Benign Prostatic Hyperplasia (BPH), commonly known as an enlarged prostate, is a non-cancerous condition. This growth is a frequent occurrence in men as they age, often leading to bothersome urinary symptoms like frequency and urgency. While BPH is primarily recognized for its effect on urination, the gland’s central role in the male reproductive system means its enlargement also affects sexual health, particularly ejaculation. Understanding the relationship between the prostate’s size, its function, and the effects of treatment clarifies how this condition impacts ejaculation.
The Prostate’s Role in Ejaculation
The prostate is a small, muscular gland situated directly below the bladder, through which the urethra passes. Its main function is producing a milky fluid that constitutes approximately 20% to 30% of the total semen volume. This prostatic fluid contains various enzymes and nutrients important for sperm health and mobility.
The gland also plays a mechanical part in ejaculation due to the smooth muscle fibers within its structure. During orgasm, these muscle cells contract to forcefully propel the seminal fluid into the urethra. The prostate and the bladder’s sphincter muscle work together to close the internal opening of the urethra, preventing semen from traveling backward into the bladder.
How Prostate Enlargement Directly Affects Ejaculation
The physical presence of enlarged prostate tissue can directly interfere with the mechanics of ejaculation. As the prostate expands, it can physically compress the prostatic urethra and the muscle fibers located at the bladder neck. This compression disrupts the muscular coordination needed for the forceful expulsion of semen during climax.
Men with BPH experience a decrease in the force and volume of ejaculation. This physical obstruction can also cause the bladder neck to be less effective at sealing completely. In some cases, this pressure imbalance can lead to mild instances of retrograde ejaculation, where some semen flows backward into the bladder.
Ejaculatory Side Effects of BPH Medication and Surgery
The most significant changes to ejaculation are often caused not by the enlarged prostate itself, but by the medications and surgical procedures used to treat the condition. Two primary categories of BPH treatment have distinct effects on ejaculatory function.
Alpha-Blockers
Alpha-blockers, such as tamsulosin or silodosin, are a common pharmacological treatment for BPH symptoms. These drugs work by relaxing the smooth muscles in the prostate and the bladder neck, which helps relieve urinary obstruction. The relaxation of the bladder neck directly affects ejaculation.
During orgasm, the relaxed bladder neck sphincter may not close properly. This allows semen to flow backward into the bladder instead of moving forward through the urethra, a phenomenon known as retrograde ejaculation. Retrograde ejaculation results in a “dry orgasm” because little or no semen is expelled externally. Highly selective alpha-blockers like silodosin and tamsulosin have the highest reported rates of ejaculatory dysfunction, with a high incidence of abnormal ejaculation reported with tamsulosin alone.
Surgical Procedures
Surgical interventions for BPH, such as Transurethral Resection of the Prostate (TURP), remove obstructive tissue and improve urinary flow. These procedures physically alter the anatomy of the bladder neck, the mechanism responsible for preventing retrograde flow.
A TURP involves coring out the obstructing tissue, which often permanently damages the internal sphincter at the bladder neck. This damage means the sphincter can no longer close during ejaculation, leading to permanent retrograde ejaculation. The loss of antegrade ejaculation is a common side effect after TURP, affecting a large percentage of patients. While retrograde ejaculation is not physically harmful and does not affect the sensation of orgasm, it can impact fertility.
When to Consult a Healthcare Provider
Men experiencing changes in their ejaculatory function should consult a healthcare provider, especially when these changes coincide with BPH symptoms or treatment. It is important to distinguish between normal, age-related changes, such as minor reductions in semen volume, and symptoms that require medical evaluation. Specific warning signs include the sudden inability to ejaculate, painful ejaculation, or the presence of blood in the semen. When starting a new BPH medication or considering surgery, discuss the potential sexual side effects with your doctor. Your provider can offer alternative treatment options, such as certain procedures or less selective medications, that may help preserve ejaculatory function.