A prostatectomy is the surgical removal of the prostate gland, most commonly performed to treat localized prostate cancer. The surgery involves removing the gland and often the nearby seminal vesicles, which are integral parts of the male reproductive system. Understanding the recovery process, particularly the return to sexual activity, is a primary concern for many patients. This article focuses on the timeline for resuming sexual function and managing changes related to ejaculation and overall sexual health following a prostatectomy.
The Nature of Ejaculation After Surgery
The most significant change to ejaculation following a radical prostatectomy is the transition to a “dry orgasm.” This is a permanent physical change because the prostate and seminal vesicles, which produce the majority of seminal fluid, are removed during the procedure. Consequently, the physical expulsion of fluid ceases. Despite the lack of fluid, the sensation of orgasm is typically preserved, as the nerves responsible for the climax sensation are distinct from those controlling fluid production and release. While the physical act of ejaculation is absent, the subjective experience of orgasm remains possible for nearly all men. Some men report a change in the intensity or feeling of the orgasm.
Timeline for Resuming Sexual Activity
The timeline for safely resuming sexual activity, including achieving orgasm, is dictated by the body’s need to heal the surgical site. Physicians typically advise patients to wait approximately four to eight weeks following a radical prostatectomy. This initial delay ensures that the internal sutures, which reattach the bladder to the urethra, have fully healed. Resuming activity too soon can stress the connection point, potentially causing complications like bleeding or leakage at the surgical site. Clearance to resume intimacy must come from the operating surgeon, as recovery rates vary based on the patient’s overall health and the specific surgical approach used. Once the surgeon confirms internal healing is complete and the catheter is removed, the patient can safely return to sexual activity.
Factors Influencing Long-Term Sexual Function
While the ability to experience orgasm typically returns quickly, the recovery of erectile function follows a separate and much longer timeline. Achieving a rigid erection sufficient for penetration depends on the health and recovery of the cavernous nerves, which run along the sides of the prostate. The primary factor determining long-term success is the extent of nerve preservation during the prostatectomy. A bilateral nerve-sparing technique, where both bundles of nerves are preserved, offers the highest chance of recovery, though recovery is slow due to surgical trauma and inflammation. Age is another strong predictor, as men under 60 generally recover function more quickly and completely than older patients. Pre-operative sexual health also plays a significant role; men with excellent erectile function before surgery have a higher likelihood of regaining it. Full recovery often takes 18 to 24 months or more, as nerve tissue regenerates very slowly.
Addressing Related Post-Prostatectomy Side Effects
The return to sexual activity is often accompanied by the need to manage related side effects, most notably erectile dysfunction (ED). Nearly all men experience some degree of ED immediately after surgery. To support recovery, many urologists recommend a penile rehabilitation program, which focuses on increasing blood flow to the penis to encourage tissue health and nerve healing.
Managing Erectile Dysfunction (ED)
This rehabilitation commonly involves the use of phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil or tadalafil, which help relax muscles and promote blood flow. Other effective, non-surgical options include vacuum erection devices (VEDs) and penile injection therapies. If these non-invasive methods are insufficient after a year, surgical options like a penile prosthesis may be considered.
Managing Climacturia
Another occasional side effect is climacturia, which is the leakage of urine during sexual arousal or orgasm. This occurs because the internal sphincter muscle, which helps control urine, is often compromised during the prostatectomy. Strategies to manage this include performing pelvic floor exercises (Kegels) to strengthen supporting muscles, emptying the bladder right before intimacy, and using a variable tension penile loop to help prevent or contain leakage during sexual activity.