How does a history of prostate cancer affect ejaculation in a male patient over 50?

Ejaculation After Prostate Cancer: Universal Loss with Surgery, Preserved Orgasm

A history of prostate cancer treatment universally eliminates ejaculation after radical prostatectomy due to removal of seminal vesicles and disruption of ejaculatory ducts, though orgasm capability remains intact in most men despite the absence of ejaculate. 1

Treatment-Specific Effects on Ejaculation

Radical Prostatectomy

• Complete anejaculation (absence of ejaculate) occurs in 100% of men after radical prostatectomy, as the surgical removal of seminal vesicles and disruption of ejaculatory ducts makes ejaculation anatomically impossible. 1
• Orgasm capability is typically preserved even without an erection or ejaculate—these are separate physiologic processes. 1
• Climacturia (urine leakage at orgasm) affects a significant proportion of men, particularly within the first year post-surgery, and causes substantial distress and embarrassment. 1

Radiation Therapy

• Radiation does not immediately eliminate ejaculation like surgery does, but progressive damage to ejaculatory structures occurs over time due to ischemic tissue changes including fibrosis and necrosis. 1
• Ejaculatory dysfunction develops gradually with delayed onset, typically appearing 6 to 36 months after treatment, contrasting with the immediate effect of surgery. 1

Androgen Deprivation Therapy (ADT)

• ADT in combination with radiation therapy has at least a temporary negative impact on libido and erectile function, which indirectly affects sexual activity but does not directly eliminate ejaculation through anatomical disruption. 1

Clinical Management Algorithm

Pre-Treatment Counseling (Essential)

• Men must be counseled before treatment that prostate cancer therapy may cause sexual dysfunction, infertility, bowel and urinary problems. 1
• Pre-treatment counseling must include specific information that orgasm ability is often preserved even without ejaculation—this distinction is critical for setting realistic expectations. 1
• Sperm banking should be discussed before treatment for men of reproductive age. 1

Post-Treatment Management of Climacturia

• Recommend bladder emptying before sexual activity to minimize urine leakage at orgasm. 1
• Suggest condom use during intercourse if urine leakage at orgasm is bothersome to the patient or partner. 1

Psychosocial Considerations Requiring Specific Attention

• Men who have same-sex partners are significantly more bothered by loss of ejaculate than heterosexual men and face greater risk of depression or anxiety—this population requires specific attention to loss of ejaculate concerns. 1
• Partners' sexual function and satisfaction directly affect the survivor's erectile function recovery and overall sexual satisfaction. 1
• Many couples do not recover their sexual relationship without professional support or counseling. 1
• Referral to supportive counseling should be offered when patients express distress about body image changes. 1
• Mental health professionals trained in sex therapy can help couples develop a new sexual paradigm based on current function. 1

Critical Clinical Pitfalls to Avoid

• Do not assume that preserved erectile function means preserved ejaculatory function—these are separate physiologic processes, and surgery eliminates ejaculation regardless of erectile recovery. 1
• Do not dismiss climacturia as trivial—this symptom causes significant distress and embarrassment but has practical management solutions. 1
• Do not overlook the heightened psychological impact on men who have same-sex partners, who require specific attention to loss of ejaculate concerns. 1
• Open discussions about sexual recovery should occur during routine clinical care by directly asking about sexual function concerns at regular intervals. 1