How Cancer Can Affect Ejaculation and Orgasm
Some cancer treatments can affect your ability to ejaculate and have an orgasm. This doesn’t have to decrease the pleasure you feel during sexual activity, but it can affect your ability to father a child.
Learn more about how you might be affected and the options for managing or treating these problems.
Problems with ejaculation and orgasm
Male orgasm (climax) is the peak of sexual excitement when pleasure is highest. Male orgasm happens in two stages: emission and ejaculation.
Emission is when semen (the fluid that comes out of your penis when you ejaculate) is deposited near the top of your urethra. A small valve at the top of the urethra shuts to keep the semen from going into the bladder.
Ejaculation is the release of semen from the penis during sexual activity. The fluid released includes both sperm and other fluids.
The nerves needed for emission and ejaculation are different. You can have an orgasm without ejaculating, or you can feel pleasure and ejaculate without having an orgasm.
Problems with ejaculation can happen if:
- You have damage to the nerves needed for erection and orgasm.
- You lose your ability to make semen.
- The path semen takes to leave your body is blocked.
Problems with ejaculation can affect orgasm. As you age, it’s normal to see a mild decrease in the intensity of your orgasms. But this decrease can be more severe in men whose cancer treatments interfere with ejaculation.
The information below describes common sexual problems faced by adult men (or people with male reproductive organs*) after certain types of cancer treatment. You might have problems or needs that aren’t addressed here. Your cancer care team can help you manage your specific situation.
*To learn more about the gender terms used here, and how to start the conversation with your cancer care team about gender identity and sexual orientation, see Gender Identity, Sexual Orientation, and Cancer Treatment.
Which cancer treatments can affect ejaculation?
These cancer treatments can sometimes affect ejaculation:
- Surgery
- Radiation
- Hormone therapy
- Chemotherapy and other medicines
Cancer surgery and ejaculation
Cancer surgery can affect ejaculation in different ways.
Dry orgasm
Many men are still able to have an orgasm after cancer surgery . But for some men, these might be dry orgasms (no fluid comes out of your penis when you ejaculate). The testicles still make sperm cells, but your body simply reabsorbs them. This is not harmful.
Dry orgasm can happen if:
- Your prostate and seminal vesicles are removed, so your body no longer makes semen.
- The path semen usually takes out of your body is blocked.
- Semen goes back into your bladder instead of leaving your body.
Even without semen, you are likely to feel pleasure during an orgasm. Over time, many men adjust to having an orgasm without semen. Some men say the orgasm doesn’t feel as strong, while others report the orgasm is stronger and feels more pleasurable.
Retrograde ejaculation
Retrograde ejaculation can also cause dry orgasm. This is when semen goes “backward” into your body instead of coming out through your penis.
With retrograde ejaculation, semen shoots back into your bladder rather than out through your penis. This happens when the valve between your bladder and urethra stays open. This valve normally shuts tightly during ejaculation.
Retrograde ejaculation isn’t painful or harmful, but when you urinate after this type of orgasm, your urine might look cloudy because your semen has mixed with your urine.
A transurethral resection of the prostate (TURP) is an example of an operation that most often causes retrograde ejaculation because it damages the bladder valve. This surgery cores out your prostate using a special scope. The scope passes through your urethra to reach your prostate.
Nerve damage
Cancer surgery might also damage the nerves that control emission (when sperm and fluid mix to make semen).
These nerves come from your spine. They are separate from the nerves around your prostate that control your erections, so even when you lose your ability to make semen, you may still be able to have erections and orgasm, and experience pleasure.
Nerve damage and colorectal cancer surgery
Some surgeries for colon and rectal cancer can damage the nerves that control emission, because these nerves run close to the lower colon and rectum. This includes:
- Abdominoperineal (AP) resection: removal of the rectum and lower colon
- Total mesorectal excision (TME): removal of the rectum as well as the mesorectum
Nerve damage and testicular cancer surgery
If you have testicular cancer, you may need to have a retroperitoneal lymph node dissection (RPLND).
This surgery removes lymph nodes in the back of your abdomen (belly), and it might damage some of the nerves that control emission and ejaculation. Damage to these nerves can sometimes be prevented if a nerve-sparing approach is used by a surgeon who has experience with this procedure.
Urine leakage during ejaculation
Some men leak urine during ejaculation after they’ve had surgery for prostate cancer. (This is called climacturia.) It’s fairly common, but it might not even be noticeable to you or your partner. The amount of urine varies widely — anywhere from a few drops to more than 2 tablespoons.
Urine leakage might be more common in men who also have stress incontinence. This is when urine leaks when a person coughs, laughs, sneezes, or exercises.
Urine doesn’t harm a sexual partner, though it may be annoying 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 your erect penis. The band squeezes your urethra to keep urine from leaking out.
If you or your partner is bothered by climacturia, ask your health care team what can be done about it.
How other cancer treatments can affect ejaculation
- Radiation to the prostate can reduce the amount of semen your body makes, so less comes out when you ejaculate.
- Radiation to the prostate can irritate your urethra (the tube that carries urine and semen through your penis). This may cause a sharp pain when you ejaculate, but it should go away over time after treatment ends.
- Hormone therapy for prostate cancer can also reduce the amount of semen you make.
- Chemotherapy and other medicines