Resuming Sexual Intercourse After Prostate Aquablation
You can reasonably resume sexual intercourse 1-2 weeks after uncomplicated Aquablation, provided you can perform mild to moderate physical activity without symptoms, as sexual activity requires approximately 3-5 METs of energy expenditure.
Evidence-Based Timeline
While no specific guidelines exist for post-Aquablation sexual activity, I'm applying the cardiovascular surgery framework to this minimally invasive procedure:
- Sexual activity requires 3-5 METs of physical exertion, similar to climbing two flights of stairs 1
- For uncomplicated minimally invasive procedures, sexual activity is reasonable when you can perform mild to moderate physical activity without symptoms 1
- Cardiac surgery patients typically wait 6-8 weeks for open procedures, but Aquablation is far less invasive with no sternotomy or major incisions 1
Aquablation-Specific Considerations
Aquablation has significant advantages for sexual function preservation:
- Only 6% of patients experience retrograde ejaculation with Aquablation versus 23% with TURP (p=0.002) 2
- Fewer patients report worsening sexual function compared to TURP (33% vs. 56%, p=0.03) 2
- Ejaculatory function is relatively preserved in real-world studies 3
- No effect on sexual activity has been demonstrated at 5-year follow-up 4
Practical Algorithm for Resumption
Week 1-2 Post-Procedure:
- Engage in low-energy intimate activities (hugging, kissing, fondling) as a bridge to intercourse 1
- Ensure you can walk comfortably and perform basic activities without bleeding or significant discomfort
- Empty your bladder before sexual activity to minimize any climacturia (orgasm-associated incontinence) 1
After Week 2:
- Resume intercourse if you can perform mild to moderate physical activity without:
- Excessive bleeding or hematuria 5
- Significant pain or discomfort
- Urinary retention or severe urgency
- Consider using a semi-reclining or bottom position initially to decrease physical effort 1
Important Caveats
Bleeding risk: Aquablation has a 1.4-2.7% risk of postoperative bleeding requiring intervention, primarily in the first week 5, 3. Avoid sexual activity if you're experiencing active bleeding.
Catheter management: If you still have a catheter in place, wait until after removal and successful voiding before resuming sexual activity.
Individual variation: Prostate volume affects outcomes—larger prostates (>50cc) may require slightly longer recovery, though Aquablation handles volumes up to 150cc effectively 6
Regular exercise enhances recovery: Engaging in regular physical activity based on your physician's recommendations will improve your tolerance for sexual activity and decrease any associated risks 1