MY SURGEON GAVETH AND MY SURGEON TOOKETH AWAY
There are multiple surgical procedures for BPH. The first and until quite recently the standard one is TURP (trans urethral resection of the prostate) It was first introduced in 1926. There is no figure for the number of men who've had TURP, but you get an idea of how common it is by the number of ops in just the US each year - 150,000. In Germany between 2005 and 2022, 1,355,845 surgeries were performed - nearly 80,000 per annum. The global annual number must be more than a million.
Each different procedure (HoLep/ aqulablation etc) has potential side effects. You can easily find these eon the net. The most feared one is retrograde ejaculation or 'dry orgasm'.
With the prostate being a vital organ for the production and distribution of semen the potential for semen flow to be affected during surgery is high and it is the most common side effect of TURP with rates of occurrence estimated to be between 65% and 90%. There are no surveys, but my reckoning from spending years reading online posts is that 90% is a more likely figure.
THE TURP PROCEDURE
The TURP procedure involves shaving away prostate tissue through the urethra. During this process damage may be caused to the muscles of the neck of the bladder (internal Sphincter) or the nerves that control it. This may prevent the bladder neck muscles from closing during ejaculation. As a result semen travels backwards into the bladder instead of being ejected through the urethra/ penis. This is called a 'dry ejaculation'.
- Symptoms: The primary symptom is little or no semen produced during orgasm, which is sometimes called a "dry orgasm". After orgasm, the semen leaves the body during the next urination.
- Impact: Retrograde ejaculation does not cause pain or affect the pleasure of an orgasm. However, it does cause infertility, which can be a significant concern for younger patients wishing to have children.
- Other side effects: While other complications like temporary urinary incontinence, bleeding, or urinary tract infections can occur, they are generally less common than retrograde ejaculation.
HOW ORGASM AND EJACULATION WORK
Here's a link to a video that succinctly describes the anatomy of RE:
https://youtu.be/HxI2zft2y18?si=ECLe2w_AD8FFwba3
There are two different processes going on during orgasm and ejaculation.
Orgasm is arrived at and controlled through both physical and mental arousal. It arrives through a complex interplay between the brain and the body. It involves physical muscle contractions and hormonal responses while also activating numerous brain systems related to emotion, pleasure and thought. It is complex!
Ejaculation is physical and completely involuntary. During ejaculation the body takes over. The Semen is pumped by a combination of smooth and striated pelvic muscles, including those of the prostate gland and the bulbocavernosus muscles in the penis. The prostate's smooth muscles contract like a sponge to expel fluid, while the more powerful rhythmic contractions of the bulbocavernosus and other pelvic muscles force semen along the urethra and out of the body. The physical contraction and expansions can be felt strongly.
MY EXPERIENCE OF RETROGRADE EJACULATION
I have RE. Having known nothing about this side effect before I had the operation I didn't find this out until my first attempted orgasm some weeks after surgery. Neither my doctor nor consultant had mentioned it as a possibility and I was never given the option of another procedure. I didn't do any research. After waiting 5.5 years for surgery, when the letter came through the door offering TURP I just agreed. RE or any other side effect was last thing on my mind. I really didn't care about anything but getting out of the nightmarish situation I was in with full retention and to be completely honest, had I known, I would have gone ahead anyway. I therefore have no regrets**. That positive attitude is not however shared by many of my fellow TURP travellers. Many are thrown into deep distress and depression by the experience of RE and I do understand why. The change is enormous.
** see below
Feelings are subjective so it is difficult to describe them, but here's a stab ....
In my 48ish years of post-puberty life and many thousands of textbook orgasms on the score card I never really tried to dissect or deconstruct the various stages they went through or the resulting feeling they gave me. Whether during intercourse or self-administered it was always just one great big full bodied orgasmic pleasure that never failed to satisfy - like an Ardbeg whisky or Eggs Benedict.
Despite not having had a normal 'wet' ejaculation for 2.5 years that powerful experience is still vivid in my imagination. Some feelings are impossible to forget. Perhaps now however, with parts of my sex organs removed I am well positioned to describe what you don't get with the dry version.
What you do get with a full wet orgasm -
1 rising arousal - all cylinders firing
2 climax
3 orgasm - peak pleasure - brain triggered
4 ejaculation reflexes kick in
5 involuntary muscle contraction and semen pumping hard
6 slow 'come down' with muscles still pumping more gently
7 continued diminishing arousal as muscles slowly stop pumping
8 relief, relaxation and satisfaction
The first 3 of the above steps are experienced in exactly the same way during a dry ejaculation but there the comparison ends. It ends just after the ejaculation and before the discharge of semen. The 'involuntary muscle contraction' and pumping of semen doesn't happen. The semen has been ejected from the balls straight into the bladder so there is no physical need for the penis muscles to contract.
How to explain this in terms of a bodily 'feeling'? I can't!! It is so powerful and so unique a feeling that after days of trying I can't think of an alternative. It has no comparison. It is the ultimate physical pleasure a body is able to experience.
Perhaps I can get somewhere with describing the emotional side of the experience. The words - letdown, underwhelming, vapid, insipid, joyless and deflating come immediately to mind. Having known and loved the full effect of an ejaculation for so long the difference is huge. You go from high excitement to sudden disappointment in an instant like being overtaken at the finish line in the last second of a race. You were up for it, you invested everything you had, your expectation was high but you didn't come first .... you didn't come at all. It isn't a climax; it's an anticlimax.
It's odd that although 'peak pleasure' is technically reached at orgasm a dry ejaculation gives nothing like the pleasure of a wet one. You have achieved the moment of greatest arousal but the full follow-through pleasure of physical ejaculation doesn't arrive. Without that the orgasm sensation quickly dies away leaving just a fading memory of what once was and a longing for what could have been. The orgasm has nothing to follow through on. It is left high and dry.
Looking online for reasons why a dry orgasm is disappointing I read 'Most people associate orgasms with the visible release of semen. When this visual release component is missing, the experience can feel unusual or unsatisfying.' This doesn't do it justice. I don't think the 'visible release' is relevant. It's the physical release that matters - the feeling of your penis muscles pulsating and pumping that gloopy teaspoon full of semen out of you. That delicious feeling is to an orgasm what MSG is to Chinese food - it brings it to life. Without it everything before it loses its context - its purpose. Psychologically that's a tough thing to deal with. You are wired to expect a course of meat and 2 veg. Each requires the other for it to be a proper meal. Take away the meat and the veg is an insufficient letdown.
RETHINKING MY POSITIVE THINKING - LIBIDO
Whilst I have no regrets about TURP surgery, now that I'm thinking hard about its consequences I realise that without ejaculation I am half way to every man's worst nightmare - emasculation. I still have my balls but their contents will never see the light of day or the darkness of a welcoming vagina again. They'll all end up mixed into my pee and flushed into a toilet bowl. I'm one step below a shooter of blanks. Nothing fires out the barrel of my gun. It has been deactivated.
Masturbation is free. You can do it any time you want as often as you want. The only tool you need is your hand and your cock. It along with consensual sex gives more physical pleasure than any other activity known to wo/man. Being free at the point of delivery the full orgasmic experience is an extremely valuable one to have to hand.
Thankfully I have already had my kids and my sexual needs have always been modest. I am happily single and even before TURP I didn't crave or value regular or random sexual contact. Having the odd tug on my todger was always a welcome pleasure though. It released stress and made me feel good. I have noticed in the last months though that natural sexual arousal is happening less often in me. When I masturbate it's not just a simple pleasure. It also comes with an eye on the 'use it or lose it' principle of neuroplasticity. Its purpose is now becoming to service the machine to prevent it seizing up.
I often now do it just because I haven't done so for weeks and know I need to keep my hand in. More and more, without the great pleasure I used to experience, it is a chore. Before TURP, I never had to remind myself to have a wank. My cock always told me when it was time. I do miss that a lot.
The fading of the sexual drive (libido) is associated with old age. I'm 60 and hopefully have a few years left on the cock. I now look forward to those years without the certain knowledge that I can 'pleasure myself' at will. I've already stopped even being interested in a bit of cleavage or a beautiful ankle. I used to be aroused in a 'look, don't touch' way and just enjoyed the beauty of the female human form. That's normal for both men and women, old and young, so a waning in my interest now adds to a sense of detachment from my fellow human beings. Men are estimated to think about sex 19 times a day on average. I now think about my failing libido more often.
Soon after TURP the discovery that I no longer felt the full pleasure of sex was unexpected and concerning but I got over it by focusing on the pleasure of no longer having the pain of retention. I also believed that in time this would probably change or I'd find a 'work around' to get my mojo back. Since then I have certainly found ways to enjoy it more than I did at the start. 2.5 years on I reckon I'm getting the best experience I can out of it - maybe 60% of what I had before. Perhaps a few percent would be added if I could now just fucking forget the way it fucking used to be! Once you've driven a Mercedes no other car comes close.
WOULD I STILL RECOMMEND TURP?
Yes I would for those who have no alternative. However with the recent arrival of less invasive procedures I would say .... "Don't do it!" There are so many alternatives. Some, like HoLEP have a similar chance of causing RE, but others are much less likely to do so and I recommend you consider them. If you want advice you should talk to your doctor or join a couple of Prostate related FB groups where you'll be able to read about the experiences of men who've been through them. There's also lots of medical information on the net to help you make your decision.
MAY THE FORCE BE WITH YOU!
