From ” The Decision”
The male anatomy after the prostate has been removed becomes very similar to the female anatomy. Without the prostate, the relationship of the bladder to the external sphincter and urethra are the same. This is why men will often times experience leakage of urine with activity much like some women(stress incontinence). When the prostate is removed the vas deferens are tied off, and the seminal vesicles are removed so there is no fluid at the time of climax in post-prostatectomy male. Because the external sphincter is responsible for continence and related to the feeling one experiences with climax and the fact that it remains(see diagram below) after a prostatectomy, this muscle takes on a much more important role for the male. Over time the male external sphincter learns to be the primary muscle for continence and in doing so (in my opinion) often times is responsible for a change in the nature of the climax. I have had several patients tell me that their climax lasts longer and is more intense than before. I have had others tell me that it was different, not better or worse. How the nature of climax will be for the patient that plans to have the prostate removed(and for that matter if he can have one, if he is continent or if he can retain his erectile function) will not be known until he had the surgery and allowing for “the tincture of time” to give the answer. It is this uncertainty in these issues that often times persuades men not to choose surgery. Men’s libido(sex drive) does not change after the prostate is removed.Sex drive is dependent on the male hormone testosterone and is not affected by the surgery.As you can see with all the issues above and how some are related to the removal of the prostate and how some are not, it is not surprising that many men make treatment decisions on a flawed premise. This is probably more true for prostate cancer than for other cancers as the prostate is so intimately related to several physiologic functions.