Men facing prostate issues, such as benign prostatic hyperplasia (BPH) or cancer, are increasingly using nerve-sparing surgeries and medical technologies like penile prostheses to preserve sexual function and intimacy. While procedures often affect ejaculation, advancements in urological surgery and sex therapy are helping patients maintain sexual health during aging.
How does BPH affect male sexual function?
Benign prostatic hyperplasia (BPH) involves a non-cancerous enlargement of the prostate gland, a condition common in men over age 50. This enlargement can compress the urethra, leading to symptoms like a weak urine stream, frequent nighttime urination, and difficulty emptying the bladder.
According to Dr. Rodrigo García-Baquero, a urologist at Puerta del Mar University Hospital in Cádiz, surgical intervention for BPH often involves laser enucleation performed endoscopically. While this procedure treats the enlarged part of the prostate, it can lead to “dry orgasms” or retrograde ejaculation.
Dr. García-Baquero explains that while patients typically maintain erections and the sensation of orgasm, they may not ejaculate. He notes that the orgasmic sensation changes because the physical sensation of pressure decompression during ejaculation is absent, though he describes the experience as neither better nor worse.
Approximately 95% of semen is produced in the prostate and the seminal vesicles. Because these are often removed during radical prostatectomy, the loss of ejaculation is a near-universal symptom for those undergoing cancer surgery.
What are the surgical risks of prostate cancer treatment?
Prostate cancer diagnosis often leads to concerns regarding erectile dysfunction due to the proximity of the nerves responsible for erections to the prostate gland. Dr. Fernando Gómez Sancha, medical director at the Institute of Advanced Urological Surgery (ICUA) in Madrid, states that the primary surgical goal is balancing tumor removal with nerve preservation.
If the cancer is diagnosed early, surgeons can perform less invasive procedures to protect these nerves. Dr. Gómez Sancha reports that one year after surgery, 75% of patients worldwide are able to achieve erections, sometimes with the assistance of medication.
Other physiological changes can occur following a radical prostatectomy. Dr. Gómez Sancha notes that patients may experience a shortening of the penis when flaccid because the urethra must be sutured to the bladder, creating tension. However, the penis typically maintains its original length when erect.
When should men begin prostate screening?
Most prostate cancer cases are diagnosed in men over age 65, with the average age at diagnosis being 75. However, earlier screening is necessary for certain high-risk groups.
Dr. Gómez Sancha recommends that men with a family history of the disease, specifically those with a BRCA2 gene mutation, begin screening at age 45. Diagnosis is typically achieved through PSA tests, digital rectal exams, MRIs, and biopsies.
What medical technologies help restore sexual health?
For patients who experience persistent erectile dysfunction after surgery, several medical interventions are available. These range from topical applications to implanted devices.
- Alprostadil: A prostaglandin that acts as a powerful vasodilator to open blood vessels in the penis. It can be administered via cream or direct injection.
- Vacuum Devices: A cylinder used to create a vacuum that induces an erection.
- Penile Prostheses: An implanted device controlled by a remote, allowing a patient to achieve an erection on demand.
If a patient experiences temporary erectile dysfunction shortly after surgery, it may be due to neurapraxia—a condition where nerves are temporarily inflamed or stopped from functioning due to surgical contact. This condition often resolves as the nerves recover.
Why is the social approach to aging sexuality changing?
The conversation around male virility is shifting away from a strict focus on erections and toward a broader definition of intimacy. Raúl González Castellanos, a sexologist and therapist in Madrid, notes that the taboo surrounding prostate health persists because many men still measure masculinity through sexual performance.
Couples are increasingly using sex therapy to navigate the combined challenges of prostate issues and menopause. Isabella, a 65-year-old woman whose husband underwent cancer treatment, shared that working with a therapist helped her couple transition from a purely “sexual” focus to a more “sensual” connection.
Frequently Asked Questions
Does prostate surgery always cause impotence?
No. While there is a risk to erectile function, the outcome depends on whether the surgeon can preserve the nerves surrounding the prostate. Approximately 75% of patients regain erectile function within a year.
What is the difference between BPH and prostate cancer?
BPH is a non-cancerous enlargement of the prostate that affects urination. Prostate cancer is a malignant growth of prostate cells. Both require different surgical approaches and carry different risks.
Can you still have an orgasm without ejaculation?
Yes. Even if a patient experiences retrograde ejaculation (a “dry orgasm”) or has had the seminal vesicles removed, the neurological sensation of orgasm can still occur through penile stimulation.
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