How Cancer Can Affect Ejaculation

This information is for adult males with cancer. If you are a transgender person, please talk to your cancer care team about any needs that are not addressed here.

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, or it can cut off the path that semen normally takes out of the body. Despite this, 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. This is referred to as a “dry orgasm.”

Over time, many men adjust to having an orgasm without semen. Some others say the orgasm does not feel as strong, while others report that the orgasm is stronger and feels more pleasurable. Men might worry that their partners may notice a change since there is no actual fluid release during sex.

Some men are most concerned that their orgasms are 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 Fertility and Male Adults with Cancer for more on this.)

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. See Treating Sexual Problems for Men With Cancer.

Surgery effect on ejaculation

Surgery can affect ejaculation in different ways. For example, if surgery removes the prostate and seminal vesicles, a man can no longer make semen. Surgery might also damage 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 How 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) or cystectomy (removal of the bladder), a man will no longer produce any semen because the prostate and seminal vesicles have been removed. The testicles still make sperm cells, but then the body simply reabsorbs them. This is not harmful. After these cancer surgeries, a man will have a dry orgasm.

Sometimes the semen is there, but it doesn’t leave the body

Other operations can cause the ejaculate (semen) 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, although when a man urinates after this type of dry orgasm, his urine might look cloudy because the semen mixes in with it during the orgasm.

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

Nerve damage

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

• Abdominoperineal (AP) resection, which removes the rectum and lower colon
• Total mesorectal excision (TME), which removes the rectum as well as the mesorectum for treatment for rectal cancer
• Retroperitoneal lymph node dissection (RPLND), which removes lymph nodes in the back of the abdomen (belly), 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 or a TME. Lymph node dissection can damage the nerves higher up, where they surround the aorta (the large main artery in the abdomen).

The effects of these operations are probably very much alike, but more is known about sexual function after RPLND. Sometimes this surgery only causes retrograde ejaculation. But it usually stops emission as well. 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 collected from a man’s urine and purified in a lab to be used make a woman pregnant.

Sometimes the nerves that control emission recover from the damage caused by RPLND. But, if ejaculation of semen does resume, it can take up to several years for it to happen. Because men with testicular cancer are often young and have not finished having children, surgeons use nerve-sparing methods that often allow normal ejaculation after RPLND. In experienced hands, these techniques have a very high rate of preserving the nerves and normal ejaculation. (See 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.

RPLND 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 it might not even be noticed. The amount of urine varies widely – anywhere from a few drops to more than an ounce. It may be 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 treatment effects on ejaculation

Some cancer treatments reduce the amount of semen that’s produced. After radiation to the prostate, some men ejaculate less 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 make less semen than before.

Chemotherapy and other drugs used to treat cancer very rarely affects ejaculation. But there are some drugs that may cause retrograde ejaculation by damaging the nerves that control emission.

To learn more about ejaculation see Cancer, Sex, and the Male Body.