Sex After Prostatectomy: How To Have A Healthy Sex Life After Surgery
Medically reviewed by Kristin Hall, FNP
Prostate health issues such as benign prostatic hyperplasia and prostate cancer affect hundreds of thousands of men in the United States every year.
If youve been diagnosed with a serious prostate issue, your healthcare provider may suggest a prostatectomy a surgical procedure in which your part or all of your prostate gland is surgically removed from your body.
Prostate removal surgery is usually highly effective at treating cancer and prostate enlargement , but it can potentially lead to complications.
These include some sexual performance issues, such as erectile dysfunction and difficulty ejaculating normally.
Although these effects can change your sexual experience, many men are still able to enjoy a fulfilling, satisfying sex life after prostate surgery by making certain lifestyle changes and using medication.
Below, weve talked about what to expect if youre scheduled to undergo a prostatectomy and want to maintain an active sex life after surgery.
Weve also explained how you can have a healthy sex life after a partial or complete prostate removal, whether through exercises to improve sexual functioning, medications, devices or a combination of different approaches.
Are There Any Surgical Techniques That Have Been Developed To Improve Erectile Function Outcomes
At this time, there are several different surgical approaches to carry out the surgery, including retropubic or perineal approaches as well as laparoscopic procedures with freehand or robotic instrumentation. Much debate but no consensus exists about the advantages and disadvantages of the different approaches. Further study is needed before obtaining meaningful determinations of the success with different new approaches.
- You are bleeding from your rectum.
- You are urinating very little or not at all.
- You have pain from your procedure that does not get better, even after taking pain medicines.
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
On Sex After Prostate Surgery Confusing Data
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For men having prostate cancer surgery, one of the biggest fears is that they will be left impotent. Unfortunately, the research that might help address that question is likely only to confuse.
So which of the studies is right? Surprisingly, they both are.
The results depend on several crucial variables the type of patient studied, sex life before surgery and, most important, the definitions doctors use to define potency.
Of the 219,000 men a year who receive diagnoses of prostate cancer, nearly half undergo surgical removal of the gland, according to the National Cancer Institute. Most top surgeons report that an overwhelming majority of their patients can achieve erections adequate for intercourse after the operation.
Under that definition, a man who had regular sex after surgery, a man who managed to have sex only once and a man who struggled mightily each time he had sex would all be considered success stories.
Although he could cite statistics to give men a more hopeful view, he said that did not help the patient.
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Removal Of The Catheter
Your catheter will be removed by the clinic nurse at Urology Care Wellington 7-14 days after surgery. This is straightforward. You will be given an antibiotic tablet at the time of catheter removal. Afterward, you will be monitored by the nurse to make sure that you are able to pass urine. She will check your wounds are healing and will discuss the use of pads and pelvic floor exercises.
Most patients have some incontinence when the catheter is taken out and most are pad-free three months after surgery. Over nine out of ten are pad-free after a year. We recommend that you start the pelvic floor exercises as soon as your catheter is removed and repeat them every day.
To be prepared for your catheter removal and any temporary urine leakage, you should ensure that you have your own supply of pads at home prior to attending for catheter removal. Bring two pads to your appointment for catheter removal.
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An enlarged prostate can also be the cause of other problems. If the enlarged prostate is causing symptoms, the best treatment would be a natural remedy. In the meantime, there are treatments for a wide range of conditions that cause a man to experience pain. A common surgical procedure involves an electric loop, laser, or electro-stimulation. The procedure is a safe and effective option for treating enlarged or symptomatic BPH.
Prostatectomy Surgery & Your Sex Life: The Basics
Your prostate gland plays a key role in your sexual and urinary function. If your prostate is surgically removed, youll likely experience changes to your ability to have sex.
Several different methods are used to remove part or all of the prostate gland. The type of technique thats used for your prostatectomy may have an effect on your sex life and sexual performance after surgery.
Because your prostate plays a key role in producing and secreting semen, you may not be able to ejaculate normally after its surgically removed.
Medications like sildenafil , tadalafil and others can often help to improve your sexual performance after prostate removal.
When these arent effective, other treatments, such as injectable medications or penile prosthesis, may help you to enjoy a healthy sex life.
How Does Prostate Surgery Affect You Sexually
If you are diagnosed with prostate cancer and opt for a prostatectomy, particularly a radical prostatectomy, the surgeons will have removed your prostate.
While the prostate isnt directly responsible for your libido or sexual sensation, in some men who have had a prostatectomy, there can be damage to nerves or blood vessels.
The prostate is next to a dense group of nerves and the seminal vesicles .
There is a heightened chance of an infection such as spermatocystitis which can cause you pain or in some cases impotence.
For men who have had an open prostatectomy, they will find that they can no longer ejaculate. This is known as a dry orgasm and can still be pleasurable.
Even with less invasive surgeries, the most common complaint or side effect tends to be sexual in nature.
However, according to systematic reviews and meta-analysis of the scientific data, these cases of sexual dysfunction are often associated with psychological factors that might be present before surgery or as a result of stress related to the surgical procedure.
Radiation therapy can impact the pelvic floor muscles and nerves that control erections and provide pleasure.
According to a 2016 study, around half of Prostate Cancer patients who have any form of radiation therapy go on to develop erectile dysfunction.
For a large section of men who opt for radiation-based therapies, the first stage is usually hormone therapy.
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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.
An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.
Why Is There Increasing Concern At This Time Regarding Erectile Dysfunction Issues Following Radical Prostatectomy
The reality of the recovery process after radical prostatectomy today is that erectile function recovery lags behind functional recovery in other areas. Patients are understandably concerned about this issue and, following months of erectile dysfunction, become skeptical of reassurances that their potency will return.
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Transurethral Resection Of The Prostate
This operation is more often used to treat men with non-cancerous enlargement of the prostate called benign prostatic hyperplasia . But it is also sometimes used in men with advanced prostate cancer to help relieve symptoms, such as trouble urinating.
During this operation, the surgeon removes the inner part of the prostate gland that surrounds the urethra . The skin is not cut with this surgery. An instrument called a resectoscope is passed through the tip of the penis into the urethra to the level of the prostate. Once it is in place, either electricity is passed through a wire to heat it or a laser is used to cut or vaporize the tissue. Spinal anesthesia or general anesthesia is used.
The operation usually takes about an hour. After surgery, a catheter is inserted through the penis and into the bladder. It remains in place for about a day to help urine drain while the prostate heals. You can usually leave the hospital after 1 to 2 days and return to normal activities in 1 to 2 weeks.
You will probably have some blood in your urine after surgery.
Other possible side effects from TURP include infection and any risks that come with the type of anesthesia used.
After Prostate Removal The Sperm Has To Go Somewhere But Where
Men who are facing prostate removal due to cancer will surely wonder where their sperm will go after removal of the prostate gland. Its fair to wonder about this.
First of all, sperm is produced in the testicles.
The testicles continue to make sperm, but because the vas deferens is clipped and cut, and because there is no prostate or seminal vesicles, there is no ejaculate, explains Michael Herman, MD, director of urologic oncology at South Nassau Communities Hospital in Oceanside, NY.
People can continue to have orgasms, though, because the nerves that have to do with climax are unaffected, and are actually not related to whether or not someone ejaculates.
The sperm gets broken down and reabsorbed by the body. This is the same process as if someone were abstinent or had a vasectomy.
In short, prostate removal will not affect sperm production or quantity. It only affects what happens to the sperm once its produced.
Unfortunately, removal of the prostate may be more of an issue to a woman than to the man, if she believes she cant enjoy intimate relations without ejaculations.
Men who have partners like this should focus on all that can be done to treat their prostate cancer and prevent a recurrence.
Women who feel deprived without the ejaculate need a harsh lesson in priorities.
Prostate cancer affects one out of six men as a lifetime risk, and the number it kills every year in the U.S. averages in the high 20,000s.
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The Initial Causes Can You Still Ejaculate If Your Prostate Is Removed
One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.
Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.
If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.
Surgery To Remove The Prostate
You no longer ejaculate semen if you have had a radical prostatectomy. This is because the prostate gland and 2 glands called the seminal vesicles are removed. The seminal vesicles make the liquid part of the sperm. Your testicles will still make sperm cells but they will be reabsorbed back into your body.
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What You Need To Know About The Prostate Can You Still Ejaculate After Prostate Removal
The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. During puberty, the body produces semen in a large number of cases, including enlarged prostate. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. This is why the prostate is important to the body. It can be caused by many factors, including infection and inflammation.
A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.
While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.
How To Maintain Your Sex Life After Prostate Surgery
Although prostate surgery can affect your sexual experience and performance, getting surgery to remove part or all of your prostate doesnt mean that you can no longer have sex or enjoy a satisfying sexual life.
If youve recently had prostate surgery, its important to talk to your healthcare provider before you make any changes to your health habits. Theyll be able to inform you about what you can do to restore and improve your sexual function after surgery.
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Will There Be Any Change In My Ejaculate After Surgery/treatment And If So Anything I Should Be Worried About
There will certainly be a change in your ejaculate after radical prostatectomy there will not be any!
The reason for this is that, contrary to the popular belief that semen comes from the testicles, the majority of the ejaculatory volume actually comes from the seminal vesicles and the prostate itself. These of course are removed as part of your operation.
For further information, Bay Urology in Tauranga offers a nurse led couples clinic where issues of intimacy and sexual function can be discussed in a practical and sensitive way.
Do you have a question about prostate cancer, prostate cancer treatment or the impact of prostate cancer surgery? You can email firstname.lastname@example.org, and your question will be put to our experts for them to answer right here on the Grace Prostate Cancer Centre website.
You can also see the last question in our Ask the Experts feature: Will I Ever Be Dry Again?
What Should I Expect When I Get Home
When you are discharged from the ward you will need some baggy trousers or track pants as you may find that your abdomen is uncomfortable and the catheter is easier to manage if your clothing is loose.
There will be some blood, urine, and mucus which passes alongside or through the catheter and is particularly noticeable after passing a bowel motion this is normal. You should wash the area with soap and water to remove this discharge to reduce any irritation. Keeping a high oral fluid intake reduces the risk of catheter blockage.
You may notice some swelling and bruising around the wounds, the penis, and the scrotum which takes several weeks to resolve. You may also notice small firm lumps below the wound these are normal and are simply the knots in the suture material used to close the wound. The suture slowly dissolves and will disappear within 3 months. Most men feel quite tired after surgery and this takes several weeks to resolve.
Following surgery, you will be given a prescription for regular pain medication as well as some laxative medication to keep your bowels regular and thus avoid any straining.
Light walking is encouraged straight after the surgery. After four to six weeks you may resume heavy lifting.
Showering, bathing, and getting the wounds wet is fine the skin has been sealed with glue.
Driving is safe once you are comfortable to do so and feel able to make an emergency stop. This would normally be around 3 weeks following surgery.
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What Happens Immediately After Surgery
Once your surgery has finished, you are taken to the recovery room where you will wake up.
There will be a catheter in your bladder and sometimes a small wound drain.
You will often feel a sense of needing to empty your bladder. This is normal and is due to the irritation and spasm of the bladder caused by the catheter. This sensation slowly resolves and medication can be given to help relax the bladder. The catheter is held in place with a 3cm inflatable balloon on the catheter tip so cannot fall out with normal activity. Your catheter will remain in for approximately ten days to allow the new join between your bladder and urethra to heal.
Typically, after one hour in the recovery room, you are taken back to the ward. You will be able to sit up in bed and eat dinner on the evening of surgery and walk about the ward that day or the following morning. Blood thinners and calf compressors are used to reduce the risk of blood clots forming within the veins. Post-operative pain is well controlled through the use of regular pain medication. Once you are comfortable and confident in caring for the catheter you can head home. Hospital stay is typically 1-2 nights for robotic surgery and 2-3 nights for open surgery.