Ejaculation Problems

There are a few types of ejaculation-related problems that can occur in men because of cancer treatment.

Retrograde ejaculation

Retrograde ejaculation occurs when semen – the fluid containing sperm that comes out of the penis during ejaculation – flows backward into the bladder and mixes with urine, instead of going out through the penis during ejaculation and orgasm. This does not cause any harm, but it can cause a man to be infertile. However, sometimes sperm cells may be recovered from a man’s urine.

With retrograde ejaculation less fluid is ejaculated and the man's urine is often cloudy with semen the next time he urinates.

Some cancer treatments that can cause retrograde ejaculation in men are:

• A retroperitoneal lymph node dissection (RPLND), which removes the lymph nodes at the back of the abdomen during testicular cancer surgery and can cause nerve damage resulting in retrograde ejaculation.
• A transurethral resection of the prostate (TURP) can cause retrograde ejaculation because the bladder sphincter is widened during this prostate cancer surgery so it no longer closes during ejaculation.

Dry orgasm

A man may no longer produce any semen after some cancer surgeries, but he may still have an orgasm. This is called a dry orgasm. When a man does not produce semen he will not be able to father a child naturally, because semen helps sperm enter the woman's vagina to fertilize an egg (ova).

Some cancer surgeries that can cause dry orgasm in men are:

• Surgeries that involve removing the prostate gland and the seminal vesicles such as a radical prostatectomy or radical cystectomy, always cause dry orgasms.
• Surgeries that can damage the nerves that control the mixing of the sperm and fluid to make semen such as an abdominoperineal resection (APR) (removal of the lower colon, rectum and anus) or retroperitoneal lymph node dissection, often cause dry orgasms.