Ejaculation and sexual life problems after prostate surgery

Yes. After prostatectomy, the ability to ejaculate through the penis is lost. What happens is that ejaculation occurs but it is directed backward into the bladder, rather than forward through the urethra. The semen remains in the bladder until urination, and is carried out via that route. The man who ejaculates in this manner has the very same sensations during sex that he had before except that there is no discharge through the penis.

Can a total prostatectomy be done without impairing the ability to have an erection? 

Dr. Patrick C. Walsh, a surgeon at Johns Hopkins University Hospital in Baltimore, Maryland, has developed a way of removing the prostate which preserves potency by bypassing the intricate nerve branches of the pelvic plexus. This technique is now being adopted by many surgeons for patients with early stage prostate cancer. Until the advent of this type of surgery, 90 percent of those having prostatectomies lost their sexual ability, and 2 to 5 percent became incontinent as well. It is important to discuss the expected results of prostatectomy with your doctor before surgery.

If I can no longer have an erection, can I have a penile prosthesis implanted? 

Yes, it is possible to have a penile prosthesis implanted which will allow you to have an erection. There are several different kinds of implants.

Ejaculation after Prostate Surgery

Even though the doctor says my prostate surgery was successful and that I should have the same sexual response as before treatment, why do I have problems having an erection? 

There are many reasons for a man to lose his ability to have an erection. It happens to everyone even to those who don't have cancer. The emotional stress of having cancer depression, being tired, trying too hard, worry, alcohol all can result in erection problems. Any signs of an erection will give you proof that your body is cooperating but the psyche is so sensitive that it may take quite a long time for you to feel certain enough of your masculinity for you to resume normal intercourse. Perhaps this is a good time for you to experiment with other pleasuring techniques. If the doctor says there is no physical reason, perhaps the problem is psychological, due to pressure you feel about getting an erection.

If I ejaculate less fluid when I have an erection because of surgery, does that mean that I will be unable to father children? 

As long as sperm is intact, the amount of fluid is not the determining factor. The sperm count makes a difference, but even the production of less sperm does not mean that you will be unable to father children. As far as your sexual enjoyment is concerned, the amount of fluid ejaculated should not cause noticeable changes for you and your partner.

Can I still have children even though I've had a transurethral resection (TUR) for a prostate problem?

 As many as three quarters of the men who have had this type of surgery notice a decrease in the amount of fluid emitted at ejaculation. This is most likely due to unavoidable damage to the neck of the bladder during surgery. At ejaculation and orgasm, some or all of the seminal fluid backs up into the bladder (retrograde ejaculation) instead of being forced down and out of the penis. Nothing can be done to change this condition. But even if a smaller number of sperm are ejaculated, potency is not necessarily diminished and conception could result. In older patients wrho are not concerned about fathering children, a decrease in the amount of ejaculate should not cause a problem to patient or partner. If you are interested in having children, it is wise to have a complete fertility workup by a urologist or fertility specialist. 


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