Can surgery for an enlarged prostate affect your sex life?

Erections and ejaculation can change differently

Surgery for benign prostate enlargement can affect your sex life, and ejaculation needs a separate discussion. For example, Cambridge University Hospitals explains that studies of holmium laser enucleation of the prostate (HoLEP) show no significant change in erectile ability for most men, although a risk of deterioration remains. After full enucleation, having no semen come out during orgasm is very common. [1]

Being able to get an erection after surgery therefore does not mean that ejaculation, the sensation of orgasm and fertility are unchanged. Equally, the absence of semen alone does not establish erectile dysfunction. This article concerns surgery for benign prostate enlargement, not radical surgery for prostate cancer.

During normal ejaculation, the bladder neck closes to help direct semen out through the urethra. Surgery or other factors can alter this process, allowing semen to pass backwards into the bladder. This is called retrograde ejaculation. There may be little or no semen, followed by cloudy urine when you next urinate. [2] A doctor still needs to assess the specific cause when no semen comes out after surgery.

Retrograde ejaculation itself is generally not harmful to health, and orgasm may still occur, although it may feel different. [1,2] For someone who wants children, a change in how semen leaves the body can affect the chances of natural conception. Even if urinary symptoms are your most pressing concern, discuss plans for children before choosing a procedure.

What are the trade-offs in preserving ejaculation?

These operations mainly aim to improve urination by removing enlarged tissue that causes an obstruction. Another outcome that matters to patients is whether semen will still come out through the urethra. Both goals need to be considered together.

HoLEP uses a laser to enucleate enlarged tissue. If a surgeon proposes an ejaculation-sparing HoLEP, ask what the technique involves and which prostate characteristics it is suitable for. Full enucleation and a modified ejaculation-sparing approach cannot both be explained simply as laser surgery that does not affect sexual function. [1]

Waterjet surgery removes tissue with a high-velocity saline jet under imaging guidance. The European Association of Urology (EAU) guidelines identify the wish to preserve ejaculation as an important consideration when some patients discuss this option. In the randomised trial cited, the waterjet group had a lower rate of absent ejaculation than the transurethral resection of the prostate (TURP) group, but the risk was not zero. [3]

The chance of preserving ejaculation needs to be weighed alongside bleeding management, urinary improvement and the possibility of further treatment. The waterjet removes tissue without heat, but diathermy or other methods may still be needed to control bleeding at the end of surgery. The EAU also notes that long-term comparisons with enucleation require further study. [3] The labels waterjet and laser alone therefore cannot tell you which procedure suits you best.

What does waterjet surgery in China tell us?

On 20 November 2024, the Beijing Municipal Health Commission published a report from Beijing Chao-Yang Hospital stating that its team had performed several robotic waterjet procedures for benign prostate enlargement. It described ultrasound guidance and the aim of protecting function by avoiding relevant structures. It also reported the use of holmium laser, thulium laser and plasma-based treatments. [4]

This provides a specific point to discuss if you are considering assessment in China: different ways of removing tissue and their functional preservation goals. The report did not provide standardised erectile or ejaculatory outcomes, long-term follow-up data, or enough clinical detail to judge individual suitability. It cannot establish that having waterjet surgery at this hospital will preserve normal ejaculation. Current availability and whether the hospital can accept you also need separate confirmation.

When a Chinese surgical introduction refers to protecting sexual function, ask which function is meant: erections, forward ejaculation or the sensation of orgasm? What type of patients does the evidence concern? If your prostate is unsuitable for that approach, what alternatives are there? These explanations are more useful than a single broad preservation percentage.

Explain which functions matter to you before surgery

At your consultation, describe weak flow, straining and other urinary difficulties, but also explain your current erections and ejaculation, and whether you plan to have children. Knowing your function before treatment provides a basis for discussing what matters to you and assessing later changes.

When comparing options, ask the doctor to explain three things together: which urinary problems the treatment is expected to improve; its separate effects on erections, ejaculation and fertility; and what other trade-offs may be involved if preserving ejaculation is a priority. A urologist needs to assess your tests, health and preferences. The equipment name alone cannot determine your choice.

For a consultation in China, use the medical records preparation guide to organise existing tests, medication records and previous treatment information. If you need communication in English, SinoCareHub’s medical interpreting escort service can help convey these priorities accurately and record the doctor’s explanation of procedures and functional risks. It does not replace the doctor in recommending surgery.