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Between the Sheets - September 2022

Ever since my surgery (open radical prostatectomy) my orgasms are pretty non-existent. Seems they’re not really worth all the bother of taking the pills to get an erection in the first place. Hope that works and, if it does, get the ‘deed done’ and then pretty much nothing in terms of feeling. Why is this happening and why didn’t someone tell me that would happen?

Man getting his legs and pelvic floor stretched out

I’m going to answer the last question first, although it may be rhetorical. I don’t know why you were not told that this could happen as it is known that, after surgery, the QUALITY of orgasms may change. For some men, they are more intense to the point of pain. For others, they remain pretty much the same as before surgery. And for some men like you, unfortunately the SENSATION of orgasm is much decreased. You seem to be in the latter group and I hear your frustration. Many men in the first group (painful orgasm) may actively avoid orgasm because it hurts so much. 

It is not really clear what the cause of this is. The pelvic floor muscles seem to be the ‘culprits’ in that much of the sensation of orgasm comes from contraction of these muscles. If you have a ‘loose’ pelvic floor, the sensation of orgasm may be muted to the point of non-existence. If your pelvic floor muscles are tight (this can happen from overdoing the pelvic floor muscle exercises recommended to prevent incontinence), orgasms may be painful. In my experience, men who are overweight or obese, especially in the mid-section tend to experience loss of sensation with orgasm due to the excess pressure of their belly on the pelvic floor muscles. Internal scar tissue after radical prostatectomy may play a role in this and internal nerve damage likely has a role too. 

A visit to a knowledgeable pelvic floor physiotherapist can be very helpful. The American Physical Therapy Association is the official organization for physiotherapists in the U.S. and members of the public can search for a member through their website. However, it is important to ask if the physiotherapist you are considering visiting has expertise in pelvic floor physiotherapy, as this is not included in basic training programs. The physiotherapist will assess the tone of the pelvic floor muscles and suggest exercises and/or internal massage of the muscles to help correct the tone. Most people, including health care providers, don’t understand the importance of the pelvic floor muscles, but they hold the key to much of our daily functioning including posture, core stability, urination, defecation and yes, sexual pleasure too! 

Originally published in the January 2019 Hot SHEET newsletter.

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Dr. Anne Katz

Dr. Katz provided a bimonthly column to our platform for experts in the field to help men and women by providing answers to questions about sexual health and intimacy challenges that can result from prostate cancer treatment. Dr. Katz also provides helpful webinars to our prostate cancer patients. Katz' column was compiled with the help of Dr. Anne Katz, Certified Sexuality Counselor and Clinical Nurse Specialist at CancerCare Manitoba. She has educated thousands of healthcare providers and cancer survivors about cancer, sexuality and survivorship. She is an avid blogger for ASCO Connections and the author of 14 books on the topics of illness, sexuality, and cancer survivorship. (