{"id":4918,"date":"2026-09-06T22:35:49","date_gmt":"2026-09-06T21:35:49","guid":{"rendered":"https:\/\/www.dumonceau-urologie.fr\/urology\/prostate-and-sexuality-erection-ejaculation-libido\/"},"modified":"2026-09-06T22:58:42","modified_gmt":"2026-09-06T21:58:42","slug":"prostate-and-sexuality-erection-ejaculation-libido","status":"publish","type":"post","link":"https:\/\/www.dumonceau-urologie.fr\/en\/urology\/prostate-and-sexuality-erection-ejaculation-libido\/","title":{"rendered":"Prostate and sexuality: erection, ejaculation, libido"},"content":{"rendered":"\n<div class=\"upo-article\"><p class=\"upo-article__lead\">The truth about the impact of prostate treatments on male sexual life: <strong>erection, ejaculation, libido<\/strong> \u2014 treatment by treatment, without taboo and without mincing words.<\/p><p class=\"upo-article__byline\"> <span>By <strong>Dr. Olivier Dumonceau<\/strong> , urological surgeon specializing in prostate surgery,<\/span> <span>Urology Practice Paris Op\u00e9ra \u2014 82 Bd de Courcelles, Paris 17th <sup>.<\/sup><\/span> <span>Reading time: 14 minutes<\/span> <\/p><nav class=\"upo-article__toc\" aria-label=\"Sommaire de l'article\"><p class=\"upo-article__toc-title\"> Contents<\/p><ol><li> <a href=\"#la-question\">The question that few dare to ask<\/a><\/li><li> <a href=\"#trois-dimensions\">The three dimensions of sexuality<\/a><\/li><li> <a href=\"#hbp\">Benign prostatic hyperplasia (BPH): treatment by treatment<\/a><\/li><li> <a href=\"#endoscopiques\">Adenoma surgery and ejaculation<\/a><\/li><li> <a href=\"#cancer\">Prostate cancer and sexuality<\/a><\/li><li> <a href=\"#synthese\">Complete summary table<\/a><\/li><li> <a href=\"#apres\">Preserving sexual life after treatment<\/a><\/li><li> <a href=\"#faq\">Your frequently asked questions<\/a><\/li><li> <a href=\"#video\">The video on this topic<\/a><\/li><li> <a href=\"#retenir\">Key takeaways<\/a><\/li><\/ol><\/nav><h2 id=\"la-question\"> The question that all patients have \u2014 and that few dare to ask<\/h2><p> When a man consults a doctor about his prostate, his real concern is often not the prostate itself. <strong>It&#8217;s his sex life.<\/strong><\/p><p> 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: <em>&quot;What impact does it have on my erections? On my ejaculation? On my desire?&quot;<\/em><\/p><p> It&#8217;s a legitimate question. A fundamental one, even. Sexuality isn&#8217;t just about procreation: it touches on identity, relationships, and self-esteem.<\/p><blockquote class=\"upo-quote\"><p> A treatment that destroys sexual life in order to cure the prostate is not necessarily a good treatment if an alternative exists.<\/p> <cite>Dr. Olivier Dumonceau<\/cite><\/blockquote><p> My approach for over 20 years: <strong>I never decide on a treatment without discussing its sexual impact with the patient<\/strong> . Sometimes this changes the treatment I propose. It always changes how the patient experiences what is happening.<\/p><h2 id=\"trois-dimensions\"> The three dimensions of male sexuality<\/h2><p> Male sexuality is often reduced to erections alone\u2014as if that were the only issue. This isn&#8217;t what I observe in my practice. There are actually <strong>three distinct dimensions<\/strong> , which prostate treatments can affect very differently. Distinguishing between them is essential to understanding what&#8217;s really happening.<\/p><h3> 1. Sexual desire (libido)<\/h3><p> Libido is highly dependent on <strong>testosterone<\/strong> . Hormonal treatments can significantly reduce it.<\/p><p> It can also be affected indirectly \u2014 by anxiety related to the diagnosis, by fatigue related to treatments, or by the deterioration of the quality of erections, which generates negative anticipation.<\/p><h3> 2. Erection: rigidity, maintenance, quality<\/h3><div class=\"upo-callout upo-callout--key\"><p> <strong>Erection = nerves + arterial circulation + quality of penile erectile tissue.<\/strong><\/p><\/div><p> This is the most frequently discussed\u2014and most frequently misunderstood\u2014aspect. 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. <strong>Only hormone therapy profoundly and systematically impairs them.<\/strong><\/p><h3> 3. Ejaculation: volume, externalization, pleasure<\/h3><p> This is the most silent dimension\u2014and often the most surprising for patients who haven&#8217;t been warned about it. Ejaculation can be:<\/p><ul class=\"upo-checklist upo-checklist--dot\"><li> <strong>Retrograde<\/strong> \u2014 instead of being expelled externally, the semen flows back into the bladder (internal ejaculation). Not dangerous, but unpleasant if you&#8217;re not prepared for it.<\/li><li> <strong>Reduced in volume<\/strong> \u2014 some treatments decrease the production or expulsion of seminal fluid.<\/li><li> <strong>Completely eliminated<\/strong> \u2014 anejaculation is the absence of sperm emission during orgasm; the orgasm itself is preserved.<\/li><\/ul><div class=\"upo-callout upo-callout--warn\"> <span class=\"upo-callout__title\">The most unexpected surprise<\/span><p> Retrograde ejaculation is not dangerous\u2014semen is naturally eliminated in the urine after intercourse. However, it can diminish the pleasure of orgasm. That&#8217;s why I always ask my patients <strong>what ejaculation means to them<\/strong> before choosing a treatment. <\/p><\/div><figure class=\"upo-figure\"><img src=\"https:\/\/www.dumonceau-urologie.fr\/wp-content\/uploads\/2026\/08\/prostate-bandelettes-neurovasculaires-nerfs-erectiles-schema.webp\" alt=\"Anatomical diagram of the prostate, bladder, and neurovascular bundles responsible for erection\" width=\"1200\" height=\"675\" loading=\"lazy\" decoding=\"async\"\/><figcaption> The neurovascular bundles\u2014the \u201cerectile nerves\u201d\u2014run on either side of the prostate. Their anatomical proximity explains why some treatments can affect erections, while others do not.<\/figcaption><\/figure><h2 id=\"hbp\"> Prostate adenoma (BPH) and sexuality: treatment by treatment<\/h2><p> Prostate adenoma\u2014or <strong>benign prostatic hyperplasia (BPH)<\/strong> \u2014is 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.<\/p><h3> When treatment is not yet underway: no sexual impact<\/h3><p> When urinary symptoms are mild and quality of life remains acceptable, <strong>simple monitoring<\/strong> is often recommended. In this case, no treatment is administered\u2014and sexuality is not affected. This is an option I regularly use, and it&#8217;s worth reiterating: not treating when it&#8217;s not necessary is also a valid medical decision.<\/p><h3> Plant extracts: zero sexual side effects<\/h3><p> As a first-line symptomatic treatment, plant extracts ( <em>Pygeum africanum<\/em> , <em>Serenoa repens<\/em> ) can be offered for mild symptoms. They have <strong>no known side effects<\/strong> on erections or ejaculation. This is their main appeal\u2014even if their effectiveness remains modest.<\/p><h3> Alpha blockers: effective, but must be chosen carefully<\/h3><p> 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\u2014but <strong>their effect on ejaculation varies considerably depending on the specific molecule<\/strong> . <\/p><div class=\"upo-table-wrap\"><table class=\"upo-table upo-table--stack\"><caption class=\"upo-table__caption\"> Alpha blockers: urinary efficacy and impact on ejaculation<\/caption><thead><tr><th scope=\"col\"> Medicine<\/th><th scope=\"col\"> Urinary efficiency<\/th><th scope=\"col\"> Risk of retrograde ejaculation<\/th><th scope=\"col\"> Recommended profile<\/th><\/tr><\/thead><tbody><tr><th scope=\"row\"> Alfuzosin (Xatral)<\/th><td data-label=\"Efficacit\u00e9\"> Good<\/td><td data-label=\"\u00c9jaculation r\u00e9trograde\"> Low (< 5%)<\/td><td data-label=\"Profil\"> Patient who insists on antegrade ejaculation<\/td><\/tr><tr><th scope=\"row\"> Tamsulosin (Omexel, Omix, Josir)<\/th><td data-label=\"Efficacit\u00e9\"> Very good<\/td><td data-label=\"\u00c9jaculation r\u00e9trograde\"> Moderate (15\u201330%)<\/td><td data-label=\"Profil\"> Balance between effectiveness and side effects<\/td><\/tr><tr><th scope=\"row\"> Silodosin (Silodyx, Urorec)<\/th><td data-label=\"Efficacit\u00e9\"> Very good<\/td><td data-label=\"\u00c9jaculation r\u00e9trograde\"> High (20\u201350%)<\/td><td data-label=\"Profil\"> Maximum effectiveness; to be avoided if ejaculation is important to the patient<\/td><\/tr><tr><th scope=\"row\"> Doxazosin (Zoxan, Cardural)<\/th><td data-label=\"Efficacit\u00e9\"> Good<\/td><td data-label=\"\u00c9jaculation r\u00e9trograde\"> Weak<\/td><td data-label=\"Profil\"> Associated hypertension \u2014 double benefit<\/td><\/tr><\/tbody><\/table><\/div><p> That is why, before prescribing an alpha-blocker, I systematically ask the question: <strong>how important is ejaculation to you?<\/strong> Depending on the answer, I choose the most suitable molecule.<\/p><h3> 5-alpha-reductase inhibitors: libido and testosterone<\/h3><p> <strong>Dutasteride<\/strong> (Avodart) and <strong>finasteride<\/strong> (Chibro-Proscar) reduce prostate volume by acting on testosterone metabolism. They are effective in the long term\u2014but they can impact libido and sexual desire, precisely because they affect testosterone.<\/p><p> 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\u2014and so is their potential impact on sexuality. I always explain this before prescribing.<\/p><div class=\"upo-callout upo-callout--info\"> <span class=\"upo-callout__title\">Good to know<\/span><p> The combination <strong>of an alpha-blocker and a 5-alpha-reductase inhibitor<\/strong> 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\u2014and should be discussed during a consultation.<\/p><\/div><h2 id=\"endoscopiques\"> Endoscopic treatments: surgery and ejaculation<\/h2><p> When medication is no longer sufficient, endoscopic treatments are used. This is where the stakes regarding ejaculation become the most important\u2014and the most definitive.<\/p><h3> Laser prostate enucleation (HoLEP, ThuLEP)<\/h3><p> It involves removing the entire internal part of the prostate\u2014the adenoma. This technique is <a href=\"https:\/\/www.dumonceau-urologie.fr\/en\/urologue-expertise\/holmium-laser-thulep\/\">very effective for urinary function<\/a> . However, it results in <strong>permanent retrograde ejaculation in the vast majority of cases<\/strong> . This is irreversible.<\/p><p> 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.<\/p><h3> The UroLift: the best ejaculation preservation<\/h3><p> <a href=\"https:\/\/www.dumonceau-urologie.fr\/en\/urologue-expertise\/urolift-transurethral-implants-for-bph\/\">UroLift<\/a> \u2014a technique that uses implants to widen the prostatic urethra, a type of stapling\u2014preserves ejaculation very well. The risk of retrograde ejaculation is <strong>0.5%<\/strong> . It is often the option I recommend first for patients for whom preserving ejaculation is important.<\/p><h3> The REZUM: excellent preservation profile<\/h3><p> <a href=\"https:\/\/www.dumonceau-urologie.fr\/en\/urologue-expertise\/bph-treatment-with-rezum-steam-thermotherapy\/\">REZUM<\/a> \u2014 a treatment involving the injection of water vapor into the prostate \u2014 also has an excellent profile, with a risk of retrograde ejaculation of <strong>5 to 10%<\/strong> . Neither UroLift nor REZUM affects the quality of erections.<\/p><h3> Prostate embolization<\/h3><p> 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.<\/p><h2 id=\"cancer\"> Prostate cancer and sexuality: the discussion I have with each patient<\/h2><p> Prostate cancer itself does not affect sexuality. It is the treatments that can\u2014to 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.<\/p><h3> Robotic radical prostatectomy<\/h3><p> <a href=\"https:\/\/www.dumonceau-urologie.fr\/en\/urologue-expertise\/robotic-assisted-radical-prostatectomy\/\">Prostatectomy<\/a> has two sexual consequences, which I explain to each patient before the operation:<\/p><ul class=\"upo-checklist upo-checklist--dot\"><li> <strong>Ejaculation: permanently suppressed.<\/strong> Orgasm remains possible \u2014 but without ejaculation (&quot;dry orgasm&quot;).<\/li><li> <strong>Erectile function: possible alteration<\/strong> , from temporary to permanent, depending on the preservation of the neurovascular bundles (&quot;erectile nerves&quot;).<\/li><\/ul><p> Regarding erectile recovery: when <em>nerve-sparing<\/em> is feasible\u2014which depends on the stage of the cancer and the anatomy\u2014the majority of patients regain functional erections within <strong>6 to 24 months<\/strong> . I emphasize <a href=\"https:\/\/www.dumonceau-urologie.fr\/en\/urology\/how-can-i-preserve-my-erections-after-a-prostatectomy\/\">early erectile rehabilitation<\/a> : PDE5 inhibitors (Viagra, Cialis), vacuum therapy, and, if necessary, intracavernosal injections. This protocol begins at the 6-week post-operative consultation\u2014not months later.<\/p><div class=\"upo-callout upo-callout--good\"> <span class=\"upo-callout__title\">The point that changes everything<\/span><p> <strong>Early erectile rehabilitation<\/strong> 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.<\/p><\/div><h3> External beam radiotherapy<\/h3><p> 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 <strong>delayed<\/strong> : they appear gradually in the months following treatment.<\/p><p> 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.<\/p><h3> High-intensity focused ultrasound (HIFU) treatments<\/h3><p> Focal treatments\u2014including <strong>HIFU<\/strong> (high-intensity focused ultrasound)\u2014allow 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.<\/p><p> The profile for sexual preservation is excellent in well-selected cases. However, the indication is strict\u2014a well-identified focal tumor without extraprostatic extension\u2014and the data on medium- and long-term oncological efficacy remain limited compared to surgery or radiotherapy.<\/p><h3> Hormone therapy: the most profound impact<\/h3><p> 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.<\/p><div class=\"upo-callout upo-callout--warn\"><p> <strong>No testosterone \u2192 no libido \u2192 no erection.<\/strong> It&#8217;s brutal, but it&#8217;s the physiological reality. Hormone therapy can almost completely suppress sexual desire and erectile function.<\/p><\/div><p> 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.<\/p><blockquote class=\"upo-quote\"><p> Hormone therapy doesn&#8217;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&#8217;s an unbearable loss. This is a discussion I need to have\u2014not a fait accompli I announce after prescribing.<\/p> <cite>Dr. Olivier Dumonceau<\/cite><\/blockquote><h2 id=\"synthese\"> Summary table: all treatments, all impacts<\/h2><p> This is the overview I present to my patients during consultations. It allows them to quickly visualize, for each treatment, what can be affected \u2014 and how I approach it. <\/p><div class=\"upo-table-wrap\"><table class=\"upo-table upo-table--stack\"><caption class=\"upo-table__caption\"> Sexual impact of each prostate treatment<\/caption><thead><tr><th scope=\"col\"> Treatment<\/th><th scope=\"col\"> Impact on erection<\/th><th scope=\"col\"> Impact of ejaculation<\/th><th scope=\"col\"> What I tell my patients<\/th><\/tr><\/thead><tbody><tr class=\"upo-table__group\"><th scope=\"colgroup\" colspan=\"4\"> Treatments for benign prostatic hyperplasia (BPH)<\/th><\/tr><tr><th scope=\"row\"> No treatment (mild symptoms)<\/th><td data-label=\"\u00c9rection\"> None<\/td><td data-label=\"\u00c9jaculation\"> None<\/td><td data-label=\"Mon avis\"> Simple monitoring, no sexual coercion<\/td><\/tr><tr><th scope=\"row\"> Plant extracts<\/th><td data-label=\"\u00c9rection\"> None<\/td><td data-label=\"\u00c9jaculation\"> None<\/td><td data-label=\"Mon avis\"> A gentle option, with no sexual side effects<\/td><\/tr><tr><th scope=\"row\"> Alpha-blockers (tamsulosin, alfuzosin\u2026)<\/th><td data-label=\"\u00c9rection\"> None<\/td><td data-label=\"\u00c9jaculation\"> Retrograde 15 to 50% depending on the molecule<\/td><td data-label=\"Mon avis\"> I choose the molecule according to the importance of ejaculation for the patient<\/td><\/tr><tr><th scope=\"row\"> 5-alpha inhibitors (dutasteride, finasteride)<\/th><td data-label=\"\u00c9rection\"> Possible decrease in libido<\/td><td data-label=\"\u00c9jaculation\"> Possible decrease in ejaculate volume<\/td><td data-label=\"Mon avis\"> Affects testosterone \u2014 systematic discussion before prescribing<\/td><\/tr><tr><th scope=\"row\"> Laser prostate enucleation (HoLEP, ThuLEP)<\/th><td data-label=\"\u00c9rection\"> No impact<\/td><td data-label=\"\u00c9jaculation\"> permanent retrograde (definitive)<\/td><td data-label=\"Mon avis\"> Irreversible \u2014 a joint decision based on the patient&#8217;s priorities<\/td><\/tr><tr><th scope=\"row\"> UroLift<\/th><td data-label=\"\u00c9rection\"> None<\/td><td data-label=\"\u00c9jaculation\"> Very low risk (0.5%)<\/td><td data-label=\"Mon avis\"> An ideal option if preserving ejaculation is a priority.<\/td><\/tr><tr><th scope=\"row\"> REZUM (water vapor)<\/th><td data-label=\"\u00c9rection\"> None<\/td><td data-label=\"\u00c9jaculation\"> Risk of 5 to 10%<\/td><td data-label=\"Mon avis\"> Excellent preservation of sexual function<\/td><\/tr><tr><th scope=\"row\"> Prostate embolization<\/th><td data-label=\"\u00c9rection\"> None<\/td><td data-label=\"\u00c9jaculation\"> Very low risk; volume decrease in 5\u201325% of cases<\/td><td data-label=\"Mon avis\"> Non-surgical, good sexual profile<\/td><\/tr><tr class=\"upo-table__group\"><th scope=\"colgroup\" colspan=\"4\"> Treatments for prostate cancer<\/th><\/tr><tr><th scope=\"row\"> Robotic prostatectomy (nerve-sparing)<\/th><td data-label=\"\u00c9rection\"> Partial recovery possible over 6\u201324 months<\/td><td data-label=\"\u00c9jaculation\"> Deleted (permanent)<\/td><td data-label=\"Mon avis\"> Nerve-sparing if possible \u2014 early erectile rehabilitation recommended<\/td><\/tr><tr><th scope=\"row\"> External beam radiotherapy<\/th><td data-label=\"\u00c9rection\"> Possible alteration, often delayed<\/td><td data-label=\"\u00c9jaculation\"> Possible reduction in volume<\/td><td data-label=\"Mon avis\"> Delayed effects \u2014 monitoring and management if necessary<\/td><\/tr><tr><th scope=\"row\"> High-intensity focused ultrasound (HIFU) treatments<\/th><td data-label=\"\u00c9rection\"> Very good preservation profile<\/td><td data-label=\"\u00c9jaculation\"> Good preservation overall<\/td><td data-label=\"Mon avis\"> Conservative option \u2014 still limited perspective on certain profiles<\/td><\/tr><tr><th scope=\"row\"> Hormone therapy<\/th><td data-label=\"\u00c9rection\"> Major impact: reduced or even nonexistent libido<\/td><td data-label=\"\u00c9jaculation\"> Major impact: significantly reduced ejaculation<\/td><td data-label=\"Mon avis\"> Essential in certain cases \u2014 addressing the associated sexual impact<\/td><\/tr><\/tbody><\/table><\/div><p class=\"upo-table-note\"> The frequency data are averages derived from medical literature and my clinical experience. Individual results vary depending on the patient&#8217;s anatomy, age, and profile.<\/p><h2 id=\"apres\"> After treatment: what I suggest to preserve sexual life<\/h2><h3> Erectile rehabilitation: a discipline in its own right<\/h3><p> Regaining erectile function after prostate treatment is not a passive process. It&#8217;s an active process\u2014medical, sometimes mechanical, always personal. The options I offer vary depending on the situation:<\/p><ul class=\"upo-checklist upo-checklist--yes\"><li> <strong>PDE-5<\/strong> taken daily or on demand (sildenafil \/ Viagra, tadalafil \/ Cialis) \u2014 from the <sup>6th<\/sup> post-operative week.<\/li><li> <strong>Erection pump (vacuum)<\/strong> \u2014 used regularly to maintain oxygenation of the cavernous tissue post-operatively.<\/li><li> <strong>Intracavernous injections of alprostadil<\/strong> (Edex, Caverject) \u2014 for patients not responding to PDE-5 inhibitors.<\/li><li> <strong>P-Shot (PRP)<\/strong> \u2014 in support of cavernous tissue regeneration, particularly after prostate surgery or radiotherapy.<\/li><li> <strong>Hydraulic penile implant<\/strong> \u2014 definitive solution for patients who have failed all other options, after 18 to 24 months of attempts.<\/li><\/ul><h3> Management of retrograde ejaculation<\/h3><p> Retrograde ejaculation, when it occurs after drug treatment, is <strong>reversible upon discontinuation of the medication<\/strong> . When it is linked to surgical treatment, it is permanent.<\/p><p> What I explain to my patients is that retrograde ejaculation is not dangerous. Urine will be cloudy immediately after intercourse\u2014this is due to the semen mixing with it. It&#8217;s not a complication, it&#8217;s an expected and manageable effect.<\/p><h3> Managing the impact of hormone therapy<\/h3><p> For patients undergoing hormone therapy, suppression of libido is often unavoidable\u2014but not always total. Certain measures can improve the experience:<\/p><ul class=\"upo-checklist upo-checklist--yes\"><li> <strong>Regular physical activity<\/strong> \u2014 maintaining general tone, combating fatigue and weight gain induced by treatment.<\/li><li> <strong>Psychological or sexological support<\/strong> \u2014 accompanying the couple in redefining intimacy.<\/li><li> <strong>Evaluation of intermittent hormone therapy<\/strong> \u2014 in some selected cases, treatment-free windows allow for partial recovery of testosterone.<\/li><li> <strong>Treatment of associated erectile dysfunction<\/strong> \u2014 if libido is partially maintained, PDE-5 inhibitors may still be useful.<\/li><\/ul><h2 id=\"faq\"> FAQ: Your questions about the prostate and sexuality<\/h2><div class=\"upo-faq\"><details class=\"upo-faq__item\"><summary> Does prostate adenoma cause erection problems?<\/summary><div class=\"upo-faq__answer\"><p> 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.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> My doctor prescribed tamsulosin \u2014 will that affect my ejaculation?<\/summary><div class=\"upo-faq__answer\"><p> Yes, it&#8217;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&#8217;s not inevitable; it&#8217;s a choice that can be discussed.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> After laser surgery on the prostate, is it still possible to have erections?<\/summary><div class=\"upo-faq__answer\"><p> 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.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> After a prostatectomy for cancer, is it still possible to have orgasms?<\/summary><div class=\"upo-faq__answer\"><p> 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.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> Will hormone therapy necessarily destroy my sex life?<\/summary><div class=\"upo-faq__answer\"><p> 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.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> Can Viagra or Cialis be used after prostate surgery?<\/summary><div class=\"upo-faq__answer\"><p> 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.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> Do UroLift or REZUM preserve sexuality better than LASER treatment?<\/summary><div class=\"upo-faq__answer\"><p> 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.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> Is it possible to talk about sexuality during a urological consultation?<\/summary><div class=\"upo-faq__answer\"><p> Absolutely, and it&#8217;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&#8217;t feel comfortable bringing these topics up spontaneously, please know that I will\u2014because this is medically relevant information, not intrusive questions.<\/p><\/div><\/details><\/div><h2 id=\"video\"> Watch the full video on this topic<\/h2><p> 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: <\/p><div class=\"upo-video\"><div class=\"upo-video__frame\"><iframe src=\"https:\/\/www.youtube-nocookie.com\/embed\/f4SvZAQbAsw\" title=\"Dr. Dumonceau \u2014 Prostate and Sexuality\" loading=\"lazy\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen=\"\"><\/iframe><\/div><p class=\"upo-video__caption\"> <strong>Dr Dumonceau \u2014 Prostate and Sexuality<\/strong> A complete educational video (~8 min) on the impact of each prostate treatment on erections, ejaculation and libido.<\/p><\/div><h2 id=\"retenir\"> Key takeaways <\/h2><figure class=\"upo-figure\"><img src=\"https:\/\/www.dumonceau-urologie.fr\/wp-content\/uploads\/2026\/08\/consultation-urologue-sexualite-parler-sans-tabou-paris.webp\" alt=\"Dr. Olivier Dumonceau, urologist in Paris, during a consultation \u2014 addressing sexuality without taboo\" width=\"1200\" height=\"675\" loading=\"lazy\" decoding=\"async\"\/><figcaption> During consultations, I systematically address erectile function, ejaculation, and libido. This is medically relevant information, not intrusive questions.<\/figcaption><\/figure><div class=\"upo-takeaway\"><p class=\"upo-takeaway__title\"> The essentials in five points<\/p><ul><li> Treating the prostate <strong>does not mean sacrificing your sex life<\/strong> : treatments today offer very different impact profiles.<\/li><li> For adenoma, some techniques (UroLift, REZUM) treat the symptoms <strong>while preserving sexual function<\/strong> .<\/li><li> In the case of cancer, it is possible to <strong>reconcile oncological efficacy and quality of life<\/strong> .<\/li><li> Erection, ejaculation and libido are <strong>three distinct dimensions<\/strong> : they are not affected by the same treatments.<\/li><li> Everything hinges on one thing: <strong>discussion<\/strong> . I cannot choose the right treatment without understanding what truly matters to you.<\/li><\/ul><\/div><blockquote class=\"upo-quote\"><p> Your prostate doesn&#8217;t define your sex life. What defines it is how we address together what&#8217;s happening to your prostate.<\/p> <cite>Dr. Olivier Dumonceau<\/cite><\/blockquote><div class=\"upo-cta\"><p class=\"upo-cta__title\"> Let&#8217;s talk about it, without taboo.<\/p><p> Prioritizing cancer control? Balancing it with intimate quality of life? There&#8217;s no single right answer\u2014there&#8217;s yours. And that&#8217;s what guides the treatment decision.<\/p><p class=\"upo-cta__actions\"> <a class=\"upo-cta__btn\" href=\"https:\/\/www.doctolib.fr\/chirurgien-urologue\/paris\/olivier-dumonceau\/booking\/telehealth-suggestion\" target=\"_blank\" rel=\"noopener\">Make an appointment for<\/a> <a class=\"upo-cta__btn upo-cta__btn--ghost\" href=\"https:\/\/www.dumonceau-urologie.fr\/en\/besoins-urologie\/relieving-urinary-problems-associated-with-bph\/\">urinary problems and BPH<\/a><\/p><p class=\"upo-cta__contact\"> <span><a href=\"tel:+33142688330\">01 42 68 83 30<\/a><\/span> <span>82 Bd de Courcelles, Paris <sup>17th<\/sup><\/span> <span><a href=\"mailto:contact@dumonceau-urologie.fr\">contact@dumonceau-urologie.fr<\/a><\/span><\/p><\/div><aside class=\"upo-sources\"><p class=\"upo-sources__title\"> Medical sources and references<\/p><ul><li> EAU Guidelines on Sexual and Reproductive Health 2024 \u2014 European Association of Urology.<\/li><li> EAU Guidelines on Non-neurogenic Male Lower Urinary Tract Symptoms (HBP) 2024.<\/li><li> Rosen RC et al. \u2014 <em>The International Index of Erectile Function (IIEF)<\/em> . Urology, 1997.<\/li><li> Hamdy FC et al. \u2014 <em>15-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer<\/em> (ProtecT). NEJM, 2023.<\/li><li> Montorsi F et al. \u2014 <em>Recovery of spontaneous erectile function after nerve-sparing RALRP<\/em> . European Urology, 2010.<\/li><li> French Society of Urology (SFU) \u2014 Recommendations BPH and prostate cancer.<\/li><\/ul><p class=\"upo-disclaimer\"> This article is for informational purposes only and does not replace a medical consultation. Only a clinical examination and personalized assessment can establish a diagnosis and propose a treatment plan tailored to your situation.<\/p><\/aside><\/div> <script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"FAQPage\",\"mainEntity\":[{\"@type\":\"Question\",\"name\":\"Est-ce que l'ad\u00e9nome de la prostate cause des probl\u00e8mes d'\u00e9rection ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"L'ad\u00e9nome lui-m\u00eame ne cause pas de dysfonction \u00e9rectile. Mais il y a une co\u00efncidence d'\u00e2ge importante : les probl\u00e8mes urinaires li\u00e9s \u00e0 l'ad\u00e9nome apparaissent souvent en m\u00eame temps que les premi\u00e8res difficult\u00e9s \u00e9rectiles, li\u00e9es au vieillissement vasculaire ou hormonal. Ce sont deux probl\u00e8mes distincts, m\u00eame s'ils peuvent coexister chez le m\u00eame patient au m\u00eame moment.\"}},{\"@type\":\"Question\",\"name\":\"Mon m\u00e9decin a prescrit de la tamsulosine \u2014 est-ce que \u00e7a va affecter mon \u00e9jaculation ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Oui, c'est possible. La tamsulosine peut provoquer une \u00e9jaculation r\u00e9trograde dans 15 \u00e0 30 % des cas selon les \u00e9tudes. Avant de la prescrire, je demande toujours \u00e0 mes patients quelle importance a l'\u00e9jaculation pour eux. Si elle est importante, je choisis une mol\u00e9cule avec un profil plus favorable, comme l'alfuzosine. Ce n'est pas une fatalit\u00e9, c'est un choix que l'on peut discuter.\"}},{\"@type\":\"Question\",\"name\":\"Apr\u00e8s une intervention au LASER sur la prostate, peut-on encore avoir des \u00e9rections ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Oui. Le traitement au LASER ne touche pas les nerfs \u00e9recteurs, qui sont situ\u00e9s en dehors de la capsule prostatique. Les \u00e9rections ne sont pas affect\u00e9es par cette technique. En revanche, l'\u00e9jaculation devient r\u00e9trograde de fa\u00e7on permanente dans la plupart des cas, ce qui est \u00e0 distinguer soigneusement de l'\u00e9rection.\"}},{\"@type\":\"Question\",\"name\":\"Apr\u00e8s une prostatectomie pour cancer, peut-on encore avoir des orgasmes ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Oui. Apr\u00e8s prostatectomie, l'orgasme reste possible et per\u00e7u, m\u00eame sans \u00e9jaculation. Il peut \u00eatre l\u00e9g\u00e8rement diff\u00e9rent dans sa qualit\u00e9, mais il est g\u00e9n\u00e9ralement pr\u00e9sent. Ce que l'op\u00e9ration supprime, c'est l'\u00e9jaculation, pas la capacit\u00e9 \u00e0 l'orgasme.\"}},{\"@type\":\"Question\",\"name\":\"L'hormonoth\u00e9rapie va-t-elle forc\u00e9ment d\u00e9truire ma vie sexuelle ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"L'hormonoth\u00e9rapie a un impact significatif sur la libido et les \u00e9rections, parce qu'elle agit en supprimant la testost\u00e9rone. Cet impact est r\u00e9el et ne doit pas \u00eatre minimis\u00e9. Mais il varie selon les patients, la dur\u00e9e du traitement et les mesures d'accompagnement mises en place. Certains patients maintiennent une activit\u00e9 sexuelle partielle, surtout en d\u00e9but de traitement. Je discute toujours de cet impact avant de prescrire, et je propose un accompagnement adapt\u00e9.\"}},{\"@type\":\"Question\",\"name\":\"Peut-on utiliser le Viagra ou le Cialis apr\u00e8s une chirurgie de la prostate ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Oui. Je les recommande activement en post-op\u00e9ratoire, pas seulement \u00e0 la demande. Une prise quotidienne de tadalafil \u00e0 faible dose (5 mg) dans les mois suivant la prostatectomie am\u00e9liore la r\u00e9cup\u00e9ration \u00e9rectile en maintenant l'oxyg\u00e9nation du tissu caverneux. C'est ce qu'on appelle la r\u00e9\u00e9ducation \u00e9rectile m\u00e9dicamenteuse, et elle doit commencer t\u00f4t, pas six mois apr\u00e8s l'op\u00e9ration.\"}},{\"@type\":\"Question\",\"name\":\"L'UroLift ou le REZUM pr\u00e9servent-ils mieux la sexualit\u00e9 que le traitement au LASER ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Oui, sur le plan de l'\u00e9jaculation : l'UroLift et le REZUM pr\u00e9servent tr\u00e8s bien l'\u00e9jaculation ant\u00e9grade (moins de 5 % de risque de r\u00e9trograde), l\u00e0 o\u00f9 la r\u00e9section au laser entra\u00eene une \u00e9jaculation r\u00e9trograde permanente dans la grande majorit\u00e9 des cas. Non, sur le plan des \u00e9rections : aucune de ces trois techniques n'a d'impact n\u00e9gatif. Si la pr\u00e9servation de l'\u00e9jaculation est une priorit\u00e9 pour vous, l'UroLift ou le REZUM m\u00e9ritent d'\u00eatre discut\u00e9s en premier.\"}},{\"@type\":\"Question\",\"name\":\"Peut-on parler de sexualit\u00e9 lors de la consultation urologique ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Absolument, et c'est m\u00eame indispensable pour que je puisse vous proposer le bon traitement. Je pose syst\u00e9matiquement des questions sur la fonction \u00e9rectile, l'\u00e9jaculation et la libido lors de la consultation initiale. Si vous n'osez pas aborder ces sujets spontan\u00e9ment, sachez que c'est moi qui les aborderai \u2014 parce que ce sont des informations m\u00e9dicalement pertinentes, pas des questions indiscr\u00e8tes.\"}}]}<\/script>\n","protected":false},"excerpt":{"rendered":"<p>What is the real impact of prostate treatments on erections, ejaculation, and desire? 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