Introduction
Many men worry about enjoying a normal sex life after prostate surgery, as the removal of the prostate during surgery (radical prostatectomy) means that the pathway of sperm from the testicles is interrupted (just as it is following a vasectomy done for family planning). Furthermore, the seminal vesicles, which produce the rest of the seminal fluid, are also removed. As such, there’s no fluid buildup before climax, which may diminish the sensation during orgasm.
However, while patients are no longer able to ejaculate fluid, this does not mean that patients cannot enjoy a fulfilling sex life after prostate surgery. In fact, the vast majority of my previously potent patients don’t suffer from erectile dysfunction and are also able to achieve satisfying orgasms similar to those that they enjoyed before their prostatectomy.
We should therefore separate the components of ‘a normal sex life’ into:
- Being able to ejaculate seminal fluid (which is no longer possible after surgery);
- Suffering from erectile dysfunction (unable to initiate or sustain an erection);
- Enjoying the pleasurable sensation of orgasm.
One of the most common reasons that I hear from patients for not choosing surgery as a treatment for prostate cancer is that they don’t want to be impotent – i.e. unable to initiate or sustain an erection. This is despite surgery offering a greater degree of certainty than radiotherapy, but clearly patients are very concerned about this being a possibility.
So how likely is impotence after surgery? Furthermore, even if the patient result is excellent and incontinence and impotence is avoided, what is the quality of their sex life like? Do they continue to have a normal sex life?
Looking at the data
In 2011, I published a study of 500 men at 13.5 months after surgery performed by me on this very topic, and I can state the following. If you’d like to read more, click here to read the article at the Journal of Endourology.
Potency depended on:
- The age of the patient (this is because of age-related changes in the pelvic arteries – principally ‘furring up’ leading to poorer blood flow – and changes in nerves from the age of 35 onwards);
- The number of nerves preserved (there are 2 nerves of potency, so preserving 2 is the best and 0 is the worst);
- A patient’s potency before their operation.
In normally potent non-diabetic men, the overall potency rate after surgery was 86% (defined as being able to manage penetrative intercourse, with or without tablets such as Viagra), which should help to alleviate patient concern about impotence from prostate cancer surgery. In other words, it’s very likely that a patient of mine is able to enjoy continued potency after surgery. I cannot speak for other surgeons’ results, as results depend hugely on your surgeon’s skill and his experience.
In my study, the breakdown by age and number of nerves was as follows:-
| 40-49 | 50-59 | 60-69 | 70+ | |
|---|---|---|---|---|
| 2 nerves preserved | 100% | 91.8% | 82.9% | 60% |
| 1 nerve preserved | 100% | 66.7% | 50.1% | 0% |
Climax
After the prostate has been removed, the climax or orgasm is of course dry but compared to the pleasure they received from climax before surgery:-
- 80% of men describe it is similar.
- 10% of men say that it is more intense.
- 10% of men say that it is less intense.
In conclusion
In summary, if you are young and have normal erections the probability of retaining potency is high, as long as the stage of your cancer permits nerve preservation on both sides and your surgeon is highly skilled. In addition, you are also very likely to continue to enjoy climax. When combining the two, my conclusion from my patients is that a man can indeed have a normal sex life after prostate surgery.
If you don’t fit this description, take heart from the fact that all men can be made potent somehow. If tablets don’t work, then either a vacuum device, self-injection therapy or surgery can resolve the issue.