Orgasm and Ejaculation After Prostate Surgery: What Changes and What Helps

Erectile function receives most of the attention in discussions of sexual recovery after prostate surgery. Changes to orgasm and ejaculation are equally common, are often more persistent, and are less frequently explained beforehand. This article sets out what changes, why, what can be improved, and what cannot.

What changes after radical prostatectomy

Radical prostatectomy removes the prostate and the seminal vesicles, and the vasa deferentia are divided. These structures produce and deliver seminal fluid.

Dry orgasm is permanent and expected. After radical prostatectomy there is no semen to emit, so orgasm occurs without ejaculation. This is anejaculation, and no device, medication, or exercise reverses it. Any product suggesting otherwise is misrepresenting the anatomy.

Other changes are variable rather than universal:

• Reduced orgasm intensity. Common, and often improves over months to a few years.
• Anorgasmia. Difficulty reaching orgasm at all, or requiring much more stimulation.
• Climacturia. Involuntary loss of urine at orgasm, reported by a substantial proportion of men after prostatectomy.
• Dysorgasmia. Pain during orgasm, usually felt in the perineum or penis. Often improves with time.
• Shortened or altered orgasm. A different quality of sensation rather than an absent one.

These are distinct problems with different causes, and separating them matters, because some are treatable and some are not.

Why orgasm sensation changes

Orgasm and ejaculation are separate events that normally occur together. Ejaculation is the physical expulsion of semen. Orgasm is the sensory and central nervous system experience, driven partly by rhythmic contractions of the pelvic floor muscles, principally the bulbospongiosus and ischiocavernosus.

Surgery removes the structures responsible for emission but does not remove the pelvic floor muscles or their contractions. This is why orgasm remains possible after prostatectomy even though ejaculation does not.

Sensation changes for several reasons: disruption of the cavernous nerves and surrounding neural tissue, altered sensory feedback from structures that are no longer present, weakening of the pelvic floor following surgery, and in some men a psychological component related to the experience of cancer treatment.

What has evidence behind it

Pelvic floor muscle training is the intervention with the strongest support. It is standard care for post-prostatectomy urinary incontinence and is also associated with improvement in climacturia and orgasm quality. If you have not been referred to a pelvic floor physiotherapist, ask. This is the first thing to pursue.

Time. Orgasmic function commonly improves over the first one to two years after surgery. Early difficulty is not necessarily the final position.

Treating climacturia specifically. Climacturia is a defined problem with its own management, which includes pelvic floor training, emptying the bladder before sexual activity, and in some cases a constriction device or loop worn at the base of the penis. It is worth naming to your urologist rather than describing generally.

Where Xialla fits

Xialla's band passes around the scrotum and anchors to the lower back, which places light pressure across the perineum during use.

The rationale for relevance here is that the perineum overlies the bulbospongiosus muscle, whose contractions contribute to the sensation of orgasm. Some men who use Xialla report a more noticeable pulsing sensation at climax, including men who had lost it after surgery.

Xialla's published material describes a trial examining climacturia in men following prostate surgery, alongside the erectile function evaluations. That is the outcome in this area with trial data behind it. The effect on orgasm sensation itself is user report, not a study finding, and the mechanism above is a rationale rather than a demonstrated result.

Two things it does not do. It does not restore ejaculation, for the anatomical reason described above. And it does not repair nerve damage. A man with extensive nerve disruption may notice little difference.

If you are considering it for this reason specifically, that is worth raising with your urologist alongside pelvic floor referral, rather than instead of it.

Talking to your care team

Orgasmic changes after prostate cancer treatment are under-discussed, and many men assume nothing can be done. Some of it can.

Name the specific problem rather than describing sex as unsatisfactory. Anejaculation, anorgasmia, climacturia, and dysorgasmia point toward different responses. Ask about pelvic floor physiotherapy by name. And say how much it matters to you, because clinicians managing cancer follow-up may not raise it unprompted.

See also our article on supporting sexual function after prostate surgery.

Safe use

Xialla is a constriction device. Observe a maximum of 30 minutes of continuous wear, remove it before sleeping, and remove it immediately if numbness, coldness, discolouration, or pain occurs.

Men taking anticoagulants, men with sickle cell disease, and men with reduced penile sensation should consult a physician before use. If you have had recent pelvic surgery, confirm with your surgeon before using any device that applies pressure to the perineum.

The band should feel supportive rather than tight. Perineal pressure sufficient to cause discomfort or numbness is too much.

References

• Yafi FA, Hammad MAM, Elterman D. Xialla: a novel medical device for addressing erectile dysfunction associated with veno-occlusive dysfunction. Int J Impot Res. 2024. Full text
• Tal R, et al. Persistent erectile dysfunction following radical prostatectomy. J Sex Med. 2009.
• Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline. J Urol. 2018;200(3):633-641.