After prostatectomy, which refers to the surgical removal of the prostate gland, males can still climax. However, not all of them do, and some may find that their orgasms change.
Radical prostatectomy may cause some degree of erectile dysfunction. 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 what dry orgasms are, how prostatectomy affects orgasms, and some tips that may help improve orgasms and sexual function.
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 male 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. Other prostate operations, such as TURP, do not generally affect ejaculation.
Lack of ejaculation does not mean that a male can no longer orgasm. Many will start to have “dry” orgasms, which are orgasms without ejaculation.
Some may notice that they produce a small amount of fluid before or during orgasm. This is fluid from glands in the urethra. It will be a much smaller amount than a standard ejaculation produces.
Many males believe that ejaculation is synonymous with orgasm. However, ejaculation does not have to happen for a person to orgasm.
Normally, sexual arousal sends signals to increase blood flow to the penis. This leads to an erection. As arousal intensifies, a male gets closer to orgasm. Most ejaculate when they orgasm, though doing so is neither inevitable nor necessary for orgasm.
Undergoing surgery to remove the prostate will likely damage some of the nerve endings surrounding the prostate. This can disrupt the body’s ability to communicate signals about arousal, enabling an erection.
Even if a male does not experience erectile dysfunction 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. Most report some degree of erectile difficulty after undergoing radical prostatectomy.
Radical prostatectomy can affect orgasm in two ways: by causing erectile dysfunction, which can make sex difficult or impossible, and by eliminating a male’s ability to ejaculate.
The inability to orgasm was less common, with 39.7% of participants reporting this. An additional 38.1% reported having fewer satisfying orgasms.
The mental health effects of these symptoms were worse among highly sexually motivated participants. In fact, 52% reported that this had affected their self-esteem, and 36% reported having performance anxiety.
These issues may compound the effects of radical prostatectomy, since anxiety may cause erectile dysfunction or make it more difficult to reach orgasm.
Some males also report urine leakage or pain during orgasm following prostate removal.
There is no way to accurately predict who will have difficulties reaching orgasm after prostate removal. The skill of the surgeon and the equipment they use may play a role, as less experienced surgeons may inadvertently cause more extensive inflammation and nerve damage.
Males who have their prostate removed often have other risk factors for erectile dysfunction and other sexual issues, such as advanced age or heart disease.
A 2004 study that followed 1,187 males for 5 years after either surgery or radiation therapy found that sexual function declined over time in both groups. However, more people in the surgery group (79%) had erectile dysfunction than in the non-surgery group (64%).
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.
Males 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 erectile dysfunction 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 erectile dysfunction.
- Receiving injections: In males for whom oral erectile dysfunction 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:
- incontinence, such as urine leakage during sex
- reactions to medications and anesthetics
- blood clots
- inguinal hernia
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 a major surgery or diagnoses a serious medical condition such as prostate cancer.
Undergoing radical prostatectomy may prolong or even save a male’s life, especially when other prostate cancer treatments have not been successful. 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 will regain full sexual function.
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.