Benign Prostatic Hyperplasia (BPH) refers to the non-cancerous enlargement of the prostate gland, a condition common as men age. The prostate surrounds the urethra, and its growth leads to bothersome lower urinary tract symptoms. While BPH is best known for its effect on urination, questions about its impact on sexual function, particularly ejaculation, are frequent. Changes in ejaculation are common, but they are most often linked to the treatments for BPH rather than the physical presence of the enlarged gland itself. Any discussion of medical conditions and their treatments should be had with a qualified healthcare professional.
The Direct Impact of Prostate Enlargement on Ejaculation
The physical enlargement of the prostate gland itself rarely causes a complete inability to ejaculate, known as anejaculation. The prostate’s overgrowth restricts the urethra, the channel for both urine and semen, causing urinary flow problems. However, the complex muscular contractions involved in propelling semen forward during orgasm are generally independent of the obstructing tissue. The prostate contributes seminal fluid, and during orgasm, it contracts to help propel the ejaculate through the urethra. In some cases, the physical pressure and inflammation caused by BPH can lead to a reduced volume of semen or painful ejaculation. The most significant changes, however, are seen after treatment is initiated.
Ejaculation Changes Caused by BPH Medications
Medications are the first-line treatment for BPH symptoms and are responsible for the majority of ejaculation side effects. These effects vary significantly between the two main classes of drugs used to manage the condition. Understanding the mechanism of each drug class helps explain why their side effects on ejaculation are distinct.
Alpha-Blockers
Alpha-blockers, such as tamsulosin or alfuzosin, work by relaxing the smooth muscles in the prostate and the bladder neck. This relaxation eases pressure on the urethra, improving urine flow. However, the same muscular relaxation can cause the bladder neck—a muscular ring that normally closes during orgasm—to remain open. When this valve stays open, semen travels backward into the bladder instead of moving forward out of the penis, a condition called retrograde ejaculation. This results in a “dry orgasm” where the sensation of climax is preserved, but little to no semen is expelled. This side effect is common with alpha-blockers, particularly selective agents like tamsulosin and silodosin, with incidences reported between 4% and 26% in clinical trials.
5-Alpha Reductase Inhibitors (5-ARIs)
5-alpha reductase inhibitors (5-ARIs) include finasteride and dutasteride. These medications block the enzyme that converts testosterone into dihydrotestosterone (DHT), a hormone that stimulates prostate growth. By reducing DHT levels, these drugs can shrink the size of the prostate over several months. The hormonal changes induced by 5-ARIs can lead to different sexual side effects compared to alpha-blockers. The reduction in DHT is associated with decreased libido, and it can also cause a reduction in semen volume or an inability to ejaculate at all, known as anejaculation. Ejaculatory dysfunction is commonly reported with 5-ARIs, attributed to the hormonal influence on the reproductive system components that produce seminal fluid.
How Surgical Procedures Alter Ejaculation
When medications fail to relieve BPH symptoms, surgical procedures are necessary to physically remove or modify the obstructing prostate tissue. These procedures directly and permanently alter the anatomy, leading to a high likelihood of ejaculatory changes. The most common approach is Transurethral Resection of the Prostate (TURP), which removes tissue from the inner prostate surrounding the urethra. This removal extends to the bladder neck, compromising the function of the internal sphincter that normally closes during ejaculation.
This anatomical alteration makes retrograde ejaculation a common and expected outcome, occurring in 65% to over 80% of men who undergo TURP or similar procedures. Other surgical and minimally invasive treatments, such as laser vaporization or incision procedures, carry a similar high risk because they also modify the bladder neck. The change is physical and permanent, meaning the semen consistently flows into the bladder at the time of orgasm. While the sensation of orgasm is usually preserved, the resulting dry ejaculation is the most significant sexual side effect men must accept when choosing surgical treatment for BPH.