After prostatectomy, which refers to the surgical removal of the prostate gland, many people can function sexually and still climax. However, some people may find that their orgasms change.

Removing the prostate eliminates the ability to ejaculate during sex. The seminal vesicles make around 60% of the semen’s volume, while the prostate makes most of the rest.

A surgeon will remove both the prostate and the seminal vesicles during radical prostatectomy. Therefore, after this procedure, most males will experience dry orgasms.

Radical prostatectomy may cause some degree of erectile dysfunction (ED). This is because surgery can damage the nerves that support normal erectile function.

Males who undergo prostate removal may need medical and psychological support to deal with these changes and maximize sexual function.

This article will discuss whether sex can still be pleasurable following radical prostatectomy and provide tips that may help improve orgasms and sexual function.

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A person may require prostate surgery due to enlargement of the prostate gland or to treat prostate cancer.

Some procedures, such as transurethral resection of prostate (TURP), will only remove a portion of the prostate gland. However, radical prostatectomy removes the entire prostate, plus the seminal vesicles and sometimes the pelvic lymph nodes.

After this operation, a person will no longer be able to ejaculate. This is due to the removal of the prostate and seminal vesicles, which make the fluid in semen. They may also be unable to have an erection due to nerve damage.

Normally, sexual arousal sends signals to increase blood flow to the penis. This leads to an erection. As arousal intensifies, a person gets closer to orgasm. Most males ejaculate when they orgasm, though doing so is neither inevitable nor necessary for orgasm.

People may have “dry” orgasms, which are orgasms without ejaculation. In addition, it is possible to have a dry orgasm without an erection, although it may be more difficult.

There is no accurate way to predict who will have difficulties reaching orgasm after prostate removal. Many factors can play a role, such as the patient’s age, their baseline erectile function, comorbid conditions, the extent of the cancer, if present, and the type of surgery.

Radical prostatectomy can have wide-ranging effects — both physiological and mental. These can affect a person’s sex life.

Radical prostatectomy surgery will likely damage some of the nerve endings surrounding the prostate. This can disrupt the body’s ability to communicate signals about arousal, leading to ED.

Even if a male does not experience ED following surgery to remove the prostate and seminal vesicles, they can no longer ejaculate.

Males can still orgasm, though they might require help or medication to do so. An older 2017 article states that 14–90% of people experience some degree of erectile difficulty after undergoing radical prostatectomy. This wide range is due to different ways of defining and measuring ED.

Besides ED and an inability to ejaculate, other possible physical effects of a radical prostatectomy include:

  • urine leakage during sexual arousal
  • pain during orgasm
  • an inability to have children naturally
  • changes in penis size and shape
  • loss of sexual desire

Psychological effects of radical prostatectomy include:

  • depression
  • performance anxiety, which may cause ED or make it more difficult to reach orgasm
  • problems with self-esteem

Males who enjoy receiving anal sex may notice differences during intercourse, as there is no longer a prostate to stimulate. A 2018 paper suggests that after prostatectomy, males who engage in receptive anal sex could adapt to sexual challenges by changing their sexual role.

Those receiving hormone therapy for prostate cancer will have lower testosterone levels. This may lead to

  • a lower sex drive
  • ED
  • difficulty achieving orgasm

After a radical prostatectomy, people should allow time to fully heal before attempting sex. They can ask a doctor how long healing will take.

Some strategies that can help with regaining sexual function after healing include:

  • Taking medications: Taking medications for ED can help males who are otherwise unable to get an erection reach orgasm. These medications support blood flow to the penis and can ease many causes of ED.
  • Receiving injections: When oral ED medications do not work, receiving injections into the penis may induce an erection.
  • Trying a penis pump: A penis pump functions by pulling blood into the penis, which can help induce an erection.
  • Getting penile implants: This is a type of surgery that may restore a male’s ability to get erections through the use of silicone rods or inflatable devices.

It may also be worth considering different types of therapy, including sex therapy and physical therapy.

Sex therapy can help couples enjoy sex, learn new sexual strategies, and communicate more effectively following surgery, while physical therapy can help a male overcome any physical injuries associated with prostate removal.

Prostate removal can also lead to some other complications, including:

Males should discuss the risks and benefits of surgery and ask about alternative treatment options. They can also consider getting a second opinion whenever a doctor recommends major surgery or diagnoses a serious medical condition such as prostate cancer.

Undergoing radical prostatectomy may prolong or even save a person’s life, especially when other prostate cancer treatments are unsuccessful. However, adjusting to life without a prostate or the ability to ejaculate can take time.

With open communication, a sensitive partner, and a willingness to try different strategies, many males are able to have a fulfilling sex life.

Sex can be an important part of well-being. It is not selfish to ask for help, and sexual dysfunction is not a trivial problem. Males who experience difficulty reaching orgasm after prostatectomy should consider seeking help from a urologist who specializes in sexual health issues.