Sexuality for the Man With Cancer

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How cancer treatment can affect ejaculation

Cancer treatment can interfere with ejaculation by damaging the nerves that control the prostate, seminal vesicles, and the opening to the bladder. It can also stop semen from being made in the prostate and seminal vesicles. Despite this damage, a man can still feel the sensation of pleasure that makes an orgasm. The difference is that, at the moment of orgasm, little or no semen comes out.

Over time, most men say an orgasm without semen feels normal. Some others say the orgasm does not feel as strong, while others report that the orgasm is stronger and feels more pleasurable. Men often worry that their partners will miss the semen. Most of the time, their partners cannot feel the actual fluid release, so this is generally not true.

Some men’s chief concern is that orgasm is less satisfying than before. Others are upset by “dry” orgasms because they want to father a child. If a man knows before treatment that he may want to have a child after treatment, he may be able to bank (save and preserve) sperm for future use. (See the “How cancer treatment can affect fertility” section for more on this.)

Some men feel that their orgasm is weaker than before. A mild decrease in the intensity of orgasm is normal with aging, but it can be more severe in men whose cancer treatments interfere with ejaculation of semen. See “Is there a way to make orgasms as intense as they used to be?” in the “Dealing with sexual problems” section.

Surgery

Surgery can affect ejaculation in 2 different ways. The first is when surgery removes the prostate and seminal vesicles, so that a man can no longer make semen. The other is surgery that damages the nerves that come from the spine and control emission (when sperm and fluid mix to make semen). Note that these are not the same nerve bundles that pass next to the prostate and control erections (which are discussed in the section “How pelvic surgery to treat cancer can affect erections”). The surgeries that cause ejaculation problems are discussed in more detail here.

Dry orgasm

After radical prostatectomy (removal of the prostate) and cystectomy (removal of the bladder), a man will no longer produce any semen. The sperm cells made in his testicles ripen, but then the body simply reabsorbs them. This is not harmful. After these cancer surgeries, a man will have a dry orgasm or an orgasm without semen.

Sometimes the semen is there, but doesn’t come out

There are other operations that cause ejaculation to go back inside the body rather than come out (this is called retrograde ejaculation). At the moment of orgasm, the semen shoots backward into the bladder rather than out through the penis. This is because the valve between the bladder and urethra stays open after some surgical procedures. This valve normally shuts tightly during ejaculation. When it’s open, the path of least resistance for the semen becomes the backward path into the bladder. This is not painful or harmful to the man. When a man urinates after this type of dry orgasm, his urine looks cloudy because the semen mixes in with it during the orgasm.

A transurethral resection is an example of an operation that usually causes retrograde ejaculation. This surgery cores out the prostate by passing a special scope into it through the urethra; this often damages the bladder valve.

Nerve damage

We have already discussed the nerve bundles that sit on both sides of the prostate and help cause erections. Now, we are talking about the nerves that come from the spine and control ejaculation. The cancer operations that can cause dry orgasm by damaging the nerves that control emission (the mixing of the sperm and fluid to make semen) are:

  • Abdominoperineal (AP) resection, which removes the rectum and lower colon
  • Retroperitoneal lymph node dissection, which removes lymph nodes in the belly (abdomen), usually in men who have testicular cancer

Some of the nerves that control emission run close to the lower colon and are damaged by AP resection. Lymph node removal (dissection) damages the nerves higher up, where they surround the aorta (the large main artery in the abdomen).

The effects of the 2 operations are probably very much alike, but more is known about sexual function after lymph node surgery. Sometimes the node dissection only causes retrograde ejaculation. But it usually paralyzes emission. When this happens, the prostate and seminal vesicles cannot contract to mix the semen with the sperm cells. In either case the result is a dry orgasm. The difference between no emission at all and retrograde ejaculation is important if a man wants to father a child. Retrograde ejaculation is better for would-be fathers because sperm cells may be taken from a man’s urine and used to make a woman pregnant.

Sometimes the nerves that control emission recover from the damage caused by retroperitoneal lymph node dissection. But if ejaculation of semen does resume, it can take up to 3 years for it to happen. Because men with testicular cancer are often young and have not finished having children, surgeons have nerve-sparing methods that often allow normal ejaculation after retroperitoneal node dissection.

In experienced hands, these techniques have a very high rate of preserving the nerves and normal ejaculation. (See our document called Testicular Cancer for more information.) Some medicines can also restore ejaculation of semen just long enough to collect sperm for conception. If sperm cells cannot be recovered from a man’s semen or urine, infertility specialists may be able to retrieve them directly from the testicle by minor surgery, then use them to fertilize a woman’s egg to produce a pregnancy.

Retroperitoneal node dissection does not stop a man’s erections or ability to reach orgasm. But it may mean that his pleasure at orgasm will be less intense.

Urine leakage during ejaculation

Climacturia is the term used to describe the leakage of urine during orgasm. This is fairly common after prostate surgery, but might not even be noticed. The amount of urine varies widely – anywhere from a few drops to more than an ounce. It’s more common in men who also have stress incontinence. (Men with stress incontinence leak urine when they cough, laugh, sneeze, or exercise. It’s caused by weakness in the muscles that control urine flow.)

Urine is not dangerous to the sexual partner, though it may be a bother during sex. The leakage tends to get better over time, and condoms and constriction bands can help. (Constriction bands are tightened at the base of the erect penis and squeeze the urethra to keep urine from leaking out.) If you or your partner is bothered by climacturia, talk to your doctor to learn what you can do about it.

Other cancer treatments

Some cancer treatments reduce the amount of semen that’s produced. After radiation to the prostate, some men ejaculate only a few drops of semen. Toward the end of radiation treatments, men often feel a sharp pain as they ejaculate. The pain is caused by irritation in the urethra (the tube that carries urine and semen through the penis). It should go away over time after treatment ends.

In most cases, men who have hormone therapy for prostate cancer also produce less semen than before.

Chemotherapy very rarely affects ejaculation. But there are some drugs that may cause retrograde ejaculation by damaging the nerves that control emission.


Last Medical Review: 08/19/2013
Last Revised: 08/19/2013