Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and declines in male sexual function are common manifestations of aging, and have been associated with each other in a number of clinical and epidemiological studies. Erectile and ejaculatory function declines with age-adjusted LUTS severity as well as age itself. Although urinary symptoms and quality of life may improve with BPH therapy, the resulting effects on sexual function vary by medical or surgical treatment. Alpha-blockers improve sexual function and phosphodiesterase type 5 (PDE5) inhibitors decline LUTS scores. PDE5 inhibitors approved for daily use may represent an important new therapeutic opportunity for men with BPH-LUTS and erectile dysfunction. Larger studies on the combination of an alpha-blocker for BPH and a PDE5 inhibitor are necessary to develop an integrated treatment approach for BPH-LUTS patients with erectile dysfunction.