Can regular receptive anal sex cause Benign Prostatic Hyperplasia (BPH) or an enlarged prostate?

Receptive Anal Intercourse Does Not Cause Benign Prostatic Hyperplasia

Regular receptive anal intercourse does not cause benign prostatic hyperplasia (BPH) or an enlarged prostate. The etiology of BPH is primarily related to hormonal factors and aging, not sexual practices.

Etiology of BPH

BPH is a histologic diagnosis that refers to the proliferation of glandular epithelial tissue, smooth muscle, and connective tissue within the prostatic transition zone. According to the American Urological Association guidelines, BPH development is:

• Multifactorial with an exact etiology that remains unknown, but requires testosterone 1
• Dependent on the conversion of testosterone to dihydrotestosterone (DHT) by 5α-reductase enzymes 1
• Nearly ubiquitous in aging males, with prevalence increasing from age 40-45 years, reaching 60% by age 60, and 80% by age 80 1
• Developed due to an imbalance between cellular growth and apoptosis (cellular death) in favor of growth 1

Risk Factors for BPH

The established risk factors for BPH include:

1. Age (primary non-modifiable risk factor)
2. Hormonal factors (testosterone and DHT)
3. Metabolic syndrome and obesity 2
4. Family history/genetic factors

Notably absent from any guideline or research evidence is any mention of receptive anal intercourse as a risk factor for BPH.

Sexual Activity and the Prostate

While receptive anal intercourse (RAI) can involve stimulation of the prostate, this does not lead to prostatic hyperplasia:

• Recent research on RAI experiences among people with prostates indicates that the prostate region can be a source of pleasure during RAI for some individuals, but this stimulation does not cause pathological growth of prostatic tissue 3
• The subjective pleasure from prostate stimulation during RAI varies among individuals, with the prostate not being the primary pleasure center for all individuals engaging in RAI 3

BPH and Sexual Function

Rather than RAI causing BPH, the relationship actually works in the opposite direction:

• BPH and its treatments can affect sexual function, including potential impacts on individuals who engage in RAI 1
• Patients should be counseled about the sexual side effects of any surgical intervention for BPH 1

Anal Health and Sexual Practices

While RAI is not associated with BPH development, it is important to note:

• RAI is associated with other health considerations, including HPV infection which is linked to anal cancer risk, particularly in immunocompromised individuals 1
• People living with HIV have approximately 15-35 times increased likelihood of being diagnosed with anal cancer compared to the general population 1
• Regular screening for anal dysplasia may be appropriate for high-risk individuals 1

Conclusion

The development of BPH is primarily related to hormonal factors and aging. There is no evidence in medical literature suggesting that receptive anal intercourse causes or contributes to the development of BPH. The prostate enlargement process is driven by hormonal mechanisms involving testosterone and DHT, not by mechanical stimulation or sexual practices.

If a patient presents with lower urinary tract symptoms (LUTS), these should be evaluated according to established guidelines for BPH, regardless of sexual practices.