What is an Orgasm?
An orgasm is a climax or peak of sexual pleasure, which is believed to have its roots in the frontal lobe area of the brain. That does not mean an orgasm isn’t a pleasant physical feeling, but that the pleasure is registered in the brain.
When men near orgasm during intercourse, their pelvic thrusts become more involuntary and the muscles of the penis contract rhythmically as it prepares to ejaculate. An orgasm is accompanied by an increase in respiration, heart rate, and blood pressure and, in many cases, ejaculation. Many men may be surprised to know, however, that ejaculation does not always occur with orgasm. Men who have undergone radical prostatectomy no longer produce semen, yet they are still capable of orgasm. They experience what is known as a “dry orgasm.”
During a prostatectomy, surgeons remove the prostate gland and the seminal vesicles that produce the fluid that carries sperm cells, which are made by the testicles. Even though the prostate is gone, the testicles still produce sperm cells, but during ejaculation, the sperm have nowhere to go and so are absorbed by the body. A dry orgasm can also be caused by retrograde ejaculation and radiation therapy for prostate cancer.
Inability to Have an Orgasm
In certain situations, some men become unable to have an orgasm. Undergoing a radical prostatectomy is one such situation. In a 2010 study published in the Journal of Sexual Medicine, investigators surveyed 458 men about orgasmic function before and after radical retropubic prostatectomy at regular intervals during a two-year follow-up. Ninety percent of the men had normal orgasmic function before surgery, which declined to 66.8 percent post-surgery. (This is a condition called secondary anorgasmia, which means an inability to have an orgasm when there was no difficulty previously.) The ability to have an orgasm was better among men who underwent either a bilateral nerve-sparing procedure (73.4%) or a unilateral nerve-sparing procedure (70.9%) compared with those who had a non-nerve sparing technique (54.0%). (Dubbelman)
An inability to have an orgasm following prostatectomy can be related to post-operative pain or to anxiety about prostate cancer and/or sexual problems related to the surgery. Some men become very anxious about having erectile dysfunction, and even though they may be capable of having an orgasm, they are overly stressed about their sexuality and experience secondary anorgasmia. Men who are experiencing anxiety and stress regarding secondary anorgasmia may benefit from counseling.
Use of certain drugs, including antidepressants and ulcer medications, can hinder the ability to have an orgasm as well. Antidepressants in the selective serotonin reuptake inhibitor category, such as fluoxetin (Prozac), sertraline (Zoloft), and paroxetine (Paxil), impact serotonin levels in the nervous system, and this may reduce the ability to have an orgasm. Use of alcohol and street drugs such as cocaine can also hinder orgasm.
Painful Orgasm
Some men who undergo radical prostatectomy or radiation therapy experience dysorgasmia, or orgasmic pain. In 1998, Dr. John Mulhall questioned 380 men who had undergone radical prostatectomy about their orgasms. One year after surgery, 22 percent of men said they experienced some orgasmic pain that interfered with their sexual activities. In addition, Mulhall also found that 37 percent of men had not experienced orgasm, and 30 percent said their orgasms were of lesser quality. (Cornell)
In another study, 14 percent of 239 men who had undergone retropubic radical prostatectomy reported pain during orgasm, with a third of these men reporting pain with every orgasm. (Barnas) The pain is mild to moderate for most men and lasts less than one minute. Intense and/or long-lasting pain occurs occasionally. Fortunately the pain tends to decrease over time after surgery and radiation, and bothersome pain can be treated with medication.
References
Barnas JL et al. The prevalence and nature of orgasmic dysfunction after radical prostatectomy. BJU Int 2004 Sep; 94(4): 603-5
Cornell University Department of Urology website:
http://www.cornellurology.com/sexualmedicine/ed/prostatectomy.shtml
Dubbelman Y et al. Orgasmic dysfunction after open radical prostatectomy: clinical correlates and prognostic factors. J Sex Med 2010 Mar; 7(3): 1216-23.
