For patients
Can I Have Sex After HoLEP?
Dr. Fernando Gómez Sancha · ICUA
Dr. Fernando Gómez Sancha · YouTube
Language: English. Editorial classification in the patient catalog.
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About this video
One of the most common questions from patients considering prostate surgery: will I still be able to have sex afterwards? Dr. Fernando Gómez Sancha — urologist with 32+ years of experience and over 10,000 prostate laser surgeries — gives you an honest answer about retrograde ejaculation, sexual function, and what to really expect after HoLEP.
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Original title and description on YouTubeSource checked: 2026-10-04.
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Available transcript · English
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- Doctor, will I still be able to have sex after the operation? This is undoubtedly the question that most concerns my patients, and I completely understand. So, [music] let's talk very clearly about what happens with erections and sex life after prostate surgery for benign hyperplasia.
- I'm Dr. Fernando Gomez Sancha. I've operated on over 10,000 prostate patients with HoLEP laser, and published studies on the functional results of this technique. So, what I'm going to tell you isn't theory, it's data from my own patients.
- First point, and the most important one, holmium laser enucleation does not affect erections. The nerves responsible for erections, the erector nerves, run [music] outside the prostatic capsule.
- In holmium laser enucleation, [music] we work inside this capsule. We don't touch those nerves. It's as if the prostate were a room. We [music] empty what's in the room, but the walls and what's outside aren't touched.
- Published studies, and this includes our own data, show that erectile [music] function is maintained, or even improves after HoLEP. And how does it improve? It improves because [music] many patients already have erectile problems before surgery due to the medication they're taking.
- Tamsulosin, dutasteride, combinations with other drugs, and by stopping the medication after surgery, sexual function recovers. It's also true that patients who have surgery end up sleeping better. They'll urinate fewer times at night, and that nighttime rest also promotes [music] a good erection.
- Now, one must be honest, and I'm always honest with my patients. What does change is ejaculation. In 80 or 90% of cases, after laser enucleation of the prostate, after classic transurethral resection, it could also occur. After old-fashioned open prostatectomy, this retrograde ejaculation also occurred.
- What does it mean? It means that during orgasm, the semen goes towards the bladder instead of [music] coming out. In other words, an inward ejaculation occurs. This happens because by removing all that prostate tissue, by leaving the room empty, the ejaculatory [music] mechanism changes. The semen prefers to go backwards rather than forwards.
- Is it dangerous? No, not at all. The semen is eliminated afterwards when urinating without any problem. Does it affect the orgasm? Not to a great extent. The sensation of orgasm is maintained.
- Some patients say it's slightly [music] different. Others don't notice any change. Sometimes it's even more intense. Sometimes the orgasm is the same as before, and it's much rarer for it to be worse than before.
- Does it affect the erection? No. They are completely different mechanisms. [music] So, what is the real impact on your sex life? The erection is maintained. The orgasm is maintained. What changes is that that that orgasm's a dry orgasm. No semen comes out.
- For most patients, especially at the ages we operate on them, it's a minor change compared to the huge improvement in quality of life that urinating well brings. I'm going to tell you about something that happens in my clinic.
- When I explain this before surgery, some patients hesitate, which is normal, but after the operation, almost all of them tell me, "Doctor, I wish I'd done it sooner because the improvement [music] in daily life, sleeping through the night without getting up three or four times like before, urinating slowly, not having that urgency, more than makes up for the change in ejaculation. After all, we urinate five or six times a day, and ejaculate once every so often." Do you miss ejaculating? Well, a little bit. Would you have the operation again?
- Of course I would. So, this is something that needs to be taken into account. There is one special case, younger patients who want to have children. If in those situations, obviously, it needs to be discussed before the surgery.
- We can explore performing a procedure that preserves ejaculation, but knowing that you'll likely need surgery again in the future, or sperm cryopreservation can be done. Every case is different and needs to be tailored to the individual.
- What I don't want is for the fear of losing your erection to stop you from solving a problem that affects your quality of life, because that fear is often based on incorrect [music] information, or confusion between surgery for benign hyperplasia and surgery for prostate cancer, [music] which are completely different operations. In surgery for prostate cancer, radical prostatectomy, there's a much higher risk of affecting the nerves for erection, but that's another intervention, another procedure, another indication.
- >> [music] >> One shouldn't be confused with the other. If you have doubts about your specific case, see a urologist, and if you want to know more, in the description, you'll find the link to my website, where I explain everything in more detail. Subscribe, and I'll see you in the next video.