Prostate removal affects ejaculation and may also affect orgasm and erectile function. However, treatments can help people to have a healthy sex life following surgery.

A person can still have sex and experience sexual pleasure after the removal of the prostate, although their sexual experiences may change.

This article discusses how prostate removal can affect a person’s sex drive, ability to stay erect, ejaculate, orgasm, and mental health.

It also provides advice on how long to wait after surgery and how to ease back into sexual intimacy.

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People will need to follow the advice of their surgeon as to when they can safely have sex after prostate removal.

Following a radical prostatectomy, a person will need to wait until the wound is healed and feels comfortable if they have had open surgery.

If the person had keyhole surgery, they can be sexually active after removing the catheter. They will need to wait about 6 weeks before having anal sex.

The charity Prostate Cancer UK offers the following tips for easing back into sexual intimacy after prostate removal:

  • developing intimacy with a partner through other forms of physical contact, such as hugging, holding each other, and massage
  • seeking support if feeling down or anxious or experiencing a lack of interest in sex
  • having sex in positions that require less movement and taking breaks as necessary
  • trying nonpenetrative sex and other sexual activities together
  • if the person requires treatments for erectile dysfunction, continuing to try different methods over time to find an option that works best for them
  • beginning treatments for any erection problems as soon as possible, as this will help promote healthy blood flow to the penis, as will masturbation

Although removing the prostate does not typically result in lower libido, a person may experience a lower sex drive as a result of the cancer itself and other treatment options.

A person may temporarily experience a low sex drive as a result of:

  • fatigue
  • feeling anxious or stressed about having prostate cancer
  • medical side effects of anticancer chemotherapy or radiation treatments
  • surgery-related erectile dysfunction
  • experiencing a loss of confidence and self-esteem

A lower libido can also develop as a result of hormone therapy. Hormone therapy may lower levels of testosterone, resulting in lower libido.

Once people have completed hormone therapy and testosterone levels return to normal levels, their sex drive should return to how it was.

According to the American Cancer Society (ACS), the ability to have an erection after prostate surgery can vary for each person. If erections do return, it may be within a few months or up to 2 years after surgery.

In the first few months after surgery, a spontaneous erection may not be possible, and people may need to use medications or penile treatments.

According to a 2017 review, research suggests erectile dysfunction rates may be as high as 85% after prostate removal.

Reports of erectile dysfunction prevalence after prostate removal vary widely, from 14–90%, depending on the surgical procedure.

For this reason, a person should be sure that they fully understand the approach that the urologist recommends before agreeing to undergo prostate removal. A person should not hesitate to ask the urologist any questions they have to make the most informed choice.

People will not be able to ejaculate after prostate removal. A prostatectomy removes the glands that produce semen and cuts the vas deferens, which allows sperm to leave the body as ejaculate.

A person may release a small amount of fluid from the penis tip with orgasm, which may come from glands in the urethra.

According to the ACS, a person will still be able to achieve orgasm.

However, as a prostatectomy removes the prostate and seminal vesicles, which produce most of the fluid for semen, people will experience a dry orgasm.

In some cases, the person may not be able to experience orgasms, or the orgasms may be less intense. Less commonly, some people report feeling pain when they orgasm.

Treatments can help people to have a healthy sex life after prostate removal. The treatments for erectile dysfunction include:

  • medications, such as Viagra, Cialis, Levitra or Stendra
  • penile injection with Alprostadil
  • a penis pump, which draws blood into the penis
  • a penile implant, which uses inflatable devices or silicone rods to create an erection

Communicating with a partner over any sexual concerns is important. Tips include:

  • talking honestly to a partner about thoughts and feelings around treatment side effects and sexual issues
  • asking a partner how they feel and listening to any concerns they have
  • attending sex therapy or counseling with a partner to help facilitate a conversation and seek support
  • asking a partner to come to medical appointments with them

A 2017 study looked at mental health and sexual dysfunction in people who had received treatment for prostate cancer. Researchers found that people may have difficulty adapting to their new circumstances and side effects of treatment.

Sexual difficulties may negatively affect a person’s self-perception or intimate relationships, and people may have difficulty coping with the changes that occur after treatment.

People may experience distress or frustration around sexual dysfunction and a perceived loss of masculinity.

Tips to help manage mental health issues after prostate removal include:

  • allowing time to adjust after surgery and to sexual changes
  • talking about sex, thoughts, and feelings with a partner to help both people deal with any changes
  • seeking help from a healthcare professional or support group as soon as possible
  • focusing on self-care, such as physical activity, eating healthily, and doing enjoyable activities or hobbies
  • joining a support group or community of people who have gone through the same procedure and who can share their experiences to help feel less alone and get advice
  • talking with a counselor or therapist about any relationship or sexual issues

People will not be able to get a person pregnant through sexual intercourse after prostate removal. A prostatectomy removes the van deferens, so sperm cannot leave the body in the ejaculate, although the testicles still produce sperm.

A person may want to consider storing sperm before prostate removal, which they may be able to use in fertility treatments.

Prostate removal can affect a person’s sex life, including erectile function, ejaculation, orgasm, and fertility.

Penile rehabilitation can help recover erectile function, and other treatments and counseling can help resolve sexual dysfunction and related mental health issues.