A prostatectomy is the surgical procedure involving the removal of the prostate gland, typically performed to treat prostate cancer. A common question following this procedure concerns the ability to produce sperm and maintain fertility. The core answer is that sperm production continues because the testes, which are responsible for creating sperm cells, are not removed during a prostatectomy. The procedure only affects the pathway and fluid components necessary for the sperm to exit the body, clarifying the distinction between sperm production and the creation of seminal fluid.
Understanding Sperm Production and Prostate Function
Sperm cells are continuously manufactured within the testes through a process called spermatogenesis. These reproductive cells constitute a very small volume of the total fluid released during ejaculation. The testes and the epididymis, where sperm mature, remain intact and functional after the prostate gland is removed.
The primary function of the prostate is to produce prostatic fluid, which makes up roughly 20 to 30 percent of the total semen volume. This fluid nourishes and helps transport the sperm. Secretions from the seminal vesicles, which are often removed along with the prostate, contribute approximately 60 percent of the fluid. Since the organs responsible for producing the transport fluid are removed, sperm cells are no longer able to mix with this fluid or exit the body through the usual route.
Ejaculation Changes Following Prostatectomy
While the testes continue to generate sperm, the removal of the prostate gland permanently changes the physical mechanism of ejaculation. The prostate and the adjacent bladder neck musculature play a necessary role in directing semen forward out of the penis during climax. The surgical removal eliminates the glands that produce the bulk of the seminal fluid, resulting in a condition called anejaculation, or a “dry orgasm.”
Normally, the bladder neck sphincter closes during ejaculation to prevent semen from flowing backward into the bladder. The prostatectomy disrupts this muscular mechanism. Consequently, any small amount of fluid produced by remaining accessory glands may flow backward into the bladder instead of forward. This backward flow is termed retrograde ejaculation, resulting in an orgasm without the visible release of fluid.
The physical sensation of orgasm is preserved because the nerves responsible for climax are separate from the structures involved in fluid propulsion. However, many men report a change in the intensity or quality of the orgasm due to the absence of fluid release. This lack of visible ejaculate is a permanent and expected outcome following a radical prostatectomy.
Fertility Options After Surgery
Since sperm is still being produced but is absent from the external ejaculate, men who desire to father a child post-surgery have specialized options available. The most straightforward approach is to preserve sperm before the surgery through a process called sperm banking. This involves freezing and storing semen samples for future use in assisted reproductive techniques.
For men who did not bank sperm pre-surgery, surgical sperm retrieval is possible. Techniques like Testicular Sperm Aspiration (TESA) or Testicular Sperm Extraction (TESE) allow specialists to retrieve sperm cells directly from the epididymis or the testicular tissue. These procedures provide viable sperm that can be used in conjunction with advanced techniques like Intracytoplasmic Sperm Injection (ICSI). ICSI is a form of in vitro fertilization where a single retrieved sperm is injected directly into an egg cell.
Post-surgical fertility efforts rely on these assisted reproductive technologies because the natural pathway for sperm release is permanently altered. The continued production of sperm means that biological fatherhood remains an achievable goal for many men, despite the change in approach necessitated by the procedure.