The truth about the impact of prostate treatments on male sexual life: erection, ejaculation, libido — treatment by treatment, without taboo and without mincing words.
The question that all patients have — and that few dare to ask
When a man consults a doctor about his prostate, his real concern is often not the prostate itself. It’s his sex life.
I can see it in their eyes, even before they ask the question. And I prefer to address it directly, without waiting for them to find the courage to ask me: "What impact does it have on my erections? On my ejaculation? On my desire?"
It’s a legitimate question. A fundamental one, even. Sexuality isn’t just about procreation: it touches on identity, relationships, and self-esteem.
A treatment that destroys sexual life in order to cure the prostate is not necessarily a good treatment if an alternative exists.
Dr. Olivier Dumonceau
My approach for over 20 years: I never decide on a treatment without discussing its sexual impact with the patient . Sometimes this changes the treatment I propose. It always changes how the patient experiences what is happening.
The three dimensions of male sexuality
Male sexuality is often reduced to erections alone—as if that were the only issue. This isn’t what I observe in my practice. There are actually three distinct dimensions , which prostate treatments can affect very differently. Distinguishing between them is essential to understanding what’s really happening.
1. Sexual desire (libido)
Libido is highly dependent on testosterone . Hormonal treatments can significantly reduce it.
It can also be affected indirectly — by anxiety related to the diagnosis, by fatigue related to treatments, or by the deterioration of the quality of erections, which generates negative anticipation.
2. Erection: rigidity, maintenance, quality
Erection = nerves + arterial circulation + quality of penile erectile tissue.
This is the most frequently discussed—and most frequently misunderstood—aspect. Many treatments for benign prostatic hyperplasia (BPH) do not affect erections at all. Some cancer treatments affect them to varying degrees, and this effect is often reversible. Only hormone therapy profoundly and systematically impairs them.
3. Ejaculation: volume, externalization, pleasure
This is the most silent dimension—and often the most surprising for patients who haven’t been warned about it. Ejaculation can be:
- Retrograde — instead of being expelled externally, the semen flows back into the bladder (internal ejaculation). Not dangerous, but unpleasant if you’re not prepared for it.
- Reduced in volume — some treatments decrease the production or expulsion of seminal fluid.
- Completely eliminated — anejaculation is the absence of sperm emission during orgasm; the orgasm itself is preserved.
Retrograde ejaculation is not dangerous—semen is naturally eliminated in the urine after intercourse. However, it can diminish the pleasure of orgasm. That’s why I always ask my patients what ejaculation means to them before choosing a treatment.
Prostate adenoma (BPH) and sexuality: treatment by treatment
Prostate adenoma—or benign prostatic hyperplasia (BPH) —is a benign condition that affects the vast majority of men over 50. It does not, in itself, impair sexual function. It is the treatments that can, and the effects vary considerably depending on the chosen option.
When treatment is not yet underway: no sexual impact
When urinary symptoms are mild and quality of life remains acceptable, simple monitoring is often recommended. In this case, no treatment is administered—and sexuality is not affected. This is an option I regularly use, and it’s worth reiterating: not treating when it’s not necessary is also a valid medical decision.
Plant extracts: zero sexual side effects
As a first-line symptomatic treatment, plant extracts ( Pygeum africanum , Serenoa repens ) can be offered for mild symptoms. They have no known side effects on erections or ejaculation. This is their main appeal—even if their effectiveness remains modest.
Alpha blockers: effective, but must be chosen carefully
Alpha-blockers are the most commonly prescribed medications for benign prostatic hyperplasia (BPH). They relax the muscles of the bladder neck and prostate, improving urine flow. Their effectiveness is well documented—but their effect on ejaculation varies considerably depending on the specific molecule .
| Medicine | Urinary efficiency | Risk of retrograde ejaculation | Recommended profile |
|---|---|---|---|
| Alfuzosin (Xatral) | Good | Low (< 5%) | Patient who insists on antegrade ejaculation |
| Tamsulosin (Omexel, Omix, Josir) | Very good | Moderate (15–30%) | Balance between effectiveness and side effects |
| Silodosin (Silodyx, Urorec) | Very good | High (20–50%) | Maximum effectiveness; to be avoided if ejaculation is important to the patient |
| Doxazosin (Zoxan, Cardural) | Good | Weak | Associated hypertension — double benefit |
That is why, before prescribing an alpha-blocker, I systematically ask the question: how important is ejaculation to you? Depending on the answer, I choose the most suitable molecule.
5-alpha-reductase inhibitors: libido and testosterone
Dutasteride (Avodart) and finasteride (Chibro-Proscar) reduce prostate volume by acting on testosterone metabolism. They are effective in the long term—but they can impact libido and sexual desire, precisely because they affect testosterone.
A fact that few patients know: these same molecules, at a lower dose, are used to treat alopecia (hair loss). Their mechanism of action is identical—and so is their potential impact on sexuality. I always explain this before prescribing.
The combination of an alpha-blocker and a 5-alpha-reductase inhibitor is often prescribed for large adenomas. It combines the rapid action of the former with the long-term effect of the latter on volume. The sexual impact is then the sum of the two profiles—and should be discussed during a consultation.
Endoscopic treatments: surgery and ejaculation
When medication is no longer sufficient, endoscopic treatments are used. This is where the stakes regarding ejaculation become the most important—and the most definitive.
Laser prostate enucleation (HoLEP, ThuLEP)
It involves removing the entire internal part of the prostate—the adenoma. This technique is very effective for urinary function . However, it results in permanent retrograde ejaculation in the vast majority of cases . This is irreversible.
The difference with medication is crucial: here, stopping treatment does not cause antegrade ejaculation. It is permanently altered. This is information I clearly explain before any surgical decision is made.
The UroLift: the best ejaculation preservation
UroLift —a technique that uses implants to widen the prostatic urethra, a type of stapling—preserves ejaculation very well. The risk of retrograde ejaculation is 0.5% . It is often the option I recommend first for patients for whom preserving ejaculation is important.
The REZUM: excellent preservation profile
REZUM — a treatment involving the injection of water vapor into the prostate — also has an excellent profile, with a risk of retrograde ejaculation of 5 to 10% . Neither UroLift nor REZUM affects the quality of erections.
Prostate embolization
The risk of retrograde ejaculation is very low, although 5 to 25% of patients experience a reduction in ejaculate volume. Erections are not affected. However, effectiveness in treating urinary problems is highly variable and often short-lived.
Prostate cancer and sexuality: the discussion I have with each patient
Prostate cancer itself does not affect sexuality. It is the treatments that can—to varying degrees depending on the chosen option and the clinical situation. This is a subject I systematically address, without taboo, during the consultation for diagnosis and treatment decision-making.
Robotic radical prostatectomy
Prostatectomy has two sexual consequences, which I explain to each patient before the operation:
- Ejaculation: permanently suppressed. Orgasm remains possible — but without ejaculation ("dry orgasm").
- Erectile function: possible alteration , from temporary to permanent, depending on the preservation of the neurovascular bundles ("erectile nerves").
Regarding erectile recovery: when nerve-sparing is feasible—which depends on the stage of the cancer and the anatomy—the majority of patients regain functional erections within 6 to 24 months . I emphasize early erectile rehabilitation : PDE5 inhibitors (Viagra, Cialis), vacuum therapy, and, if necessary, intracavernosal injections. This protocol begins at the 6-week post-operative consultation—not months later.
Early erectile rehabilitation after prostatectomy significantly improves the chances of recovery. Do not wait for erections to return on their own: the erectile tissue must be actively stimulated to keep it oxygenated and preserve its responsiveness.
External beam radiotherapy
Radiation therapy effectively treats cancer, but the radiation can reach the erectile nerves and the blood vessels that supply the corpora cavernosa. The effects on sexuality are often delayed : they appear gradually in the months following treatment.
A disadvantage compared to surgery: the late effects on erection are difficult to predict and manage, and once established, they are less reversible than post-surgical effects.
High-intensity focused ultrasound (HIFU) treatments
Focal treatments—including HIFU (high-intensity focused ultrasound)—allow for the treatment of a well-localized tumor without removing the entire organ. Their main advantage is the preservation of anatomical structures not affected by the tumor, particularly the erectile nerves.
The profile for sexual preservation is excellent in well-selected cases. However, the indication is strict—a well-identified focal tumor without extraprostatic extension—and the data on medium- and long-term oncological efficacy remain limited compared to surgery or radiotherapy.
Hormone therapy: the most profound impact
This is the treatment with the most significant impact on sexuality, yet it is the least openly discussed. Hormone therapy aims to suppress testosterone production to slow the progression of cancer cells, which are androgen-dependent.
No testosterone → no libido → no erection. It’s brutal, but it’s the physiological reality. Hormone therapy can almost completely suppress sexual desire and erectile function.
In locally advanced or metastatic cancers, hormone therapy is often essential and can save lives. I prescribe it while always discussing its impact on sexual function, offering support measures, and regularly assessing with the patient whether their quality of life remains acceptable.
Hormone therapy doesn’t destroy libido because something is broken. It puts it on standby because the hormonal fuel is lacking. For some patients, this is acceptable. For others, it’s an unbearable loss. This is a discussion I need to have—not a fait accompli I announce after prescribing.
Dr. Olivier Dumonceau
Summary table: all treatments, all impacts
This is the overview I present to my patients during consultations. It allows them to quickly visualize, for each treatment, what can be affected — and how I approach it.
| Treatment | Impact on erection | Impact of ejaculation | What I tell my patients |
|---|---|---|---|
| Treatments for benign prostatic hyperplasia (BPH) | |||
| No treatment (mild symptoms) | None | None | Simple monitoring, no sexual coercion |
| Plant extracts | None | None | A gentle option, with no sexual side effects |
| Alpha-blockers (tamsulosin, alfuzosin…) | None | Retrograde 15 to 50% depending on the molecule | I choose the molecule according to the importance of ejaculation for the patient |
| 5-alpha inhibitors (dutasteride, finasteride) | Possible decrease in libido | Possible decrease in ejaculate volume | Affects testosterone — systematic discussion before prescribing |
| Laser prostate enucleation (HoLEP, ThuLEP) | No impact | permanent retrograde (definitive) | Irreversible — a joint decision based on the patient’s priorities |
| UroLift | None | Very low risk (0.5%) | An ideal option if preserving ejaculation is a priority. |
| REZUM (water vapor) | None | Risk of 5 to 10% | Excellent preservation of sexual function |
| Prostate embolization | None | Very low risk; volume decrease in 5–25% of cases | Non-surgical, good sexual profile |
| Treatments for prostate cancer | |||
| Robotic prostatectomy (nerve-sparing) | Partial recovery possible over 6–24 months | Deleted (permanent) | Nerve-sparing if possible — early erectile rehabilitation recommended |
| External beam radiotherapy | Possible alteration, often delayed | Possible reduction in volume | Delayed effects — monitoring and management if necessary |
| High-intensity focused ultrasound (HIFU) treatments | Very good preservation profile | Good preservation overall | Conservative option — still limited perspective on certain profiles |
| Hormone therapy | Major impact: reduced or even nonexistent libido | Major impact: significantly reduced ejaculation | Essential in certain cases — addressing the associated sexual impact |
The frequency data are averages derived from medical literature and my clinical experience. Individual results vary depending on the patient’s anatomy, age, and profile.
After treatment: what I suggest to preserve sexual life
Erectile rehabilitation: a discipline in its own right
Regaining erectile function after prostate treatment is not a passive process. It’s an active process—medical, sometimes mechanical, always personal. The options I offer vary depending on the situation:
- PDE-5 taken daily or on demand (sildenafil / Viagra, tadalafil / Cialis) — from the 6th post-operative week.
- Erection pump (vacuum) — used regularly to maintain oxygenation of the cavernous tissue post-operatively.
- Intracavernous injections of alprostadil (Edex, Caverject) — for patients not responding to PDE-5 inhibitors.
- P-Shot (PRP) — in support of cavernous tissue regeneration, particularly after prostate surgery or radiotherapy.
- Hydraulic penile implant — definitive solution for patients who have failed all other options, after 18 to 24 months of attempts.
Management of retrograde ejaculation
Retrograde ejaculation, when it occurs after drug treatment, is reversible upon discontinuation of the medication . When it is linked to surgical treatment, it is permanent.
What I explain to my patients is that retrograde ejaculation is not dangerous. Urine will be cloudy immediately after intercourse—this is due to the semen mixing with it. It’s not a complication, it’s an expected and manageable effect.
Managing the impact of hormone therapy
For patients undergoing hormone therapy, suppression of libido is often unavoidable—but not always total. Certain measures can improve the experience:
- Regular physical activity — maintaining general tone, combating fatigue and weight gain induced by treatment.
- Psychological or sexological support — accompanying the couple in redefining intimacy.
- Evaluation of intermittent hormone therapy — in some selected cases, treatment-free windows allow for partial recovery of testosterone.
- Treatment of associated erectile dysfunction — if libido is partially maintained, PDE-5 inhibitors may still be useful.
FAQ: Your questions about the prostate and sexuality
Does prostate adenoma cause erection problems?
The adenoma itself does not cause erectile dysfunction. However, there is a significant age-related coincidence: urinary problems associated with the adenoma often appear at the same time as the first erectile difficulties, linked to vascular or hormonal aging. These are two distinct problems, even though they can coexist in the same patient at the same time.
My doctor prescribed tamsulosin — will that affect my ejaculation?
Yes, it’s possible. Tamsulosin can cause retrograde ejaculation in 15 to 30% of cases, according to studies. Before prescribing it, I always ask my patients how important ejaculation is to them. If it is important, I choose a medication with a more favorable profile, such as alfuzosin. It’s not inevitable; it’s a choice that can be discussed.
After laser surgery on the prostate, is it still possible to have erections?
Yes. Laser treatment does not affect the erectile nerves, which are located outside the prostate capsule. Erections are not affected by this technique. However, ejaculation becomes permanently retrograde in most cases, which is a crucial distinction to distinguish from erection.
After a prostatectomy for cancer, is it still possible to have orgasms?
Yes. After a prostatectomy, orgasm remains possible and can be experienced, even without ejaculation. It may be slightly different in quality, but it is generally present. What the operation eliminates is ejaculation, not the ability to orgasm.
Will hormone therapy necessarily destroy my sex life?
Hormone therapy has a significant impact on libido and erections because it works by suppressing testosterone. This impact is real and should not be minimized. However, it varies depending on the patient, the duration of treatment, and the support measures implemented. Some patients maintain partial sexual activity, especially at the beginning of treatment. I always discuss this impact before prescribing and offer appropriate support.
Can Viagra or Cialis be used after prostate surgery?
Yes. I actively recommend them post-operatively, not just on demand. A daily dose of low-dose tadalafil (5 mg) in the months following prostatectomy improves erectile recovery by maintaining oxygenation of the corpora cavernosa. This is called drug-assisted erectile rehabilitation, and it should begin early, not six months after the operation.
Do UroLift or REZUM preserve sexuality better than LASER treatment?
Yes, regarding ejaculation: UroLift and REZUM very effectively preserve antegrade ejaculation (less than 5% risk of retrograde), whereas laser resection results in permanent retrograde ejaculation in the vast majority of cases. No, regarding erections: none of these three techniques has a negative impact. If preserving ejaculation is a priority for you, UroLift or REZUM should be discussed first.
Is it possible to talk about sexuality during a urological consultation?
Absolutely, and it’s even essential so I can offer you the right treatment. I always ask questions about erectile function, ejaculation, and libido during the initial consultation. If you don’t feel comfortable bringing these topics up spontaneously, please know that I will—because this is medically relevant information, not intrusive questions.
Watch the full video on this topic
If you would like to hear these explanations directly from me, I invite you to watch this video that I made specifically about the prostate and sexuality:
Dr Dumonceau — Prostate and Sexuality A complete educational video (~8 min) on the impact of each prostate treatment on erections, ejaculation and libido.
Key takeaways
The essentials in five points
- Treating the prostate does not mean sacrificing your sex life : treatments today offer very different impact profiles.
- For adenoma, some techniques (UroLift, REZUM) treat the symptoms while preserving sexual function .
- In the case of cancer, it is possible to reconcile oncological efficacy and quality of life .
- Erection, ejaculation and libido are three distinct dimensions : they are not affected by the same treatments.
- Everything hinges on one thing: discussion . I cannot choose the right treatment without understanding what truly matters to you.
Your prostate doesn’t define your sex life. What defines it is how we address together what’s happening to your prostate.
Dr. Olivier Dumonceau
Let’s talk about it, without taboo.
Prioritizing cancer control? Balancing it with intimate quality of life? There’s no single right answer—there’s yours. And that’s what guides the treatment decision.
Make an appointment for urinary problems and BPH
01 42 68 83 30 82 Bd de Courcelles, Paris 17th contact@dumonceau-urologie.fr