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When a man thinks about his prostate, it's often not the prostate itself that worries him most. The real question, the one that comes up constantly in consultations, concerns sexuality. Will I continue to have normal erections? Will my libido change? Will I still be able to ejaculate normally after treatment?<\/p>\n
These are legitimate questions. The prostate and sexuality are closely linked, primarily because urinary problems and sexual dysfunction often appear around the same time in life, generally from the age of 50. But it's important to distinguish between two things: prostate diseases themselves<\/strong> and the potential consequences of their treatments<\/strong> .<\/p>\n In most cases, it is not prostate adenoma or prostate cancer that directly affects sexuality. However, certain treatments can have an impact, sometimes temporary, sometimes permanent. Understanding these effects allows for more informed choices.<\/p>\n Before discussing the prostate, it's important to remember that male sexuality isn't limited to erections. It encompasses several distinct dimensions:<\/p>\n A treatment can therefore modify one of these aspects without necessarily affecting the others. This is a crucial point, because many men confuse decreased ejaculation, loss of desire, and erectile dysfunction, when in fact these are different mechanisms.<\/p>\n Prostate adenoma, or benign prostatic hyperplasia, is extremely common with age. As long as it causes few symptoms and does not require treatment, there is no reason for it to have a direct impact on sexuality.<\/p>\n It is when treatment begins that possible side effects should be discussed.<\/p>\n When urinary symptoms are mild, herbal extracts can be a good starting point. These treatments are used to improve urinary comfort and have the advantage of being well-tolerated.<\/p>\n They have no side effects on erections or ejaculation.<\/strong><\/p>\n When natural treatments are no longer sufficient, alpha-blocker medications are often prescribed, such as:<\/p>\n These medications are often very effective in improving urinary flow. However, they can cause what is known as retrograde ejaculation<\/a><\/strong> .<\/p>\n In practical terms, at the moment of orgasm, semen is no longer expelled externally. It travels back up to the bladder and mixes with the urine. There is no danger<\/strong> or medical concern<\/strong> . After intercourse, the semen is simply eliminated in the urine.<\/p>\n However, this phenomenon can alter sexual sensations and impair the quality of pleasure in some men.<\/p>\n The risk of retrograde ejaculation with alpha-blockers varies depending on the molecule, from 15 to 50%<\/strong> . This is why the choice of treatment must always take into account a very simple element: how important is ejaculation to you?<\/strong><\/p>\n It's a personal question, but it must be asked before prescribing.<\/p>\n There is another class of medications that affect prostate size by altering hormonal metabolism. The best known are:<\/p>\n These treatments can reduce prostate volume, which is helpful in some cases of benign prostatic hyperplasia. However, because they interfere with hormonal mechanisms related to testosterone<\/a> , they can decrease libido<\/strong> , or sexual desire.<\/p>\n Here again, the issue is not just urinary. The expected benefit and the possible impact on intimate life must be weighed.<\/p>\n When symptoms become more bothersome or medication is no longer effective enough, interventional treatments are considered. Here too, not all procedures have the same impact on sexuality.<\/p>\n The most well-known treatment involves removing the internal part of the prostate, i.e., the adenoma, endoscopically. Today, this is very often done with a laser.<\/p>\n From a sexual perspective, two things should be remembered:<\/p>\n The difference with medication is significant. With alpha-blockers, ejaculation returns to normal when treatment is stopped. After adenoma surgery, however, this change is permanent.<\/p>\n This is therefore a major point to discuss before the intervention.<\/p>\n Today there are minimally invasive treatments designed specifically to relieve urinary symptoms while limiting the impact on sexuality.<\/p>\n Urolift<\/a><\/strong> involves placing small implants inside the prostate to separate the prostatic tissue and open the urethra. It can be compared to a form of internal stapling of the prostate.<\/p>\n Its main purpose is clear:<\/p>\n For men who are particularly keen to preserve ejaculation, this is an important option to know about.<\/p>\n Another minimally invasive technique is Rezum<\/a><\/strong> . The principle is to inject water vapor into the prostate in order to retract and soften the prostatic tissue.<\/p>\n Here again, the goal is to treat urinary obstruction while preserving sexual function as much as possible.<\/p>\n Key points to remember:<\/p>\n For many men, especially those who want to avoid the classic side effects of adenoma surgery, this strategy represents an attractive compromise.<\/p>\n What we really call \u201csexuality\u201d in men<\/h2>\n
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Prostate adenoma: the disease does not impair sexuality, but some treatments can alter it.<\/h2>\n
Plant extracts<\/h3>\n
Alpha blockers: effective on urinary flow, but with a risk to ejaculation<\/h3>\n
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Finasteride and dutasteride: an action on the prostate, but also on sexuality<\/h3>\n
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When medication is no longer sufficient: what are the effects of surgical or minimally invasive treatments?<\/h2>\n
Endoscopic laser resection or enucleation of the prostate<\/h3>\n
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Urolift: a minimally invasive option that preserves ejaculation<\/h3>\n
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Rezum: Water vapor to treat adenoma with minimal sexual impact<\/h3>\n
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Prostate embolization<\/h3>\n