We must review concepts like virility and change the rules of the game
For generations, prostate disease has occupied a silence men rarely broke — a private reckoning with the body that culture dressed in shame and left unexamined. In Madrid and beyond, men facing surgery for benign hyperplasia or cancer discover that the loss of ejaculation or erection need not mean the loss of intimacy itself, provided medicine and meaning are allowed to work together. What emerges from their stories is not merely a clinical question about function, but a deeper civilizational one: whether masculinity can be reimagined before loss forces the conversation.
- Men who undergo prostate surgery often emerge from the operating room into a silence their doctors helped create — vague reassurances replacing honest preparation for what their bodies will no longer do.
- The stakes differ sharply between conditions: benign hyperplasia surgery typically preserves erections while eliminating ejaculation, whereas prostate cancer treatment risks erectile dysfunction entirely, fracturing a man's sense of self at its most intimate root.
- Medicine has answered the physical gap with an arsenal — sildenafil, vacuum pumps, alprostadil injections, remote-controlled penile prostheses — yet even specialists concede that assisted function is not the same as a life freely lived.
- Couples who work with sex therapists are finding a different path forward, trading a narrowly sexual vocabulary for a broader sensual one, rediscovering connection where performance once stood.
- The sharpest urgency belongs to younger men, for whom the change arrives not as a gradual fading but as a sudden rupture — and for whom society has not yet built the language to grieve or adapt.
A 63-year-old man in Madrid learned he had benign prostatic hyperplasia and felt the particular relief of a diagnosis that wasn't cancer. But when he tried to understand what surgery would mean for his sex life, his doctors offered little, and the men who'd been through it offered less. He was left to carry his uncertainty alone.
The silence around prostate health persists even as menopause has become a subject of open cultural conversation. Sexologist Raúl González Castellanos traces the gap to a stubborn equation: male virility measured exclusively by erections and ejaculation, leaving no room for honest reckoning when those functions change.
The two main prostate conditions carry different consequences. Surgery for benign hyperplasia — typically performed with laser technology through the urethra — preserves erections but commonly produces retrograde ejaculation, a dry orgasm whose sensation is altered but not absent. Prostate cancer surgery is more radical: the entire prostate and seminal vesicles are removed, eliminating ejaculation entirely, though orgasm through penile stimulation remains possible. The greater danger is erectile dysfunction, since the relevant nerves run close to the prostate. When cancer is caught early and nerves are spared, roughly 75% of patients worldwide recover erectile function within a year.
For those who don't recover on their own, medicine offers a range of interventions — medications, vacuum devices, injectable vasodilators, and prostheses. Yet one specialist offers a candid counterweight: even with all of these tools, a life requiring assistance is not identical to one that didn't.
Isabella was 65 when her husband was diagnosed and subsequently struggled with severe erectile dysfunction. What ultimately helped was not a device but a sex therapist who guided them toward reimagining intimacy altogether. "We've rediscovered our connection," she says. "Now we're more sensual and less sexual — and that's not bad at all."
The hardest cases belong to younger men, for whom the change is not a gradual dimming but a sudden break. González Castellanos argues that the work ahead is cultural as much as clinical: reviewing what virility means, rewriting the rules so that the game — connection, pleasure, closeness — can continue under new conditions.
A 63-year-old man from Madrid learned he had benign prostatic hyperplasia—a common, non-cancerous enlargement of the prostate gland that affects many men over fifty. His first response was relief: at least it wasn't cancer. But when he asked his doctors what would happen to his sex life after surgery, they offered vague reassurances. Other men who'd had the procedure told him everything was fine, though none seemed willing to discuss the details. He was left to wonder in silence, caught between gratitude for his health and anxiety about his body.
For centuries, certain life passages have been treated as the unofficial end of sexuality itself. Women have long faced menopause—a transition that brought not just the end of fertility but, in the cultural imagination, the end of desire and pleasure. Men have faced their own version: prostate problems that could steal erections or the ability to ejaculate. Both topics were considered too delicate to discuss openly. But menopause has become a trending conversation in recent years, while men still struggle to speak candidly about their prostates. "It's a taboo subject, because a man's virility is still measured by his erections and ejaculations," says Raúl González Castellanos, a sexologist and couples therapist in Madrid.
The prostate presents two distinct medical challenges. Prostate cancer is a malignant tumor that requires aggressive treatment. Benign prostatic hyperplasia is simply an enlargement of the gland that compresses the urethra, making urination difficult—a condition that becomes increasingly common with age. The symptoms are unmistakable: a weak stream, the need to urinate four or five times a night, a persistent sense that the bladder hasn't fully emptied, sudden urgency, dribbling. These typically begin around age fifty-five to sixty. Surgery for benign hyperplasia, usually performed with laser technology through the urethra, removes only the enlarged portion of the gland. It preserves erections but frequently causes retrograde ejaculation—what doctors call a dry orgasm. The sensation changes slightly, because part of the pleasure comes from the physical release of pressure during ejaculation. It's different, neither better nor worse, but different nonetheless.
Prostate cancer surgery carries higher stakes. A radical prostatectomy removes the entire prostate and seminal vesicles, which produce ninety-five percent of semen. Men lose the ability to ejaculate entirely. But they can still experience orgasm through penile stimulation, even without an erection. The real risk is erectile dysfunction. The nerves that produce erections run very close to the prostate, and surgeons must balance complete tumor removal against nerve preservation. When cancer is caught early, surgeons can sometimes spare those nerves. One year after surgery, seventy-five percent of patients worldwide regain erectile function, with or without medication—though many men had erectile difficulties before the operation began. There's also an unexpected side effect: the penis becomes shorter when flaccid, because the surgeon must pull the urethra inward slightly when reattaching it to the bladder. The erect length remains unchanged.
When nerves are preserved, some patients experience neurapraxia—a temporary inflammation that causes erectile dysfunction in the first few months after surgery. Most recover. For those who don't, medicine offers solutions. Medications like sildenafil can help. Vacuum devices create an erection by drawing blood into the penis. Alprostadil, a powerful vasodilator, can be applied as a cream or injected directly into the penis. Penile prostheses, controlled by remote, allow erections that last as long as desired. Yet one urologist and prostate expert notes a hard truth: "Even with assistance, a life in which you can never have sex again isn't the same as one in which you can."
Isabella was sixty-five when her husband, then fifty-seven, was diagnosed with prostate cancer. After surgery, he struggled with severe erectile dysfunction. They tried various treatments, but what truly helped was working with a sex therapist to reimagine their intimate life. "We've rediscovered our connection after a difficult period," she says. "Now we're more sensual and less sexual… and that's not bad at all." Her experience points toward something the medical community is beginning to recognize: technology matters, but so does a fundamental shift in how we understand sexuality itself.
The challenge is especially acute for younger men. Older men undergoing prostate surgery have already experienced gradual changes in sexual function over time. But a man in his fifties or sixties who suddenly loses the ability to ejaculate or faces erectile dysfunction experiences a rupture, not a gradual fade. "We have to keep at it," González Castellanos says. "We must review concepts like virility and change the rules of the game, so that the game can continue." Making peace with one's body, regardless of circumstance, is always worthwhile. But it requires more than pills and devices. It requires permission to redefine what intimacy means.
Citações Notáveis
It's a taboo subject, because a man's virility is still measured by his erections and ejaculations.— Raúl González Castellanos, sexologist and couples therapist
We've rediscovered our connection after a difficult period. Now we're more sensual and less sexual… and that's not bad at all.— Isabella, whose husband underwent prostate cancer surgery
A Conversa do Hearth Outra perspectiva sobre a história
Why is prostate surgery such a taboo topic for men when menopause has become openly discussed?
Because menopause is framed as a natural life stage, while prostate problems feel like a failure of the body—and specifically, a failure of masculinity. A man's sexuality has been tied to his ability to perform, to maintain an erection, to ejaculate. Anything that threatens that feels like a threat to his identity.
But the surgery itself doesn't always destroy sexual function. Why the shame?
Because the uncertainty is paralyzing. Doctors can't promise what will happen. Some men lose ejaculation but keep erections. Some lose both temporarily. Some recover, some don't. And men don't talk to each other about it honestly—they say they're fine, but they don't elaborate. So every man faces it alone, imagining the worst.
What changes when a couple works with a sex therapist after surgery?
They stop measuring sexuality by a single metric. They discover that intimacy can be sensual without being sexual in the traditional sense. They learn that pleasure doesn't require ejaculation or even a perfect erection. It's a kind of grief work, really—mourning what was lost, then finding what's possible.
Is the technology—the vacuum devices, the injections, the prostheses—enough?
It helps. But a doctor said something stark: even with all these tools, a life where you can never have sex again isn't the same as one where you can. Technology restores function, but it doesn't restore spontaneity or the feeling of your body working as it always has. That requires something deeper.
What would actually change the conversation?
If we stopped measuring virility by erections and ejaculations. If younger men especially—those who face sudden changes—could see sexuality as something that evolves rather than something that ends. If we talked about it the way we talk about menopause now: as a real transition that requires support, not shame.