What is the relationship between ejaculation and prostate health?

From the Guidelines

Ejaculation is associated with improved prostate health, potentially reducing the risk of prostate cancer and alleviating symptoms of prostatitis and benign prostatic hyperplasia (BPH) [ 1 ]. Regular ejaculation, typically defined as 4-7 times per month, may help to clear out toxins and reduce inflammation in the prostate gland.

Key Points to Consider

• Ejaculation can be affected by various factors, including prostate cancer treatment, which can lead to issues such as anejaculation or climacturia [ 1 ].
• Medications such as alpha-blockers (e.g., tamsulosin 0.4mg daily) or 5-alpha-reductase inhibitors (e.g., finasteride 5mg daily) may be prescribed to help manage prostate health [ 1 ].
• In cases of delayed ejaculation, treatment options may include pharmacotherapies such as oxytocin, pseudoephedrine, or ephedrine, although the evidence base for these treatments is limited [ 1 ].
• It is essential to note that ejaculation is not a substitute for medical treatment, and individuals with prostate concerns should consult their healthcare provider for personalized advice.

Important Considerations for Prostate Health

• Prostate-specific antigen (PSA) levels can be elevated due to various factors, including ejaculation, infection, or trauma [ 1 ].
• The use of 5-alpha-reductase inhibitors can decrease serum PSA levels, which should be considered when interpreting PSA test results [ 1 ].
• A qualified healthcare professional should be consulted for proper diagnosis and treatment of prostate-related issues.

From the FDA Drug Label

1. 5 Effect on Semen Characteristics Treatment with finasteride tablets for 24 weeks to evaluate semen parameters in healthy male volunteers revealed no clinically meaningful effects on sperm concentration, mobility, morphology, or pH. A 0.6 mL (22. 1%) median decrease in ejaculate volume with a concomitant reduction in total sperm per ejaculate was observed.

• sexual dysfunction that continued after discontinuation of treatment, including erectile dysfunction, decreased libido and ejaculation disorders (e. g. reduced ejaculate volume).

The relationship between ejaculation and prostate health is that reduced ejaculate volume has been observed in patients taking finasteride tablets, a medication used to treat prostate health issues such as Benign Prostatic Hyperplasia (BPH) 2. Additionally, ejaculation disorders have been reported as a postmarketing adverse event in men taking finasteride tablets for the treatment of BPH 2. Key points to consider include:

• Reduced ejaculate volume: a median decrease of 0.6 mL (22.1%) was observed in healthy male volunteers taking finasteride tablets for 24 weeks.
• Ejaculation disorders: reported as a postmarketing adverse event in men taking finasteride tablets for the treatment of BPH.

From the Research

Relationship Between Ejaculation and Prostate Health

The relationship between ejaculation and prostate health is complex and has been studied in various contexts.

• Ejaculation frequency has been inversely related to the risk of prostate cancer (PCa) 3.
• A study found that men reporting higher compared to lower ejaculatory frequency in adulthood were less likely to be subsequently diagnosed with prostate cancer 3.
• Benign prostatic hyperplasia (BPH) is commonly responsible for lower urinary tract symptoms (LUTS) in men aged 50 or over, and ejaculatory disorders (EjD) are frequently overlooked in the initial evaluation 4.
• The prevalence of painful ejaculation in men with clinical BPH is approximately 20%, and these men have more severe LUTS and reported greater bother 5.

Ejaculation Frequency and Prostate Cancer Risk

• A prospective cohort study found that ejaculation frequency at age 40-49 yr was positively associated with a reduced risk of PCa incidence 3.
• The hazard ratio for PCa incidence for ≥21 compared to 4-7 ejaculations per month was 0.81 (95% confidence interval [CI] 0.72-0.92; p<0.0001 for trend) for frequency at age 20-29 yr and 0.78 (95% CI 0.69-0.89; p<0.0001 for trend) for frequency at age 40-49 yr 3.
• Frequent ejaculation seems to be protective from the development of prostate cancer 6.

Benign Prostatic Hyperplasia (BPH) and Ejaculation

• BPH-related ejaculatory disorders (EjD) are frequently overlooked in the initial evaluation, and approximately 46% of men presenting with LUTS reported EjD 4.
• Medical therapies for BPH were exposed to anejaculation, rather than retrograde ejaculation (RE), and surgical therapies such as trans-urethral resection of the prostate (TURP) and incision of the prostate (TUIP) are associated with a high rate of RE 4.
• Recent surgical techniques, such as Rezum©, Aquablation©, or Urolift©, were developed to preserve antegrade ejaculation with promising short-term results 4.

Prostate Health and Sexual Activity

• Sexual activity can affect prostate cancer pathogenesis in a variety of ways, including the proposed high androgen status, risk of sexually transmitted infections, and the potential effect of retained carcinogens within the prostatic cells 6.
• Multiple sexual partners may be protective from prostate cancer, excluding the risk of sexually transmitted infections 6.
• Homosexual men are at a greater risk for the diagnosis of prostate cancer 6.