Incontinence during sex is a long-lasting problem for roughly one in eight men who've had their prostate removed due to cancer, a study of more than 1,400 patients has found.
Although the urine leakage resolved for some men over time, 36 percent of them still had the problem — called climacturia — two years after surgery. And 12 percent of the men called it a "major bother."
According to the American Cancer Society, one in six men gets prostate cancer at some point in his life, and one in 36 will die from the disease.
While there is controversy over how to treat low-risk tumors, some of which may never cause any harm if left untreated, surgery and radiation are common options when the disease is more advanced.
This year, about 90,000 men will undergo radical prostatectomy, a procedure in which the entire prostate is removed. They face common side effects such as impotence and incontinence during routine activities, and urologists have recently learned that some may also leak urine during sex.
"I think that it's something that is under-appreciated, because if you look through all the discussion, everything is always about erectile dysfunction" after prostate surgery, Dr. Herbert Lepor, a urologist at New York University, told Reuters Health.
"We overlook some of the other issues that are relevant to overall sexual function," added Lepor, who led the new study.
Lepor's team looked at responses to questionnaires from 1,459 men who had undergone radical prostatectomy at NYU's Langone Medical Center between 2000 and 2007.
He performed all the surgeries himself, without using a robot, but said he believes the incidence of sexual incontinence would not differ after robot-assisted procedures.
Although most of the men who reported sexual incontinence also complained of leakage during daily activities, some of them experienced only one of the problems, suggesting they might have different causes.
The findings, published in the Journal of Urology, suggest urination issues may be a bigger deal than suggested by earlier studies.
Last May, another urology group reported that only one in 20 men said they were significantly bothered by incontinence a year or more after prostate surgery.
Whether the discrepancy is due to questionnaire differences or other factors is unclear.
The term climacturia was coined in a 2006 paper in the Journal of Urology by Dr. Neil Fleshner at the University of Toronto and his colleagues.
Fleshner told Reuters Health he's surprised by how few men report the problem after prostate surgery. That's because surgeons typically remove a sphincter muscle in the neck of the bladder that shuts off the flow of urine during an orgasm (another that allows semen flow is left intact, although with the prostate gone, the body no longer makes seminal fluid).
"I do tend to tell our patients prior to surgery that this could happen," Fleshner told Reuters Health.
Surgery can help relieve incontinence in some men who develop the problem after prostate removal. So, too, may exercises that strengthen the pelvic muscles, although the benefits of such rehabilitation are unproven, Flesher noted.
Lepor said he and his colleagues were "a bit surprised" by how common sexual incontinence was in their study.
"I think it's something that those of us who perform radical prostatectomy should be aware of in terms of counseling our patients, and also in terms of finding ways to treat this if it ends up being a problem," he said.
Ironically, Lepor added, some men seem to enjoy climacturia because it makes them feel as if they've had a successful orgasm.