Climacturia: The unsexy part of sex after Prostatectomy
You are not alone. It’s more common than we think.
Climacturia is urinary leakage with orgasm. More than 25% of men report climacturia after prostatectomy or surgical removal of the prostate for prostate cancer. Typically, this is seen with stress urinary incontinence or urinary leakage with physical activities or movement such as coughing, running, heavy lifting, but not always.
About 50% of these men and 20% of their partners are bothered by climacturia. Combined with difficulties with getting good erections, climacturia can lead to frustration, anxiety, and sometimes even avoidance of sexual activity. This can have a tremendous impact on your relationship with your partner and your quality of life. Often, these sensitive issues after prostatectomy are not given enough attention in the conventional cancer surveillance after surgery.
Thankfully there are several ways to address symptoms of climacturia:
Here are my top 4 recommendations:
1. Empty your bladder prior to sexual activity – This seems obvious but if the bladder is empty or nearly empty, there is a lower chance that you will leak urine with orgasm.
2. Silicone Penile Tension Loop – This is a soft, silicone ring that can be applied over the penis with an erection. It can help maintain an erection and place light pressure of the urethra or the urine channel to reduce urinary leakage with orgasm. Some providers advocate for using a condom during intercourse, however I find that many patients have slightly decreased penile sensation with intercourse and female partners often find condoms uncomfortable or even painful without adequate lubrication.
3. Pelvic Floor Muscle Training – Strengthening the pelvic floor muscles can help with stress-incontinence and climacturia. An intensive program under the direction of an experience pelvic floor physical therapist requires dedication.
4. Surgery – The right surgical option depends on whether you suffer from other related conditions common after prostatectomy (erectile dysfunction, urinary leakage, penile curvature, etc). Ultimately, you need to work with your doctor to develop an individualized treatment plan that addresses all your goals.
In men with significant stress urinary leakage and climacturia, they will be best served with an artificial urinary sphincter, a prosthetic implant that compresses the urethra and releases that compression with urination. In men with mild stress urinary leakage and climacturia, they will be best served with a urethral sling, an implant that provides fixed compression on the urethra.
In men with erectile dysfunction and isolated climacturia (no or very mild stress urinary leakage), a penile implant with a mini-sling can provide great outcomes. The mini-sling is fashioned from a biologic implant and placed through the same incision to compress the urethra when the penile implant is inflated. This provides tight compression on the urethra during sexual activity when the chances of urine leakage with orgasm are the highest, but with day-to-day activities the compression is reduced allowing you to urinate normally. Performing this mini-sling at the time of your implant to address climacturia, reduces the number of incisions and surgeries and shortens recovery compared to undergoing a surgery for a formal urethral sling or artificial urinary sphincter.
Not all surgeons and urologists ask about climacturia specifically after prostate cancer surgery. But if it is an issue for you or your partner, do not be afraid to bring it up to your Urologist and seek out a true expert if considering surgery to tailor a personalized treatment for your goals.
-Dr. Patel
