia like alpha blockers such as tamsulosin and terazosin, and 5-alpha-reductase inhibitors such as finasteride and dutasteride have side effects that include erectile dysfunction. 

In treating prostate cancer, procedures like a radical prostatectomy may lead to injuries of the cavernous nerve and blood cells. 

This can cause ED. Hormonal therapy in the form of androgen-deprivation is also known to cause erectile dysfunction and decreased sexual desire. 

Radiation therapy to treat cancer can also lead to nerve damage, which may lead to ED. There are however some promising approaches to reduce the risks of erectile dysfunction following this treatment.

In instances where ED occurs following treatment for a swollen gland, measures like the use of PDE5 inhibitors, intracavernosal injections, and combination therapy (using a mix of drugs and other modalities) may be able to treat sexual dysfunction. 

As always, it is important to talk to your healthcare provider to ensure you get the best and safest advice on what approaches to consider for your specific condition.

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In Conclusion

A swollen prostate could mean different things — benign prostatic hyperplasia, prostatitis or even prostate cancer.

BPH and prostatitis may be direct causes of erectile dysfunction, while prostate cancer could give rise to ED directly or indirectly. 

A swollen prostate can be uncomfortable and dangerous to deal with, it may require measures like medication, radical prostatectomy or hormonal therapy to help manage it, depending on the cause.

These measures can unfortunately also lead to difficulty in erectile function.

Should you experience erectile dysfunction as a result of a swollen prostate, make sure to consult a qualified healthcare provider to advise on the best steps to take.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.