Can you have an orgasm after a prostatectomy?

Orgasm After Prostatectomy: What to Expect

Yes, men can experience orgasm after prostatectomy, although the sensation and experience may be different than before surgery. 1, 2

Understanding Orgasmic Function After Prostatectomy

Orgasmic function is preserved in most men after prostatectomy, but several important changes can occur:

• Prevalence of orgasm preservation: 82-90% of men can achieve orgasm after prostatectomy 3, 4
• Recovery timeline: Orgasmic function typically plateaus at 15-21 months after surgery 4
• Dry orgasm: Since the prostate and seminal vesicles are removed, there will be no ejaculate (dry orgasm)
• Altered sensation: Many men report changes in orgasmic sensation compared to pre-surgery

Potential Orgasmic Complications

Several orgasmic dysfunctions can occur after prostatectomy:

1. Climacturia (orgasm-associated urinary incontinence)

   • Occurs in approximately 20-30% of men following prostatectomy 1, 2
   • Characterized by involuntary loss of urine during orgasm
   • More common after surgical treatment than radiation therapy (4-5.2%) 1

2. Altered orgasmic sensation

   • Can affect 33-77% of patients 5
   • May include decreased intensity or different quality of sensation

3. Anorgasmia

   • Complete inability to achieve orgasm
   • Less common but can occur in some patients

4. Dysorgasmia (painful orgasm)

   • Reported in up to 19% of patients 5
   • Usually presents as referred pain at the level of the penis

Factors Affecting Orgasmic Function Recovery

Several factors influence the likelihood of preserving good orgasmic function:

• Age: Younger men (≤60 years) have better orgasmic recovery (88.4%) compared to older men (82.6%) 3, 4
• Nerve-sparing technique: Bilateral nerve-sparing significantly improves orgasmic function recovery (90.7%) compared to unilateral (82.1%) or non-nerve-sparing (60.8%) approaches 3, 4
• Preoperative function: Men with better preoperative orgasmic function have better postoperative outcomes 4
• Erectile function: Better erectile function is associated with better orgasmic function 4
• Urinary control: Urinary incontinence negatively affects orgasmic function 4

Management Strategies

For men experiencing orgasmic dysfunction after prostatectomy:

• Climacturia management:

  • Empty bladder before sexual activity
  • Pelvic floor muscle exercises
  • Penile tension loops or condom use during sexual activity

• For altered sensation or anorgasmia:

  • Phosphodiesterase type 5 inhibitors may help increase orgasmic sensation 6
  • Exploring different stimulation techniques

• For painful orgasm:

  • Alpha-blockers can help alleviate pain 6
  • If persistent, consultation with a urologist specializing in sexual medicine

Important Considerations

• Recovery timeline: Orgasmic function recovery is a lengthy process that can take up to 21 months 4
• Partner involvement: Including partners in discussions about sexual changes is important for adjustment
• Psychological factors: Addressing anxiety and expectations can improve sexual satisfaction
• Regular follow-up: Monitoring recovery and addressing persistent issues is important

Patients should be counseled before surgery about all potential changes to sexual function, including orgasmic changes, to set realistic expectations and improve satisfaction with outcomes.