I have been diagnosed with an enlarged prostate and my doctor prescribed Cialis. I can achieve an erection without difficulty, but during sex I find it very difficult to reach orgasm, and sometimes I cannot reach orgasm at all.
Could this be caused by my enlarged prostate or Cialis, and is there a solution?
Quick Answer
Being able to achieve a good erection but struggling to reach orgasm is not erectile dysfunction. It is more consistent with delayed orgasm, anorgasmia or delayed ejaculation, depending on exactly what happens during sex.
Cialis, whose generic name is tadalafil, is commonly prescribed as a 5 mg once-daily treatment for urinary symptoms caused by BPH. It can also improve erections.
However, tadalafil does not shrink the prostate or simply “reduce swelling.” It improves lower urinary tract symptoms through effects on smooth muscle and related pathways. Medicines such as finasteride or dutasteride are the BPH drugs that can gradually reduce prostate volume in appropriately selected men.
Difficulty reaching orgasm is not one of the main expected effects of tadalafil. Before assuming Cialis is responsible, I would review other medicines, particularly antidepressants and some prostate medicines, as well as alcohol, hormonal problems, diabetes or nerve disease, penile sensation, prostate or pelvic conditions, and psychological or relationship factors.
There may be a solution, but the correct treatment depends on identifying why orgasm has become difficult.
What Is the Difference Between an Erection, Ejaculation and Orgasm?
These are related parts of sexual function, but they are not the same thing.
| Sexual Function | What It Means |
|---|---|
| Erection | The penis becomes firm enough for sexual activity because blood flow increases and is maintained within erectile tissue. |
| Ejaculation | Semen is expelled through the urethra. Ejaculation involves coordinated nerves, muscles and reproductive organs. |
| Orgasm | The pleasurable sensory and neurological experience of sexual climax. |
Orgasm and ejaculation usually occur together, but they can become separated. A man may:
- have a normal erection but delayed orgasm;
- reach orgasm without much or any semen;
- ejaculate but experience reduced pleasure;
- or be unable to reach orgasm despite prolonged stimulation.
This distinction is especially important when evaluating loss of pleasure or changes during ejaculation .
What Is Delayed Orgasm or Anorgasmia?
Delayed orgasm means that reaching climax takes much longer than expected or requires unusually prolonged stimulation.
Anorgasmia means orgasm is absent despite adequate sexual stimulation and arousal.
Some men experience the problem only during intercourse but can still reach orgasm during masturbation. Others have difficulty in every sexual situation. That distinction can provide important clues.
The EAU recommends evaluating delayed ejaculation and orgasmic disorders with a detailed medical and sexual history, including the onset of the problem, sexual stimulation, sensation, medications, medical conditions and psychological or relationship factors.
Does an Enlarged Prostate Cause Difficulty Reaching Orgasm?
BPH itself is not a straightforward direct cause of anorgasmia.
However, men with BPH frequently experience overlapping sexual problems. Urinary symptoms can reduce confidence, disturb sleep, increase anxiety around sexual activity and affect quality of life.
In addition, some BPH treatments can influence ejaculation and sexual function.
Therefore, when orgasm changes after a BPH diagnosis, I would consider both the underlying condition and the treatment rather than assuming that the enlarged prostate itself is physically preventing orgasm.
What Does Cialis Do for BPH?
Cialis is the brand name for tadalafil, a phosphodiesterase type 5 inhibitor.
Tadalafil is used for:
- erectile dysfunction;
- urinary symptoms associated with BPH;
- or both ED and BPH in the same patient.
The official tadalafil prescribing information lists 5 mg once daily as the standard daily dose for BPH.
Daily tadalafil can improve lower urinary tract symptoms such as frequency, urgency and urinary-flow symptoms, but it is different from finasteride and dutasteride, which can gradually reduce prostate volume in men with appropriate prostate enlargement.
Can Cialis Make It Difficult to Reach Orgasm?
Tadalafil is much better known for improving erectile function than for causing delayed orgasm.
Delayed orgasm or anorgasmia is not among its characteristic common adverse effects.
That does not make it impossible for an individual patient to notice a sexual change after starting any medicine. Timing is still important.
I would ask:
- Did the orgasm problem begin before or after tadalafil?
- Did it start immediately after beginning treatment?
- Does it happen every time?
- Can you reach orgasm during masturbation?
- Has penile sensation changed?
- Can you ejaculate even when orgasm feels absent?
- Are you taking any other medicines?
Do not stop prescribed tadalafil solely on the basis of this page. The prescribing clinician can assess whether a supervised medication adjustment is reasonable.
Which Medicines Commonly Affect Orgasm or Ejaculation?
The full medication list is extremely important in this situation.
| Medication Group | Possible Sexual Effect |
|---|---|
| SSRIs and other antidepressants | Can cause delayed ejaculation, delayed orgasm or anorgasmia. |
| Antipsychotic medicines | Can affect libido, hormones, ejaculation and orgasm. |
| Opioid pain medicines | Can reduce testosterone and sexual desire and interfere with orgasm. |
| Alpha blockers | Some medicines used for BPH can alter ejaculation, including reduced or absent seminal emission. |
| 5-alpha-reductase inhibitors | Finasteride and dutasteride can cause sexual adverse effects in some men, including reduced libido and ejaculatory changes. |
| Some blood-pressure medicines | Certain antihypertensive drugs may contribute to sexual dysfunction. |
The EAU lists antidepressants, antipsychotics, opioids and other medications among recognized contributors to delayed orgasm and anorgasmia.
Could Another BPH Medicine Be Responsible?
Yes, potentially.
If you are taking tadalafil plus another prostate medicine, that additional drug may be more relevant to an ejaculation problem.
For example, alpha blockers can alter semen emission. Some are more likely than others to cause ejaculation changes.
Finasteride and dutasteride can also affect sexual function in some patients.
That is why saying simply “I take Cialis” is not enough. Bring your complete medication list to the appointment, including prescription medicines, over-the-counter drugs and supplements.
Could Testosterone Be Low?
Low testosterone can affect sexual desire and orgasmic function in some men.
However, testosterone should not be assumed to be low merely because orgasm is difficult.
If the history suggests a hormonal problem—such as reduced libido, fatigue, loss of spontaneous erections or other symptoms—a clinician may consider a properly timed morning testosterone test.
The EAU also identifies thyroid and prolactin abnormalities among possible contributors to delayed orgasm or anorgasmia.
Could Diabetes or Nerve Problems Affect Orgasm?
Yes.
Normal orgasm depends on intact sensory and autonomic nerves. Conditions that alter nerve function can therefore affect sexual climax even when erection remains reasonably good.
Possible contributors include:
- diabetes and diabetic neuropathy;
- spinal or neurologic disorders;
- pelvic nerve injury;
- reduced penile sensation;
- and some previous pelvic operations.
A medical history and focused examination help determine whether neurological evaluation is warranted.
What About Prostate Surgery?
Previous prostate or bladder-neck surgery matters because several procedures can substantially change ejaculation.
For example, TURP and bladder-neck procedures can cause semen to travel backward into the bladder rather than outward through the penis.
This is called retrograde ejaculation.
Retrograde ejaculation is different from anorgasmia. A man can still experience an orgasm even though little or no semen comes out.
If you have undergone previous prostate surgery, tell the clinician because that changes the differential diagnosis.
Could Prostatitis or Pelvic Pain Cause This?
Prostatitis and chronic pelvic pain syndrome can sometimes affect ejaculation, sexual pleasure and orgasm.
The EAU lists prostatitis among conditions associated with delayed ejaculation.
If you have pelvic pain, painful ejaculation, burning urination or genital discomfort, it may be worth considering prostatitis or chronic pelvic pain rather than treating the problem solely as BPH.
Can Alcohol Make Orgasm More Difficult?
Yes, particularly in larger amounts.
Alcohol may initially reduce anxiety, but increasing amounts can impair sexual sensation, arousal and orgasm.
The EAU includes reduction of alcohol among lifestyle measures that may be considered in men with delayed orgasm or anorgasmia.
If the problem is inconsistent, note whether it is worse on days when more alcohol is consumed.
Could the Problem Be Psychological?
Yes, but this should not be interpreted as meaning the symptom is imaginary.
Orgasm is both a neurological and psychological process.
Performance anxiety, relationship distress, depression, distraction, changes in sexual stimulation and a mismatch between preferred stimulation and partnered intercourse can all influence climax.
Some men can reach orgasm easily during masturbation but struggle during partnered sex. That pattern provides useful information and may respond to changes in stimulation or psychosexual therapy.
What Tests Might Be Needed?
Not every man requires a large battery of tests.
Current EAU guidance emphasizes a detailed medical and sexual history and physical examination first.
Depending on the findings, a clinician might consider:
- review of all prescription and nonprescription medicines;
- assessment of libido and penile sensation;
- morning testosterone when indicated;
- thyroid testing when clinically appropriate;
- prolactin when indicated;
- blood glucose or HbA1c when diabetes is possible;
- neurological assessment if sensation or nerve function is abnormal;
- and evaluation for prostatitis or other pelvic disease when symptoms suggest it.
NIDDK similarly notes that evaluation of male sexual dysfunction includes a medical, sexual and mental-health history and asks specifically about erection, ejaculation, climax and sexual desire. :contentReference[oaicite:2]{index=2}
Is There a Medication That Restores Orgasm?
There is no single medication that reliably cures delayed orgasm in every man.
Treatment should target the underlying cause.
For example:
- a causative medication may sometimes be adjusted by the prescriber;
- a hormone abnormality may be treated when confirmed;
- diabetes should be appropriately managed;
- pelvic pain or prostatitis should be treated according to its cause;
- psychosexual therapy may help when anxiety, stimulation pattern or relationship factors contribute;
- and increased or modified genital stimulation may help some men.
The EAU notes that evidence for specific medical treatment of anorgasmia is limited, so treatment must be individualized.
Should Cialis Be Stopped?
Not without discussing it with the prescribing doctor.
If tadalafil is controlling urinary symptoms or helping erectile function, stopping it unnecessarily may cause those symptoms to return.
Instead, clarify the timeline:
- When did tadalafil begin?
- When did orgasm become difficult?
- Were other medicines started at the same time?
- Does the problem occur with masturbation as well as intercourse?
If there is a convincing temporal relationship, the prescriber can decide whether a supervised trial of adjustment is appropriate.
Tadalafil can dangerously lower blood pressure when combined with nitrates used for conditions such as angina. Always make sure all clinicians know you are taking tadalafil.
Does Cialis Treat the Enlarged Prostate Permanently?
No.
Daily tadalafil is primarily a symptom treatment for BPH. It does not remove enlarged prostate tissue and should not be described as permanently reducing prostate swelling.
If the prostate is substantially enlarged and there is concern about long-term progression, other treatments may be considered depending on prostate volume, PSA, symptoms, urinary flow and individual risk.
See: BPH treatment options and BPH medications .
Dr. Albana’s Perspective
If you can achieve and maintain a good erection but cannot easily reach orgasm, I would not focus primarily on erectile dysfunction.
I would first clarify whether the problem is delayed orgasm, inability to ejaculate, reduced penile sensation or loss of the pleasurable sensation of orgasm. Patients sometimes use these terms interchangeably, but medically they can point to different causes.
I would also correct one point about Cialis: tadalafil can improve BPH urinary symptoms, but it does not shrink the prostate in the way finasteride or dutasteride can.
Next, I would review every medicine you take. Antidepressants are particularly important because they are a common cause of delayed orgasm, while some BPH medicines can alter ejaculation.
If no medication explains the change, I would consider alcohol use, diabetes or neurologic disease, hormone abnormalities when clinically indicated, prostatitis or pelvic symptoms, penile sensation and psychosexual factors.
There are treatment options, but the best solution comes from identifying which of these mechanisms applies to you rather than simply increasing the Cialis dose.
— Dr. Albana Greca, MD, MMedSc
Family Physician / General Practitioner
Questions to Ask Your Doctor
- Am I experiencing delayed orgasm, delayed ejaculation or true anorgasmia?
- Could any of my medicines be causing this?
- Did the problem begin before or after starting Cialis?
- Am I taking another BPH medicine that can alter ejaculation?
- Is my tadalafil dose appropriate for BPH?
- Do I need testosterone, thyroid, prolactin or diabetes testing?
- Does reduced penile sensation need neurological evaluation?
- Could prostatitis or pelvic-floor problems be contributing?
- Would a medication adjustment be appropriate?
- Could psychosexual therapy or changes in stimulation help?
When to Seek Prompt Medical Care
Difficulty reaching orgasm alone is generally not an emergency. However, men taking tadalafil should seek urgent medical attention for:
- an erection lasting more than four hours;
- sudden loss of vision;
- sudden decrease or loss of hearing;
- chest pain during sexual activity;
- or severe dizziness or fainting.
Never take nitrate medication for chest pain while tadalafil is still active without informing emergency clinicians that tadalafil has been used.
Frequently Asked Questions
Can I have erectile function but still have an orgasm disorder?
Yes. Erection and orgasm are different processes. A man can have a firm, sustained erection and still experience delayed orgasm or anorgasmia.
Does Cialis shrink an enlarged prostate?
No. Daily tadalafil can improve urinary symptoms associated with BPH, but it does not significantly shrink prostate tissue. Finasteride and dutasteride are examples of medicines that can reduce prostate volume in appropriately selected men.
Is Cialis normally prescribed for BPH?
Yes. Tadalafil 5 mg once daily is an approved treatment for signs and symptoms of BPH and can also be used when erectile dysfunction and BPH coexist.
Does Cialis normally cause anorgasmia?
Anorgasmia is not a characteristic common adverse effect of tadalafil. Nevertheless, if the problem clearly began after starting treatment, the prescribing clinician should review the timing and other possible causes.
Which medicines commonly delay orgasm?
Antidepressants, particularly SSRIs, are well-known causes. Antipsychotics, opioids and some other medicines can also interfere with ejaculation or orgasm. Some BPH medicines affect ejaculation rather than orgasm itself.
Can low testosterone cause difficulty reaching orgasm?
It can contribute in some men, particularly when low sexual desire or other symptoms are present. Testosterone testing should be based on the clinical history rather than performed automatically in every case.
Can alcohol make it harder to climax?
Yes. Larger amounts of alcohol can interfere with sensation, arousal, ejaculation and orgasm. Reducing alcohol is reasonable if symptoms are worse after drinking.
Should I stop Cialis if I cannot reach orgasm?
Do not stop prescribed tadalafil without speaking with the clinician who prescribed it. The orgasm problem may have another cause, and stopping tadalafil may worsen urinary symptoms or erectile function.
Related Guides
Medical References
-
U.S. National Library of Medicine, DailyMed.
Tadalafil Prescribing Information.
DailyMed Tadalafil -
American Urological Association.
Management of Lower Urinary Tract Symptoms Attributed to Benign
Prostatic Hyperplasia: AUA Guideline.
AUA BPH Guideline -
European Association of Urology.
Disorders of Ejaculation — Sexual and Reproductive Health Guidelines.
EAU Disorders of Ejaculation -
National Institute of Diabetes and Digestive and Kidney Diseases.
Diagnosis of Erectile Dysfunction.
NIDDK Male Sexual Function Evaluation
Medical information notice: This page provides general patient education. Difficulty reaching orgasm can have medication-related, hormonal, neurological, pelvic, psychological and sexual causes. Do not stop or change tadalafil or another prescribed medicine without discussing the change with the prescribing clinician.
Written & medically reviewed by Dr. Albana Greca, MD, MMedSc • Family Physician / General Practitioner • Last medically reviewed: August 2026