Side effects related to sexual function following prostate cancer treatment can impact your ejaculations, erectile function and libido if you are on hormone therapy. It is essential to have frank and honest communications and to obtain, in a timely manner, medical help and support from a sexologist to cope with these changes.

Regarding your ejaculations, we are always surprised to hear the question “where did my ejaculation go” following radical surgery or radiation therapy. Because one of the important side effects, according to patients, is erectile dysfunction… long before ejaculation!

Other treatments, such as those to decrease the size of your prostate in the presence of hyperplasia/enlarged prostate (BPH) can also have an impact on your ejaculations.

Here are some answers to your questions.

Why am I not ejaculating anymore? 

To answer this question, you need to understand the anatomy of your prostate and its role in ejaculation.

Your prostate is essential to your fertility. Without it, you cannot fertilize an egg naturally. Its main role is to produce the prostate fluid, rich in enzymes, proteins and minerals, which help protect and nourish your sperm. During orgasm, your prostate pushes this fluid into your urethra, where it mixes with your sperm and the seminal fluid produced and stored in your seminal vesicles – pouches on either side of your prostate – before being ejaculated as semen.

The impact of radical surgery 

Radical surgery to treat your prostate cancer affects your ejaculations as the source of your semen (ie your prostate and seminal vesicles) is removed; your libido remains intact, you can still have orgasms, but without semen. This is called aspermia or anejaculation, hence the expression “dry orgasm”.

Another common phenomenon in recovery from radical surgery is leakage of urine during orgasm, known as climacturia. Although it usually improves over time, there are strategies you can adopt to work around this problem during sex by doing your Kegel exercises, emptying your bladder before sex, and wearing a condom as needed. Easier to write than to put into practice, we know. Give yourself time and don’t give up!

What about radiation therapy? 

Because external beam radiation therapy or brachytherapy delivers important doses of radiation to your prostate, more or less significant ejaculation disorders can occur after these treatments: volume reduction (hypospermia) or disappearance of ejaculation (aspermia), retrograde ejaculation or discomfort during ejaculation.

Why am I urinating my semen?

Because you have what is called a retrograde ejaculation. It is an ejaculation that goes up to your bladder instead of exiting through the urethra and out of the penis. Orgasm, however, remains present, as does the mechanism for the expulsion of your semen (with the contraction of your muscles from the perineal region). Retrograde ejaculation is not always total: indeed, part of your semen can go up into your bladder while the other follows the normal path of ejaculation. Thus, you produce urine mixed with your sperm.

Retrograde ejaculation often occurs after surgery on your prostate through the natural/TURP routes to treat severe BPH. Surgery for benign prostatic hypertrophy widens your bladder neck and it can no longer close during ejaculation: this leads to the expulsion of sperm into the bladder rather than outside the penis.

Take the time to visit each of our pages on this website, as well as our YouTube channel, in order to get familiar with the disease with our expert lectures, our section on available resources, the support that is offered to you.

Do you have any questions or concerns? Above all, do not hesitate. Contact us at 1 855 899-2873 to discuss with a nurse specializing in uro-oncology. It’s simple and free, like all our services.

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