A common problem…sex after prostate surgery – post-prostatectomy sex. Are there any solutions, devices, procedures, etc. that will help?
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A common problem…sex after prostate surgery – post-prostatectomy sex. Are there any solutions, devices, procedures, etc. that will help?
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© 2009 - 2024 Michael Castleman
There are two common types of prostate surgery, the operation for benign prostate enlargement (BPH, the H is for “hypertrophy,” the technical term for enlargement), and the operation for prostate cancer. The former removes part of the prostate gland, the latter, all of it.
Either type of surgery raises the possibility of erectile dysfunction (ED), but men need to know that an erection is NOT necessary for sexual pleasure or orgasm. Even if prostate surgery leaves you with ED, you can still experience sexual fulfillment and climax. Of course, it’s a big adjustment to get used to the idea of sex without erection, but even with ED, the capacity for sexual pleasure remains intact and men can still enjoy intensely pleasurable orgasms.
Compared with prostate cancer surgery, BPH surgery is less likely to impair erection, but ED is possible. The studies differ, but averaging the findings, it appears that around one-third of men suffer erection difficulties afterward. However, if you experience erection problems after surgery, that does not necessarily mean you’re fated to have ED. It may take up to a year for erection function to return.
But BPH surgery causes a major change in ejaculation. You no longer ejaculate semen out of your penis. Instead you have “dry orgasm,” medically “retrograde ejaculation.” You continue to ejaculate, but the semen backfires into your bladder where it mixes with urine and leaves the body during urination. Dry orgasm occurs because the surgery destroys a muscle in the neck of the bladder. This muscle contracts during sexual arousal and directs semen out the penis. But after BPH surgery, with this muscle gone, the path of least resistance for semen is not out the penis, but into the bladder. Dry orgasm is disconcerting, but some couples grow to enjoy it because it makes sex less messy.
Surgery for prostate cancer is likely to cause ED because the nerves involved in erection run next to the gland and are often cut during prostate removal. But ED is not inevitable. If the tumor is located on the side of the prostate away from the nerve line, removal may not cut the nerves. In addition, no matter where the tumor is located, nerve-sparing surgery may preserve erection. Unfortunately, nerve-sparing surgery does not always leave the nerves intact. At Fred Hutchinson Cancer Center in Seattle, researchers checked in with 1,291 men 18 months after prostatectomies. Among those who had ordinary surgery, 66 percent reported ED. Those who had nerve-sparing surgery reported less ED, but not much less—57 percent. Now this study was performed some years ago. Since then, surgical techniques have been refined and some surgeons claim better results. But the fact remains that nerve-sparing surgery does not always preserve erection function. For more on this, read the article Sex After Prostate Cancer.
Most men who have prostate surgery, either for BPH or cancer, have it after 60. By age 60, virtually every man is intimately familiar with later-life erection changes. It takes more stimulation (often much more) to raise erections. When they rise, they are nowhere near as firm as they were decades earlier. And later-life erections are less resilient. They often wilt with minor distraction or no discernible distraction, sometimes right in the middle of sex. This is totally normal. It’s not ED. For more on this, read Weak Erections? Or Erectile Dysfunction?
But after prostate surgery, especially prostate cancer surgery, you may experience severe ED, no possibility of erection ever again. Some men equate “sex” with erection. Faced with ED, they decide they can no longer have sex, and they retire from lovemaking. But sex is much more than erection. In fact, an erection is NOT necessary for fulfilling lovemaking and orgasm. Men who embrace this expanded definition of sex must adjust to sex without erection–a big adjustment–but over time, they experience the pleasant surprise that even without erection, mutually fulfilling sex is still possible. For more on this, read the articles Great Sex Without Intercourse and Forget “Foreplay.”
If you have persistent difficulty adjusting to the sexual changes of either type of prostate surgery, I urge you to consider a brief course of sex therapy. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists or the Society for Sex Therapy and Research.