Men who undergo radical prostatectomy or cystectomy, two types of prostate cancer surgeries, may experience changes to their sex life. This is because the prostate and seminal vesicles are removed during these operations.
During these procedures, your surgeon will put you under anesthesia to keep you asleep and pain free.
Semen
When a man has radical prostatectomy, the prostate gland and seminal vesicles are taken out. This changes the way sperm travels during sex, because the pathway they normally take down the penis to reach an egg is cut off. The sensation of orgasm may still be pleasurable, but there is no ejaculation of fluid. This is sometimes referred to as “dry orgasm.”
Radiation, hormone therapy and other treatments for prostate conditions may also impact sperm production or the amount of semen produced. For instance, chronic prostatitis can lower sperm count and make it harder to get an erection. And if you have an inflamed prostate (prostate cancer or benign prostatic hyperplasia), you might receive antibiotics that reduce the amount of semen your body makes.
Fortunately, these changes don’t usually affect a man’s ability to father a child, even if he can’t ejaculate after surgery. That’s because the testicles produce sperm, and the ejaculatory nerve bundles that go to the prostate don’t control erections. Moreover, the nerves that control other sexual feelings are unaffected by these types of surgeries.
Urethra
The prostate gland produces a slightly alkaline fluid that is part of semen, the sperm-carrying liquid that mixes with sperm during male sexual climax (orgasm). During orgasm, muscle fibres in your penis push this mixture down the urethra to create ejaculate. The urethra is the tube that conveys both urine and semen out of your body.
During open radical prostatectomy (RP), surgeons remove the entire prostate gland along with its surroundings, including the seminal vesicles and vas deferens, which connect to the urethra and produce semen. In some cases, a small section of the bladder may also be removed.
The removal of the prostate gland and seminal vesicles means that you can no longer produce semen, so you will not be able to ejaculate after prostatectomy. Some men say that this makes their orgasms less pleasurable. Others report that their orgasms are more intense after prostatectomy.
In addition, if your prostate is surgically removed, you will not be able to father a child the natural way. However, if you want to have children in the future, you can ask your doctor about “banking” sperm before your surgery or therapy. They can then reintroduce the sperm when you are ready to become fertile again. You can also discuss the possibility of using artificial insemination with your partner if you are not planning to have children.
Bladder
A prostatectomy is a surgery to remove part or all of your prostate gland. It’s done to treat conditions such as BPH (enlarged prostate) or prostate cancer.
The prostate is a small gland about the size of a ping-pong ball. It produces seminal fluid that carries sperm down the urethra to the penis during orgasm. This enables sperm to be released for fertilization with an egg. If your prostate is removed during a prostatectomy, the path for sperm to leave your body through orgasm will be blocked. You can still make sperm, but you won’t be able to get pregnant.
Radiation therapy for prostate cancer can also reduce your ability to produce semen. In addition, if your doctor uses a procedure called robotic prostatectomy, it might damage the nerves that control erectile function and result in an incomplete or painful erection.
However, your doctor may be able to use a more nerve-sparing technique that can preserve or restore erections after prostatectomy. Medications such as sildenafil (Viagra) and tadalafil (Cialis) can also improve sexual function after prostate removal. In some cases, men can experience a satisfying sex life with the help of these drugs and a healthy diet that includes low-fat dairy, vegetables, whole grains and aphrodisiac foods such as oysters and dark chocolate. A vacuum constriction device such as the VacuVent can be used to maintain an erection for orgasms during sexual activity, but it’s not always effective in all men.
Penis
During male climax, the muscles of the penis contract and relax rhythmically, pushing semen out. At the same time, a message of pleasure is sent to the brain. This is a normal part of sex and leads to orgasm. In some men, this does not happen and they never experience ejaculation. This can be due to surgery or other treatments for prostate cancer, such as radiation or hormone therapy. These treatments can damage the prostate and seminal vesicles and affect the ability to produce semen.
Some men who have prostate surgery experience a reduction in the length of their penis. Generally, the shortening is temporary. The length can be restored with physical activity and a healthy diet. Some doctors recommend using a vacuum constriction device, which is a penile sex toy that pulls blood into the penis, helping it maintain an erection during intercourse.
Prostate cancer treatment can also affect sperm production, so it may be difficult to have children naturally. However, some men who want to have children later in life can have their sperm frozen before prostatectomy and used in artificial insemination. Men who have a hernia or other conditions that cause sex problems should consider getting surgery to remove their hernia before they undergo a prostate removal procedure. This will improve their quality of life and increase the chances of regaining an erection after prostate removal.
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