Loss of ejaculatory ability is high after radiation therapy

Patients who have surgery as their primary treatment for prostate cancer know that after their surgery they will have lost the ability to ejaculate at orgasm — making orgasm feel very different to their prior experience. It has not been so clear that — over time — the same applies to most radiation therapy patients.

A presentation from the annual meeting of the American Urological Association (AUA) that few appear to have noted at the time of the actual meeting has just been featured on Medscape. Stember et al. reported at the meeting on data from 364 consecutive patients treated with various types of radiotherapy and followed for an average (mean) of 6.0 ± 4.5 years. As indicated, Medscape has offered a summary of the actual presentation.

Here are the basic data presented by Stember et al.:

  • 252/364 patients were treated with external beam radiation therapy (EBRT) and most of these patients (n  = 225) receive intensity modulated radiation therapy (IMRT).
  • 112/364 patients were treated with brachytherapy, of whom 84 received brachytherapy only and 28 received a boost of EBRT.
  • The average age of the patients was age was 64 years (range, 42 to 78 years).
  • 262/364 patients (72 percent) had lost the ability to ejaculate in a normal (“antegrade”) manner at the time of their last follow-up visit to the clinic.
  • The proportion of patients experiencing inability to ejaculate (“anejaculation”) at 1, 3, and 5 years after radiation therapy was 16, 69, and 89 percent, respectively.
  • Orgasm domain scores decreased dramatically over the follow-up period (for men who completed at least two of the relevant questionnaires): from 7.4 at < 12 months follow-up to 2.8 at > 36 months of follow-up.
  • The probability of anejaculation appeared to be higher in men who received combination therapy (brachytherapy + EBRT), were of older age, and had smaller prostates.

The authors concluded that, “The vast majority of men after prostate RT will experience anejaculation and should be counseled accordingly prior to undergoing therapy.”

Quoted in the Medscape article referenced above, Dr. John Mulhall, the senior author of this study stated that, “Anejaculation is an inevitable and well-recognized sequela of radical prostatectomy and may represent a significant source of bother and sexual dissatisfaction. Loss of ejaculation or a severe decrease in ejaculate volume has been associated with a self-reported deterioration in sexual activity.” It seems likely, however, that at least some men are choosing to have radiation therapy over surgery because of a mistaken impression that they will retain normal ejaculatory function.  Anejaculation after radiation therapy appears to have been significantly under-reported in the medical literature in the past, and the published data on this issue are few and far between. Clinical experience — by contrast — suggests that this is a common consequence of pelvic radiation therapy.

44 Responses

  1. At 2.75 years after EBRT/IMRT, pelvic cavity + prostate target, I find this article to be very true. However, I did not choose this treatment to retain ejaculation. I chose this treatment because with 12 of 12 cores, it was a high probability that prostate cancer had left the barn.

  2. I had radiation therapy about 2 years ago. Ejaculation is becoming an increasing “challenge.” The amount of ejaculate is far less and not a bother to me. What does the future hold?

    I am 72, in good physical shape, and been very sexually active all my life. I take no medication other than half a Viagra to perform sex.

  3. Mr. Newton:

    I would suggest that you joined our social network to seek input from others on reasonable expectations.

  4. I would love to hear how other men are coping or overcoming this problem.

  5. James:

    If you join our social network, dealing with post-treatment sexual function is a common topic of conversation.

  6. I had radiation treatment for my prostate cancer about a year ago. My ejaculations have decreased in volume since that treatment.

  7. I’m going for a check-up on Friday. My question will, of course, be “How much time do I have left” … for ejaculation response. I had my radiation therapy in 2003.

    Jim Newton

  8. I have iatrogenic acquired anejaculation due to radiation therapy for anal cancer. I was never made aware of this by my radiation therapist. I am hoping that the urologist I see next month will be able to restore function. At 55 years old I am very much negatively affected by ejaculatory failure and the failure on the doctor’s part to tell me about this vital information. When I questioned him in writing about it post-treatment, he provided no response at all.

  9. I had radiation 3 years ago. For a while I had painful, bloody, dry ejaculations. Now even an erection is impossible, even with 10 mg of cialis. Ejaculation is non-existent. Still having pain on urination. Not amused or pleased by any of this. Wish I had never had anything done.

  10. Radiation 2 years ago for prostate cancer. 67 years old and still no erection or ejaculation. Help!!

  11. My urologist was not even sympathetic about my loss of ejaculation and the pleasurable sensations. I studied the Internet for any/all information concerning negative side effects following radiation and only found ED that could be dealt with a vacuum pump … nothing about total loss of ejaculation. It was stated that the prostate would no longer contribute to the volume, but nothing about the various sources of lubrication. I don’t blame my oncologist but I feel the urologist was negligent in his obligation. Having a PSA of 0.1 or 0.2 is little trade-off for the other surprise losses. Maybe a class action can be taken?

    R. Adams, 2+ years after external radiation

  12. Radiation treatment in January 2010. … Still no ejaculation, but erection no problem, thanks to vacuum pump (Erec-Tec the best). I’m 67 years old, but sex will never be the same.

  13. Dear Tom:

    If your radiation therapy was properly executed so as to eliminate your prostate cancer, this would have killed all the cells in your prostate (not just the cancerous ones). The consequence is that patients so treated are never going to be able to recover normal ejaculatory function.

  14. I completed the 42 IMRT treatments 7 months ago and I have little ejaculate and what is there is clear and viscous. It had been less and less and now I’m having a constant ache in the prostate area which the urologist says is the result of radiation reaching the bladder. Radiation is the gift that keeps on giving. He didn’t stress this possibility but did “mention” it in passing. I am not a happy camper and, at this point, a PSA of 1.2 is meaningless. Sex will never be the same. I could cry.

  15. I’ve been “cancer free” for 3 years now. I have also been sex free. The first year there were no erections. Then after Viagra I was able to get a patrial erection, although my penis is very bent and uneven. After 3 years they discovered I had very low testosterone. I asked them to check for 3 years and they completely ignored me.finally I went to a new doctor (at the V.A. Hospital) who tested and put me on Andro-gel.

    Now I get erections but it is very painful to ejaculate, which is quite rare, maybe once monthly. It is a burning and pressure pain like I was trying to pass peanut butter. Doctors are totally dismissive of any of this. I feel a strong need to ejaculate but it never feels complete and burns for 5-10 minutes almost unbearably.

    Sound familiar?

  16. I had EBRT in May to July 2014. I have had trouble with ED and have not ejaculated since my treatment (43 treatment sessions in total). I have been trying trimix for erections but have a lot of trouble climaxing. I would appreciate any suggestions from men with similar problems. Originally had a PSA of 158; last test down to 7.4 ng/ml. Still on hormone therapy.

  17. Dear Glen:

    The combination of radiation therapy and ongoing androgen deprivation therapy (ADT, also known as “hormone” therapy) was bound to seriously effect your erectile and sexual function, and if radiation therapy was effective it is also quite normal for you not to be able to have “normal” orgasms, although relatively “dry” orgasms, without much ejaculate of any type may be possible.

    If you are able to obtain functional erections using trimix, that is obviously a good thing, but I don’t know of any way to be able to stimulate anything resembling a “normal” orgasm in someone who has received (and is still receiving), the type of treatment you have had.

  18. Albert Peckham here:

    My PSA is now 0.6 which, according to my urologist, means that my prostate cancer is in remission. I should be jumping with joy but … alas … that is not the case. After leaving the appointment, I was truly upset. If, as they say, I am “cured” then … why am I not back to the original? Oh … they were so happy … they didn’t mention that, as a male, I’m, for all practical purposes, a eunuch! i should be happy! Wow.

  19. After reading all of these concerns and conditions after radiation therapy, I get really angry that these “therapists” know what the results will be but, in their necessity to “bring in the bucks,” they don’t tell these men what the ultimate result will be and never tell us that radiation never stops. It destroys every nerve it reaches until the pleasures of manhood are non-existent.

  20. I had seed implants 7 months ago and was well aware, if you understand your anatomy, that the semen that makes up 90% of ejaculate is produced in the prostate they are destroying. I think we men have to put some responsibility on ourselves to investigate potential problems. I am having bad urinary and colon side effects from the radiation and this was not anticipated to last this long but the more I explore medical resources my side effects might go on for 2 years. A lot of burning during urination and internal burning in the prostate. I can get an erection (almost as erect as before) but for months my side effects had my body so that sore any sexual relations were off the table. I am beginning to feel better. I have always had a very high libido and it is not so intense right now but I can enjoy sexual relations and joke about not making a mess!! Be happy if you can get an erection and climax. My oncologist told me this would most likely happen on our first appointment. I joked with him that he would end my career as a porn star and he offered me a letter to get disability. Better to be alive and hopefully cancer free than have ejaculate. We are not 18 anymore and most of our wives or girlfriends (boyfriends, depending on your preference) don’t care. They would rather have us alive!

  21. This is very frustrating. I am 65, had brachytherapy in 2009, and now 6 years later can’t ejaculate at all and am unable to maintain an erection. I feel like my manhood and joy of having sex and ejaculating has been stripped away permanently without any warning. This is a trade-off in order to stay alive. What’s even more frustrating is that there is no remedy.

  22. I feel for all of you but recognize that you are lucky in many ways. I’m 43 and had RP at 42. Barely any ability to gain an erection and orgasm is oh so different. I would have loved another 20 years of normal sex but it wasn’t go be. I’ve used bi-mix and it works but who likes needles in your penis? Also erections and intercourse can be painful. I’m also quite certain my penis has shrunk. Fortunately I have a loving wife. Feel almost worse for her than myself.

  23. I’m 77 and had seed implants followed by radiation about 9 years ago. My PSA is now 0.0. I was treated by RCOG in Atlanta and we were all told in numerous meetings during treatment that most of us in time would experience “dry” ejaculations. I have experienced very little loss in sexual desire and ability to get erections. I’ve used Viagra at times. My ejaculation volume has decreased significantly but orgasms are still pleasurable.

  24. I had 25 treatments of external beam radiation, and then 28 seeds implanted in my prostate, but after that I don’t have no ejaculation. I want to know why.

  25. Dear Ron:

    You wrote “after that I don’t have no ejaculation” and I am not sure what you mean by that. Do you mean that you have no ejaculate at orgasm now, or do you mean that you do still have some ejaculate at orgasm now? There are different possible explanations for either situation.

  26. I have a orgasm, but a dry orgasm

  27. Ron:

    OK. Thanks. So as indicated in the article above, this is actually perfectly normal after a while for many men who have radiation therapy for their prostate cancer. It happens because radiation therapy doesn’t just kill cancer cells in the prostate. It is actually designed to kill of the majority of cells in the prostate, inclusive of the cancerous ones. A consequence of that is that a man who is effectively treated with radiation therapy will commonly no longer have a functioning prostate that is capable of the act of ejaculation.

    In the case of surgery, there is no longer a prostate there to ejaculate at all. In the case of radiation therapy, there is often no functional prostate there that is capable of ejaculation (but it may take a while from the time of radiotherapy for all of the cells to die off). Thus, it is possible: (a) that you can still get a functional erection; (b) that early on after you had the radiation therapy there was still enough function prostate tissue for you to be able to ejaculate normally to some degree; but (c) that now that all of that functional tissue has died as a consequence of the radiation therapy, you can only have dry orgasms.

    Does that help you to understand?

  28. “many men who have radiation therapy for their prostate cancer. It happens because radiation therapy doesn’t just kill cancer cells in the prostate. It is actually designed to kill of the majority of cells in the prostate, inclusive of the cancerous ones. A consequence of that is that a man who is effectively treated with radiation therapy will commonly no longer have a functioning prostate that is capable of the act of ejaculation.”

    “In the case of radiation therapy, there is often no functional prostate there that is capable of ejaculation (but it may take a while from the time of radiotherapy for all of the cells to die off). Thus, it is possible: (a) that you can still get a functional erection; (b) that early on after you had the radiation therapy there was still enough function prostate tissue for you to be able to ejaculate normally to some degree; but (c) that now that all of that functional tissue has died as a consequence of the radiation therapy, you can only have dry orgasms.”

    Thank you Sitemaster. This did help me understand what is happening now to me, 14 months after EBRT (in December 2015), I am having “soft” erections but most disturbing is the fluid that comes out is very dark red. Now the doctor wants to do a cystoscopy because some blood was in my urine for several days. Not looking forward to that procedure.

    I’m 60 years old and my PSA has gone from 9 to 1 after 12 months, so I’m happy about that!

  29. I had anal cancer 7 years ago. To shrink the tumor, I had high dosages to the lower extremities of my body. It was close enough to affect my prostate. To this day, I rarely ejaculate after sex and masturbation. While thankful to be alive and have a “new normal”, part of me feels devastated because, as a gay man, this is usually a very important part of having sex as well, I’m sure, for many straight couples. It has definitely caused me to second guess if sexual partners think I’m faking an orgasm or making up an excuse. It’s difficult to want to have sex or start a relationship because I have to explain this and it gets old. Good news? I’m alive and, well, puts new meaning to the words “safer sex”.

  30. At age 70, otherwise excellent health … workout 5 days/week … I had prostate cancer radiation treatment.

    Much to my surprise, I also have lost 90% of ejaculate as well as the “not so great” orgasm.

    Surprise, surprise … when I advised my radiologist what “wasn’t” happening, she said a fast sentence, which went over my head, and continued talking about what she was talking about … as though this “loss” was next to meaningless.

    Now I know more, am majorly pissed off re the doctors “nothing” reply, and am having a difficult time dealing with this. I do use Viagra to even get things going. My psa is 0.4, so all well and good … but damn, every patient needs to be told, understand that loss of ejaculate as well as 75% pleasure, will probably be the trade-off.

  31. I had prostate radiation therapy; lost the ejaculation and all.

    Still get erect, but I went from a PSA going in of 5.7 to 0.6 within 7 months, and we’re happy the outlook looks good for us and the grandchildren.

    What’s life without family?

  32. Avoid prostate radiation if at all possible. I’ve had terrible side effects. My bowels are all messed up. I’ve had my intestines cauterized twice to stop bleeding and I still have blood. My sphincter is loose. My ejaculations are terrible and mostly dry. Semen just oozes out. Radiation is harmful!!!

  33. Dear William:

    I am sorry to hear that you have had the side effect that you describe after your radiation therapy. However, side effect like this are unsual these days and it sounds as though there must have been problems with the way you were treated for some reason. I say this only because — for many men — radiation therapy is a very safe and effective way to treat prostate cancer today, and the vast majority of men treated with radiation therapy would not experience side effects like this. It is therefore no advisable for all men to “Avoid radiation therapy if at all possible”. Radiation therapy is just one of many possible ways to treat some types of prostate cancer. You need to talk to whoever treated you about why this may have occurred in your case.

  34. To WordPress.com

    Please remove post on Facebook from Feb. 12, 2020 at 2:26 pm, thank you.

  35. Dear Mr. Amantea:

    If you left a post on Facebook. only you can remove such a post. However, we have NOT posted the material you left as a comment on this site at the time and date you refer to. If you wish us to post that set of comments, please let us kn ow,

  36. Thank you. I inadvertently typed my last name on my post and wanted it removed.

  37. I HAVE HAD a problem with decreased ejaculate also … but have avoided the other problems mentioned. … The difference may have been in the type radiation I had … the more accurate proton radiation

    Max Cromer

  38. I am 72 years old. Had five fractions of SBRT in June 2020. I still have some ejaculate but no problems with erections and orgasms. I had no problems whatsoever with my RT. Had a few days of bladder irritation but that was it. Pleased over all. PSA continues to trend down.

  39. Wow. I wasn’t informed either of these apparently very common, negative side effects of RT when I went through SBRT therapy 3 years ago — not from my urologist nor from my radiation oncologist. I’m a clinician and I researched all the various forms of treatment very thoroughly and never ran across mention of these.

    I thought all my increasingly worsening problems were”‘just me.” I had no idea that (a) loss of ability to get/maintain an erection (now use TriMix and it works like a charm), (b) loss of ejaculate volume (very minimal and disappointing) and, lately, (c) getting more difficult to climax were/are common with RT.

    I would still have chosen SBRT over all the other options, but it is now somewhat ‘comforting’ to know that my problems are more related to RT rather than who-knows-what-else. Sex was/is getting more and more frustrating! The sad thing is, it looks like this is a permanent condition — especially after reading these posts. True, a PSA of 0.8 is much better than the high of 13.59 as well as the knowledge that my cancer is probably well into remission, but the sequelae of RT are frustrating.

  40. I don’t think that “c) getting more difficult to climax ” is due to RT. Anorgasmia probably has different causes. You may want to get checked out by a specialist in sex medicine. There may be neurological or psychological issues that are causing that.

  41. What can be done to have ejaculation volume after seed implants?

  42. Dear Lawrence:

    While I don’t wish to be a nay-sayer. I am not aware that there is anything that can be done that will potentially (let alone definitively) increase ejaculation volume after seed implantation.

  43. I have the same problem with ejaculation after 8 weeks of IMRT. Also have ED. Dry orgasms if at all. Viagra does little. I feel like I have become a eunuch! They did not tell me about the side effects. I guess you can’t have it all. I guess you have to give up something to get something; give up sex for life. I am still fighting being depressed over this, but I am a believer in Christ and trust in him to help me cope thru this new life season; it is still hard but others go though far worst.

  44. I am about 5 years removed from brachytherapy. I use ED meds to achieve an erection and that seems “kinda” OK. Orgasms are extremely difficult to achieve and not near as satisfying. It seems to be getting worse. As many have stated I was not informed of this “side effect”. Certainly would have given a lot more thought to having the procedure if I knew what lay ahead.

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