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Nerve-sparing Prostate Surgery & Orgasms

Most men can still reach orgasm after prostate cancer surgery, as long as the nerves surrounding the prostate are spared, according to recent research from Cornell University.

A man’s age and the number of nerves spared are important factors in the ability to reach orgasm, the authors said.

In this study, researchers focused on one particular type of surgery: robotic-assisted laparoscopic radical prostatectomy (RALP). This operation involves removing the prostate gland with the help of a robot. It is less invasive than an open prostatectomy.

Nerves are found on either side of the prostate gland, much like a hammock. During a prostatectomy, a surgeon takes care to save as many nerves as possible. Nerves may be spared bilaterally (on both sides) or unilaterally (one one side only). Sometimes nerves cannot be spared, especially if the cancer has spread.

408 men participated in the study. 54% of them were under age 60. All of them were able to have intercourse and reach orgasm before having the RALP procedure. About three-quarters of the men had nerves spared on both sides of the prostate.

After surgery, the researchers followed up with the men to check on their sexual functioning and find out if they were able to reach orgasm.

Overall, 91% of the men with bilateral nerve sparing (both sides) had the same orgasmic function that they had before surgery. For men with unilateral nerve sparing (one side), this rate was 82%; 61% of men with little or no nerve sparing had the same experiences.

When broken down by age group, the researchers found that 88% of the men under 60 could reach orgasm after surgery. For the men over 60, the rate was 83%. Again, the degree of nerve-sparing played a role.

Most men in both age groups said that their orgasms felt the same as they did before the surgery. However, some said their orgasms were “diminished.” Still others said their orgasms were better. 12% of men under age 60 and 17% of men over age 60 were unable to reach orgasm at all.

In a press statement, Dr. Ashutosh Tewari, lead author of the study, remarked, “Orgasm has a major influence on patients’ satisfaction with the overall sexual experience and alterations in orgasm are associated with significant reduction in emotional and physical satisfaction. They may also lead to men avoiding sex, experiencing relationship problems and even the total breakdown of those relationships.”

He added, “Our study shows that men under the age of 60 and those who underwent bilateral nerve sparing surgery were more likely to recover the same orgasmic function they enjoyed before surgery than older men and those with no nerve sparing.”

Dr. Tewari is the Director of the Prostate Cancer Institute and the LeFrak Robotic Surgery Center at Weill Cornell Medical College.

The study was published in the February issue of BJUI.