After an operation for a prostate adenoma, also called benign prostatic hyperplasia or BPH, a man can have an orgasm… without seeing any sperm come out. The practical answer is: after certain procedures, sperm may return to the bladder instead of exiting through the penis. It will then be eliminated with the urine.
This situation is called retrograde ejaculation. It does not necessarily mean that the erection has disappeared, nor that the pleasure is absent. On the other hand, it can surprise and worry if it has not been explained before treatment. Important: we are talking here about an intervention for adenoma/BPH, and not a radical prostatectomy for cancer, the consequences and mechanisms of which are different.
“Before an operation for prostate adenoma, the question of ejaculation must be clearly asked: it is not a detail, it is useful information to decide” explains Dr. Gérald Kierzek.
Orgasm, erection, ejaculation: don’t confuse everything
The first benchmark is simple: erection, orgasm and ejaculation are three different phenomena. Erection corresponds to the rigidity of the penis. Orgasm is the feeling of pleasure. Ejaculation is the expulsion of sperm.
After certain BPH treatments, ejaculation may be altered while orgasm remains possible. Some men talk about a “dry orgasm” because they experience orgasm without visible semen release. To understand the mechanism, our article on retrograde ejaculation details the possible causes and the consequences on fertility.
“A change in ejaculation does not automatically mean that the erection disappears or that the pleasure disappears: these three subjects must be separated” recalls Dr. Gérald Kierzek.
Why can sperm go to the bladder?
During habitual ejaculation, the semen is directed outwards. But after certain interventions at the prostate or bladder neck, the mechanism which directs the sperm can be modified. Result : sperm travels back to the bladder instead of being expelled through the urethra. It then mixes with urine and is eliminated during urination.
This phenomenon is common after prostate adenoma surgery: Health Insurance mentions approximately 75% of cases after a surgical procedure. But the risk varies depending on the technique used, the patient’s situation, the condition of the prostate and the objectives discussed with the urologist. Some medications used for BPH, including alpha-blockers or hormonal treatments such as finasteride or dutasteride, can also cause ejaculation or sexual problems.
We must therefore not attribute everything mechanically to the operation. The good reflex is to check with your doctor, particularly if the disorder appears after the introduction of treatment. Our file on treatments for benign prostatic hypertrophy also allows us to place the different options in their context.
“The right question to ask the urologist is very concrete: with this option, what is the risk for my ejaculation, my sexuality and my fertility?” advises Dr. Gérald Kierzek.
Fertility, treatment, emergency: the right reflexes
Retrograde ejaculation is not necessarily dangerous in itself. On the other hand, it can have an important consequence: it can complicate a child’s projectsince the sperm is no longer emitted outwards in the usual way. If a pregnancy is desired, this must be said before treatment in order to discuss possible options with the urologist, or even with a fertility specialist.
“If you have a plan to have a child, say so before treatment: sexuality and fertility must be part of the medical discussion, without embarrassment and without taboo” underlines Dr Gérald Kierzek.
Another essential point: never stop medication prescribed for the prostate on your own because ejaculation has changed. Unsupervised cessation can worsen urinary symptoms. It is better to make an appointment to check the cause, assess the discomfort and adjust the treatment if necessary.
Finally, certain signs after an intervention should prompt medical attention: inability to urinate, fever, severe pain, heavy bleeding, clots in the urine or malaise. In these situations, it is no longer just a possible sexual effect: urgent medical advice is necessary.