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For more on advances in the diagnosis and treatment of prostate diseases, read the Annual Report on Prostate Diseases from Harvard Medical School. As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.

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These drugs relax the muscles around the prostate and the opening of the bladder, so urine can flow more easily. Common BPH symptoms often improve within two days. They are most effective for men with normal to moderately enlarged prostates. Commonly prescribed drugs in this class include alfuzosin Uroxatral , doxazosin Cardura , silodosin Rapaflo , tamsulosin Flomax , and terazosin Hytrin.

Drugs in this class slowly shrink the prostate so it stops pressing on the urethra. Treatment often reduces the prostate's size by one-quarter after six months to a year. The two common drugs are finasteride Proscar and dutasteride Avodart.

Men might opt for surgery to remove excess tissue from the prostate if medications do not relieve symptoms sufficiently or cause undesirable side effects, or if there are complications like urinary retention or recurring urinary tract infections, adds Dr. For men who have both erectile dysfunction and symptoms of BPH, once-daily low-dose tadalafil Cialis is another option. As a service to our readers, Harvard Health Publishing provides access to our library of archived content.

Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Thanks for visiting. Don't miss your FREE gift. Have you recently grown interested in a new partner? As part of this health history, be prepared to tell your doctor specific details about the symptoms that brought you to the office and when they began.

Your doctor may conduct a written or verbal screening test. If the cause is clear — a recent operation for prostate cancer, for example — the conversation may move directly to your treatment options. Otherwise, you may need to answer more questions to help the doctor narrow down the possible causes and avoid unnecessary testing.

A key issue is whether the symptoms came on gradually or suddenly. Erectile dysfunction that comes on gradually often points to causes that involve blood flow or nerves. On the other hand, a sudden loss of sexual desire or the ability to have erections usually suggests that a medication or psychological difficulty, such as depression or stress, may be to blame.

The ability to do so is an important clue in determining whether the problem is psychologically or physically based see Table 1. Takes your blood pressure and listens to your heart. Checks pulse in groin and feet. Checks your abdomen for aortic aneurysm. Tests reflexes of your knees and ankles, as well as anus. Checks for sensation in your legs and feet. Checks your prostate. Assesses the history of the problem, especially whether it started suddenly and if nocturnal erections are affected.

During the physical exam, the doctor will listen to your heart for signs of a murmur and other abnormalities that can affect blood flow. He or she will also take your blood pressure; both high and low blood pressure can impair blood flow.

The doctor will check your pulse in several places — at the wrist, ankle, and groin. Slow or low pulse in any of these areas can mean that not enough blood is reaching tissues in the extremities, including the penis. In addition, the doctor will examine your testicles, penis, and chest. Abnormally small testicles and enlarged breasts are sometimes signs of inadequate testosterone.

Your doctor may check the prostate gland for signs of infection or cancer, by doing a digital rectal exam. Your checkup will probably include tests for cholesterol to assess your risk of cardiovascular disease and triglyceride and blood sugar levels to check for diabetes. The doctor might also ask for a urine specimen because the presence of red or white blood cells could be a sign of a un underlying urologic problem.

Now that medication can successfully treat most men with erectile dysfunction, many once routine diagnostic tests are used only when the doctor suspects the patient has an underlying problem requiring additional treatment. Hormone tests. Checking testosterone levels used to be one of the first tests ordered for men with erectile difficulty, but that was before doctors realized that testosterone deficiency was rarely the source of the problem.

Now, hormone testing is done for men whose medical exams suggest an endocrine problem and for those who have experienced a loss of sexual desire. Your doctor also may want to check your blood levels of prolactin a pituitary hormone that can block the action of testosterone or thyroid—stimulating hormone a good indicator of an under-active or overactive thyroid gland.

Blood flow tests. A color duplex Doppler ultrasound, an imaging technique, can reveal problems with blood flow through the arteries or veins of the penis, such as venous leakage. Nocturnal tumescence tests. Physical causes affect both kinds of erections. Requires training; injections unpleasant for many men; may cause penile pain or painful sustained erections priapism. Approved by the FDA in , sildenafil Viagra revolutionized the way we think about — and treat — erectile dysfunction, largely because it is so easy to use and effective.

Since then the FDA has approved three closely related drugs, vardenafil Levitra , avanafil Stendra and tadalafil Cialis. All four drugs work in a similar fashion, by affecting the normal physiology of the penis. In particular, they block PDE5, an enzyme that breaks down the erection-producing chemical cyclic guanosine monophosphate.

This enables the penis to fill with blood and to stay erect long enough for intercourse. The main differences between the drugs have to do with timing: how quickly they begin to work, and how long their effects last see Table 2. Levitra may start working slightly faster than Viagra within a half-hour instead of an hour although the FDA says that like Viagra, it should be taken about an hour before sexual activity. Cialis stays active in the body much longer than the other drugs.

Viagra and Levitra last about 4 to 5 hours and sometimes up to 12 hours. Cialis has also been approved to treat men with both erectile dysfunction and BPH. The dose is lower, usually 5 milligrams per day. Side effects. So far, the risks and side effects of these three drugs seem to be roughly the same. They all work by relaxing smooth muscle cells, which widens blood vessels — primarily in the penis, but also in other parts of the body.

Other reactions include flushing, upset stomach, nasal congestion, and urinary tract infections. But when the drugs are used properly, these side effects are relatively mild, and most disappear after a few hours. In rare cases, some men experience temporary, mild visual problems, mainly seeing a blue tinge, but also increased sensitivity to light and blurred vision. However, men with retinitis pigmentosa, a rare eye disease, should be very cautious about using these medications.

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