Questions about prostate removal
I work with many men, and their partners, each year who have been through prostate cancer. Their questions around how prostate removal affects intimacy generally focus on the impact on their erections, what orgasm will feel like, and whether anal penetration is still OK. In this blog article I’ll cover all three and share my experiences as an intimate bodyworker. The physical and emotional impacts of prostate cancer and prostate surgery can be extremely challenging; if you have questions or want support I encourage you to contact your medical practitioner or www.prostatecancer.uk.
What is the prostate?
The prostate is a walnut sized gland that grows bigger as you get older. It sits underneath the bladder and surrounds the urethra, which is the tube that carries urine out of the body. The prostate’s main job is to help make semen – the fluid that carries sperm. (Ref.) Many men find prostate stimulation very pleasurable and arousing, and enjoying anal/prostate massage has nothing to do with your sexuality (it’s not only for gay guys!)
Prostate surgery: what you need to know
Prostate issues are becoming more and more common, and include prostatitis, prostate enlargement and prostate cancer. In the UK it’s estimated that 1 in 8 men will get prostate cancer in their lifetime. Men over 50 (and younger men with other risk factors) are encouraged to regularly have their prostate checked by their doctor, and get their PSA levels tested. However, I encourage all men to cultivate a healthy relationship with their anus and prostate throughout their lifetime for relaxation, pleasure and wellbeing. Having a connection with, and awareness of, this area of your body means that you might be more tuned in to early signs that something is ‘off’.
There are several types of prostate surgery, I encourage you to read about them here, or consult with your Doctor or Urologist, as I am not a medical practitioner or expert.
How does prostate surgery affect sex, arousal and erections?
The most obvious effect of prostate surgery on sexual function is that you will no longer ejaculate because the prostate gland and two glands called the seminal vesicles are removed. Your testicles will continue to make sperm cells but they will be reabsorbed back into your body. This is often referred to as retrograde ejaculation. This means you are still able to have an orgasm, but it’s a ‘dry orgasm’. Some of my clients say that a dry orgasm feels normal, but others find them less intense and pleasurable. For some men there is a big psychological impact with the loss of a visible ejaculation, and it can also affect their partner’s enjoyment of sex.
The sexual repercussions of prostate removal often also include a reduction in sex drive and an impact on the immediacy, strength and sustainability of erections. Not all men who undergo a prostatectomy will experience erectile dysfunction, and the extent of the impact can vary from person to person. Some men I’ve worked with have experienced a complete loss of arousal and erectile function. For others their erections are just a little slower to appear, and intimacy requires more relaxation and patience compared to before their surgery. Prostate surgery can impact erections in the following ways:
Surgical procedures may affect the nerves essential for achieving and maintaining erections.
The removal of the prostate can affect the normal blood flow to the penis, making it more challenging to achieve and sustain an erection.
Some men may experience hormonal imbalances following prostate surgery. While this doesn’t directly inhibit testosterone production, it can affect the body’s ability to regulate hormones properly.
Dealing with the diagnosis of prostate cancer and the prospect of surgery can be psychologically stressful. Stress, anxiety, and depression can contribute to erectile dysfunction, regardless of the physical changes resulting from the surgery.
In addition to this typical advice and information given on medical websites and by medical practitioners, there are many other ways that prostate surgery can affect arousal and intimacy. Many men I work with share that they feel cut off from their masculinity, that they are struggling to find a new way to relate to their sexuality, that they experience pain or numbness in their pelvis and genitals, that they feel overwhelmed by feelings of inadequacy and shame, and that they are realising how limited their experience of sex and intimacy has been because it’s been so entirely focussed on the goal of penetration and ejaculation. As a person who has undergone a leg amputation needs to learn to move and walk again, prostate surgery forces many of my clients into a journey of re-wiring and exploring their relationship to their body and their pleasure.
Intimate massage and recovery after prostate surgery
Surgery for prostate issues can result in damage to the nerves and/or arteries that supply the erectile tissue of the penis. This can take a long time to heal, and can be made worse by a lack of ‘use’ following the surgery. Early ‘rehab’ (like mindful masturbation and massage) can improve blood flow which may help improve long-term erectile function. In my sessions we work with genital massage as a way to bring relaxation and healing to the whole pelvic area. The touch techniques and bodywork I use are designed to relax physical tension, improve blood flow, help you connect to emotion and support the nervous system in dealing with the impacts of trauma.
Sessions can help you to learn new ways of accessing arousal, for example through breath work; by sensitising other areas of your body (not just your genitals); and with simple movement practices that help your body and brain re-wire for pleasure. Some studies suggest that it can take up to 3 years for impacts on sexual function to improve after prostate surgery.
Having sex after prostate surgery
It’s important to understand that your experience of sex and intimacy might be different after prostate surgery. This can be challenging for you, and your partner, but it can also open up a new phase of exploration and connection between you. Here are some things I always encourage my clients and their partners to remember:
- Communication is key. Be open and honest with your partner about your feelings, concerns, and expectations. Discuss your desires, fears, and any changes you’ve noticed in your sexual relationship.
- Ask questions. Don’t be afraid to speak to your medical team about the potential impacts on your sex life – many men are often too embarrassed to ask. Understanding the potential sexual side effects of your surgery before it happens, can help reduce anxiety and frustration afterwards.
- Be patient with each other. It may take time to adapt to the changes in your body. Remember that it’s normal for things to be different, and it doesn’t diminish the emotional and physical connection between you and your partner.
- Explore new ways to be intimate. If genital-focussed, penetrative sex is challenging due to erectile dysfunction, there are many other ways to enjoy each other. Focus on emotional and physical connection through things like foreplay, oral sex, erotic massage and mutual masturbation. Experiment and get creative with different forms of sexual expression that work for you both. Be open to trying new things in the bedroom.
- Pelvic floor exercises (Kegel exercises) can be beneficial for many men. They can help improve neural connections in the pelvic floor muscles, increase blood flow and promote good muscular tone and relaxation which are all vital for sexual function.
- Consult your Doctor or Urologist if your experience of arousal, erections and intimacy are not improving over time. There are various treatments and therapies available to help manage issues like erectile dysfunction. Medications like Viagra or Cialis may be prescribed, or you may consider the use of vacuum erection devices, penile implants, or injections to improve sexual function.
Is anal play OK after prostate surgery?
If you enjoy anal play as part of your sex life it’s important to mention this to your Doctor/Surgeon before surgery. They will be able to advise you on the healing process and when it might be safe to be penetrated again. Generally it’s suggested that it’s OK to have anal sex again after six weeks (Ref.) but, as always, every body is different and you should listen to your body and what feels right for you. It’s important that you give your body time to heal so if you attempt any anal play and notice pain or any blood then consult your Doctor and give your body some more time.
A prostatectomy can change the way anal play feels if you are the receiving partner. If, previously, your main pleasure was gained from stimulating the prostate (i.e. with toys like the Aneros, or through prostate massage) then when the prostate is no longer there, the sensations will be different. If the pleasure was previously carried predominantly through the hypogastric nerve pathway (which innervates in the prostate) you can re-wire this pleasure via the pelvic nerve pathway (which predominantly innervates the rectum and anus). It’s not only prostate stimulation that makes anal play feel pleasurable; the feeling of expansion or ‘stretching’ is a different kind of sensation to experiment with.
Finally, remember that the anus doesn’t produce it’s own lubrication so it’s always a good idea to use plenty of lube. This will reduce friction and protect the delicate inner tissues of the rectum, which is especially important after surgery.