Most discussion about sexual health after prostate cancer focuses on erections. Changes to ejaculation and fertility receive less attention but matter to many men, particularly younger men and those in new relationships. Knowing what to expect, and planning ahead where needed, avoids unwelcome surprises.
Why treatment affects ejaculation
The prostate and seminal vesicles produce most of the fluid in semen. Treatments that remove or damage these glands change how much fluid is produced. The nerves and muscles involved in ejaculation can also be affected.
After surgery
After a robotic prostatectomy, the prostate and seminal vesicles are removed, and the tubes that carry sperm from the testicles are cut and sealed. This means:
- dry orgasm: you can still have an orgasm, but no semen comes out
- no natural fertility: you will not be able to father a child through intercourse
- sensation: orgasm can still be pleasurable, though some men notice it feels different
Some men notice a small leak of urine at the time of orgasm, called climacturia. It usually improves over time and can be managed by emptying the bladder beforehand or with pelvic floor exercises. Our step-by-step guide to pelvic floor exercises explains how.
After radiotherapy
Radiotherapy usually reduces the amount of semen over time. Some men produce very little or none. Sperm count and quality can also be reduced, and the effect on fertility may be permanent. Men are usually advised to use contraception during and for a period after treatment, because radiation can affect sperm. Ejaculation may also become uncomfortable for a while during treatment, and this usually settles once treatment has finished.
After hormone therapy
Hormone therapy lowers testosterone. This can reduce sex drive, the amount of semen and sperm production. Effects may partly reverse if treatment stops, but this is not guaranteed.
After focal therapy
Focal treatments such as HIFU may preserve ejaculation for some men, as part of the prostate is left in place. However, semen volume is often reduced. Our guide to focal therapy and HIFU explains these treatments.
Planning for children
If there is any chance you may want children in the future, talk to your team before treatment begins. Options include:
- Sperm banking: storing samples of semen before treatment. This is usually arranged quickly, often within days, so it does not delay treatment.
- Surgical sperm retrieval: after surgery, sperm can sometimes be taken directly from the testicles and used in fertility treatment such as IVF.
The Human Fertilisation and Embryology Authority has independent information about sperm storage and fertility treatment.
Talking to your partner
Changes to ejaculation can affect intimacy for both partners. Talking openly helps. Many couples find that, with time and understanding, sexual satisfaction can remain good. It can help to explain to a partner in advance what physical changes to expect, so that neither of you is caught off guard. Some couples choose to attend an appointment together, which gives both partners a chance to ask questions. Our article on regaining erectile function after surgery covers the wider picture of sexual recovery.
Questions to ask before treatment
- How will this treatment affect ejaculation and fertility?
- Should I consider sperm banking?
- How long will it take to arrange?
- Is there anything that can reduce the impact on orgasm?
- Who can I speak to about sexual health after treatment?
Getting support
Sexual health clinics, psychosexual therapists and specialist nurses can all help. Prostate Cancer UK has a helpline and resources on sex and relationships after treatment.
Professor Prokar Dasgupta discusses sexual health and fertility as part of treatment planning at The London Clinic. Please contact the clinic to arrange a consultation.