Does benign prostatic hyperplasia (BPH) surgery affect sexual function?

Yes, surgeries performed to treat benign prostatic hyperplasia (BPH) can affect sexual function in some men. Although the primary goal of these surgeries is to improve urinary flow and alleviate bothersome symptoms, the anatomical proximity of the prostate to the nerves and tissues responsible for sexual function means there is a potential for complications. These potential complications include erectile dysfunction or retrograde ejaculation, a condition in which semen enters the bladder rather than exiting the penis [2]. It is essential that these points be part of an open dialogue with your doctor before making a surgical decision.

Understanding sexual risks associated with prostate surgery

When a doctor decides to use surgery to treat prostate enlargement, they remove part of the prostate or make adjustments to widen the urethra and facilitate urine passage. The sensitive nature of this area lies in the presence of delicate nerves that control erections and coordinate the ejaculation process. Surgical interventions may cause minor damage to these nerves or changes in the mechanics of the bladder neck, leading to retrograde ejaculation [2]. Retrograde ejaculation is when semen travels to the bladder instead of exiting through the urethra, and it may affect fertility [4].

As for erectile dysfunction, the effect of surgery can vary from one man to another. Erectile dysfunction is considered a potential complication after BPH surgery [2]. The outcomes cannot be predicted with absolute certainty for every individual, so the desired benefits of alleviating urinary symptoms must be weighed against these potential risks [2].

Variety of surgical options and individual results

There are numerous surgical options available, ranging from transurethral resection of the prostate (TURP) to newer, less invasive techniques that use heat, water vapor, or stents to lift the urethra. Each technique has a specific risk and benefit profile. The body's response and sexual function outcomes vary based on the technique used, prostate size, symptom severity, and the patient's general health status [2]. Understanding the differences between these options may help you make an informed decision. For more details on making this decision, you can review our article on Refractory Benign Prostatic Hyperplasia: When Should We Consider Surgical Options? (Arabic).

Recovery and medical follow-up

After surgery, it is normal for the patient to experience a period of discomfort, and they may need to use a urinary catheter for several days to drain urine and prevent complications [2]. The recovery phase may include the presence of blood in the urine, a burning sensation when urinating, or bladder spasms. These symptoms are often temporary and improve gradually. If sexual problems persist or if you face significant challenges in your life after surgery, do not hesitate to consult your doctor; there are therapeutic options available to help patients manage these side effects [2].

When do symptoms require immediate medical attention?

Beyond long-term sexual concerns, there are emergencies related to prostate enlargement or post-surgical complications that require prompt medical intervention. You must contact the medical team immediately if you experience any of the following: a complete inability to urinate (acute urinary retention), severe pain with fever and chills, the presence of thick blood in the urine, or unbearable pain in the lower abdomen. These conditions are considered medical emergencies and are not merely routine side effects [1].

Medical references

• Enlarged Prostate (BPH)
• Enlarged Prostate (Benign Prostatic Hyperplasia)
• Ejaculation problems - NHS