I was diagnosed with an enlarged prostate in 2008. My PSA was 1.6 ng/mL in 2008 and 1.9 ng/mL in 2011.
I now frequently experience a burning sensation when I urinate and tenderness or pain in the lower abdomen. I also have difficulty getting an erection and do not enjoy sex as I used to.
I have been taking tamsulosin for about two months without enough improvement.
What should I do about the painful urination and sexual problems?
Quick Answer
Burning during urination and lower abdominal pain should not simply be assumed to come from an enlarged prostate.
Possible causes include a urinary tract infection, bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome, urethral inflammation, bladder stones, incomplete bladder emptying and other urinary conditions.
A sensible first assessment usually includes urinalysis, and urine culture when infection is suspected. Because you already have BPH symptoms, your clinician may also want to measure post-void residual urine and urinary flow.
Your historical PSA values of 1.6 and 1.9 ng/mL do not rule out prostatitis and do not identify the cause of the current pain.
Tamsulosin may improve urinary flow when prostate/bladder-outlet resistance is contributing, but it does not treat a urinary infection and may not resolve pelvic pain or erectile dysfunction.
Erectile dysfunction also deserves its own assessment because it can be associated with age, cardiovascular disease, diabetes, medications, testosterone deficiency, psychological factors and lower urinary tract symptoms.
Does an Enlarged Prostate Cause Burning During Urination?
It can coexist with burning or painful urination, but burning is not specific for BPH.
Typical BPH symptoms include weak urine flow, hesitancy, straining, incomplete emptying, frequency, urgency and nighttime urination.
When burning becomes a prominent symptom, I would look for another explanation as well.
NIDDK lists burning or pain during urination among the symptoms that can occur with bacterial prostatitis. Chronic prostatitis/chronic pelvic pain syndrome can also cause pain involving the penis, scrotum, central lower abdomen and urinary tract. :contentReference[oaicite:1]{index=1}
What Could Cause Burning Urination?
The possibilities include:
- urinary tract infection;
- acute or chronic bacterial prostatitis;
- chronic prostatitis/chronic pelvic pain syndrome;
- urethritis;
- sexually transmitted infection when relevant;
- bladder or urethral stones;
- irritation from incomplete bladder emptying;
- recent urinary instrumentation;
- and less commonly other bladder or urinary tract disease.
This is why treating the symptom with another prostate medicine or supplement before identifying the cause can be misleading.
Could This Be Prostatitis?
Yes, prostatitis is one possibility, although it cannot be diagnosed from the question alone.
Prostatitis is not one single disease. It includes:
- acute bacterial prostatitis;
- chronic bacterial prostatitis;
- chronic prostatitis/chronic pelvic pain syndrome;
- and asymptomatic inflammatory prostatitis.
Chronic prostatitis/chronic pelvic pain syndrome can cause discomfort lasting three months or longer in the:
- lower abdomen;
- penis;
- scrotum;
- perineum;
- or lower back.
Pain during or after ejaculation and urinary symptoms can occur as well. NIDDK describes this symptom pattern specifically. :contentReference[oaicite:2]{index=2}
PSA is not the test used to rule prostatitis in or out. PSA can sometimes rise during prostate inflammation, but many men with prostatitis will not have a diagnostic PSA pattern.
What About a PSA of 1.6 or 1.9?
Those historical PSA measurements provide information about your prostate at the time they were taken, but they cannot explain symptoms occurring many years later.
A PSA value should be interpreted according to:
- age;
- previous PSA results;
- prostate size;
- medications such as finasteride or dutasteride;
- infection or inflammation;
- recent urinary retention or instrumentation;
- family history;
- and other prostate-cancer risk factors.
If your clinician thinks repeat PSA testing is appropriate, it should be interpreted as part of a broader prostate assessment rather than used as a test for the cause of painful urination.
For more detail, see how PSA should be interpreted .
Why Does the Lower Abdomen Hurt?
Tenderness or discomfort in the lower abdomen can occur for several reasons.
In a man with urinary symptoms, two possibilities deserve particular attention:
1. Pelvic or prostate-related pain
Chronic prostatitis/chronic pelvic pain syndrome can cause central lower abdominal discomfort as well as penile, scrotal, perineal and lower-back pain. :contentReference[oaicite:3]{index=3}
2. Incomplete bladder emptying
If obstruction or weak bladder contraction causes a substantial amount of urine to remain after voiding, the bladder may become distended and produce suprapubic pressure or discomfort.
A post-void residual measurement can help evaluate this.
What Tests Would Be Reasonable?
The exact investigation depends on examination findings, but the initial evaluation can be much more focused than the old answer suggested.
| Assessment | What It Can Help Identify |
|---|---|
| Medical and sexual history | Clarifies burning, urinary flow, frequency, pelvic pain, ejaculation, erections, medications and risk factors. |
| Urinalysis | Can identify findings suggesting infection, blood, glucose or other urinary abnormalities. |
| Urine culture | Useful when bacterial urinary infection or bacterial prostatitis is suspected. |
| Physical examination | May include abdominal, genital and prostate assessment depending on symptoms. |
| Post-void residual | Measures urine remaining in the bladder after urination. |
| Uroflowmetry | Measures urinary flow and helps assess voiding difficulty. |
| Blood glucose / HbA1c | May be appropriate when diabetes is possible because diabetes can contribute to urinary and erectile problems. |
| Cardiovascular risk assessment | Important in men with erectile dysfunction because ED may be associated with underlying vascular disease. |
| Morning testosterone | May be checked as part of the evaluation of erectile dysfunction when clinically appropriate. |
Current EAU guidance recommends urinalysis in men being assessed for lower urinary tract symptoms and strongly recommends measuring post-void residual. :contentReference[oaicite:4]{index=4}
Do You Automatically Need an ECG and Heart Ultrasound?
No.
Erectile dysfunction is important because it can be a marker of cardiovascular risk, but that does not mean every man with ED needs an ECG and echocardiogram without first considering his medical history, symptoms and cardiovascular risk.
The AUA erectile dysfunction guideline recommends that men with ED be advised that it may be a risk marker for underlying cardiovascular disease and other health conditions that warrant appropriate evaluation. :contentReference[oaicite:5]{index=5}
A clinician may therefore assess:
- blood pressure;
- smoking history;
- cholesterol;
- blood glucose or HbA1c;
- weight;
- exercise tolerance;
- known cardiovascular disease;
- and relevant symptoms such as chest pain or breathlessness.
More extensive cardiac testing is then based on the findings rather than being ordered automatically.
Does Tamsulosin Treat Burning Urination?
Not directly.
Tamsulosin is an alpha-1 blocker. It relaxes smooth muscle around the prostate and bladder outlet and can help symptoms caused by resistance to urinary flow.
It may improve:
- weak stream;
- difficulty starting urination;
- straining;
- and some other lower urinary tract symptoms.
But it does not eradicate bacteria, and it is not a specific treatment for urethritis, urinary stones or chronic pelvic pain syndrome.
If you have taken tamsulosin for two months without sufficient improvement, the next step should be reassessment rather than simply increasing or continuing treatment indefinitely without knowing the cause.
Can Tamsulosin Affect Sexual Function?
Yes.
Tamsulosin can affect ejaculation in some men. Depending on the individual, there may be reduced semen emission, altered ejaculation or little/no visible ejaculate.
That is different from erectile dysfunction.
An erection depends on vascular, neurologic, hormonal and psychological factors, so persistent difficulty becoming or staying erect deserves a separate assessment.
Can BPH and Erectile Dysfunction Occur Together?
Yes.
Lower urinary tract symptoms and erectile dysfunction frequently coexist, particularly as men age.
However, one condition does not necessarily directly cause the other. Shared factors can include:
- aging;
- vascular disease;
- diabetes;
- obesity;
- smoking;
- medications;
- pelvic pain;
- sleep problems;
- and psychological stress.
Could Diabetes Be Relevant?
Yes, but it should be investigated sensibly rather than assumed.
Diabetes can damage blood vessels and nerves involved in erections and may also contribute to bladder dysfunction.
If you have never been screened recently or have risk factors, testing such as fasting blood glucose or HbA1c may be reasonable.
That does not mean diabetes is necessarily the cause of your current symptoms.
What About Difficulty Reaching Orgasm?
Erection, ejaculation and orgasm are related but distinct processes.
A man may:
- have difficulty becoming erect;
- maintain an erection but experience altered ejaculation;
- ejaculate but have reduced orgasmic pleasure;
- or have pelvic pain during or after ejaculation.
Therefore, the exact sexual symptom matters.
If your main problem is reduced or absent orgasm rather than erection alone, tell your clinician explicitly because medication effects, pelvic pain, hormonal factors and neurologic conditions may need to be considered.
See also my guide to loss of pleasure during ejaculation .
Can Erectile Dysfunction Medication Help?
Possibly, once the clinician has reviewed the cause and whether such treatment is safe for you.
PDE5 inhibitors such as sildenafil and tadalafil are established treatments for erectile dysfunction.
Tadalafil also has an approved role in men with lower urinary tract symptoms associated with BPH.
However, these medicines are not appropriate for everyone. Of particular importance, PDE5 inhibitors can interact dangerously with nitrate medications used for angina, and blood-pressure effects also need consideration.
This is why erectile dysfunction treatment should be chosen after medication and cardiovascular review rather than simply prescribed because an erection problem is present.
The safe choice depends on your medications, blood pressure, cardiovascular status and the exact cause of the sexual difficulty.
Should Antibiotics Be Used?
Only when there is a reasonable indication.
If urinalysis, culture and clinical findings suggest bacterial infection, the doctor can select an appropriate antibiotic based on the suspected infection and, when available, culture results.
But not all prostatitis is bacterial.
Chronic prostatitis/chronic pelvic pain syndrome is frequently nonbacterial, and repeated antibiotic courses without evidence of infection may expose a patient to side effects and antibiotic resistance without treating the true problem.
Should You Take Saw Palmetto or Uva Ursi?
I would not recommend either as the answer to unexplained burning urination and lower abdominal pain.
Saw palmetto has not shown reliable benefit over placebo for typical BPH symptoms in high-quality studies and is not a treatment for urinary infection.
Uva ursi is sometimes marketed for urinary problems, but it should not be used as a substitute for diagnosing and treating a urinary tract infection or other cause of dysuria.
For evidence on common supplements marketed for BPH, see: natural remedies for enlarged prostate .
Dr. Albana’s Perspective
Ephraim, the part of your question that concerns me most is not the historical PSA of 1.6 or 1.9. It is the combination of persistent burning with urination, lower abdominal discomfort and a change in sexual function.
I would not assume that all three problems are simply consequences of BPH.
The first practical step is to evaluate the urinary pain. I would want a urinalysis, and if infection is suspected, a urine culture. I would also want to know whether you are emptying your bladder properly, especially because tamsulosin has not given you enough relief.
At the same visit, I would discuss the erectile problem separately. Checking for diabetes and cardiovascular risk factors is reasonable, and depending on the history, testosterone testing may also be appropriate.
What I would not do is order a long list of unrelated investigations automatically or prescribe herbs before establishing what is causing the burning.
— Dr. Albana Greca, MD, MMedSc
Family Physician / General Practitioner
When Does Lower Abdominal Pain Need Faster Assessment?
Pain deserves more urgent evaluation when it is associated with:
- fever or chills;
- inability to urinate;
- visible blood in the urine;
- severe or rapidly worsening pain;
- vomiting;
- marked weakness or confusion;
- or severe genital/testicular pain.
When to Seek Urgent Medical Care
Seek prompt or emergency medical assessment if you have:
- complete inability to urinate;
- burning/frequent urination together with fever and chills;
- significant blood in the urine;
- severe lower abdominal or urinary-tract pain;
- new severe testicular pain or swelling;
- or rapidly worsening illness.
NIDDK specifically advises immediate medical care for inability to urinate, painful urgent urination with fever/chills, blood in the urine, or substantial lower abdominal and urinary-tract pain. :contentReference[oaicite:6]{index=6}
Questions to Ask Your Doctor
- Could the burning be caused by a urinary infection?
- Should I have urinalysis and urine culture?
- Could I have prostatitis or chronic pelvic pain syndrome?
- What is my current post-void residual urine?
- Is tamsulosin actually improving my urinary flow?
- Do I need uroflowmetry or an ultrasound?
- Should my PSA be repeated now?
- Could my erectile problem be vascular, hormonal or medication-related?
- Should I have fasting glucose or HbA1c testing?
- Would a morning testosterone test be appropriate?
- Would tadalafil or another ED treatment be safe for me?
- Could any of my current medicines be affecting sexual function?
Frequently Asked Questions
Is burning urination a normal symptom of an enlarged prostate?
It can occur in men who also have BPH, but burning is not specific for prostate enlargement. Urinary infection, prostatitis, urethral inflammation, stones and other urinary conditions should be considered.
Can prostatitis occur with a normal PSA?
Yes. PSA cannot reliably rule prostatitis in or out. The diagnosis depends on symptoms, examination and appropriate urine or other testing.
Can prostatitis cause lower abdominal pain?
Yes. Chronic prostatitis/chronic pelvic pain syndrome and bacterial prostatitis can cause lower abdominal or pelvic discomfort as well as penile, scrotal, perineal or lower-back pain.
Can prostatitis cause sexual problems?
It can. Pelvic pain syndromes may be associated with painful ejaculation and sexual dysfunction. Erectile dysfunction may also coexist for unrelated or shared reasons.
Why hasn’t tamsulosin stopped the burning?
Tamsulosin relaxes the prostate and bladder outlet. It does not treat urinary infection or urethritis and is not a specific pain treatment for chronic pelvic pain syndrome, so another cause may need investigation.
Can tamsulosin cause sexual side effects?
Yes. Tamsulosin can cause ejaculatory changes in some men. Erectile dysfunction is different and may have vascular, neurologic, hormonal, medication-related or psychological causes.
Should I use antibiotics for burning urination?
Only if your clinician believes a bacterial infection is present or likely. Urinalysis and urine culture can help guide treatment. Burning urination does not always mean a bacterial infection.
Should I take saw palmetto for the burning?
No herbal supplement should substitute for evaluation of persistent painful urination. Saw palmetto has not been established as a treatment for infection, prostatitis or unexplained dysuria.
Related Guides
Medical References
-
National Institute of Diabetes and Digestive and Kidney Diseases.
Prostatitis: Inflammation of the Prostate.
NIDDK Prostatitis -
European Association of Urology.
EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary
Tract Symptoms — Diagnostic Evaluation.
EAU Diagnostic Evaluation -
European Association of Urology.
EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary
Tract Symptoms — Disease Management.
EAU Male LUTS Guideline -
American Urological Association.
Erectile Dysfunction: AUA Guideline.
AUA Erectile Dysfunction Guideline
Medical information notice: This article provides general patient education. Persistent burning urination, lower abdominal pain, erectile dysfunction or changes in urinary flow require individual assessment. Treatment depends on the cause and may differ substantially between BPH, bacterial infection, prostatitis/chronic pelvic pain syndrome, bladder dysfunction and other conditions.
Written & medically reviewed by Dr. Albana Greca, MD, MMedSc • Family Physician / General Practitioner • Last medically reviewed: August 2026