Common Questions · After prostate treatment · No. 44
Leaking during sex
Reported by more than a quarter of men after prostatectomy, and almost never mentioned before the operation.
By Mr Musaab Yassin, Consultant Urological Surgeon & Andrologist. Oxford and central London.
Urine leakage at orgasm after radical prostatectomy is called climacturia. It is under-discussed but not rare. A 2025 systematic review identified 1,417 cases among 5,208 men—an overall prevalence of 27.2% across the included studies.1
Why does it happen?
The precise mechanism is not fully settled. Prostatectomy changes bladder-neck and urethral anatomy, and orgasm produces pelvic-floor and sphincter contractions. Men with other post-prostatectomy leakage may be more likely to experience climacturia, but it can also occur when day-to-day continence is relatively good.
Does it mean the cancer operation failed?
No. Climacturia is a functional sexual side effect, not a marker of cancer recurrence or oncological failure.
Why is it so distressing?
It can make men avoid orgasm, penetration or intimacy altogether. Often the anticipated partner reaction is worse than the actual physical amount of urine. Because men may not volunteer the symptom, clinicians need to ask directly.
What practical measures can help?
Emptying the bladder before sex, condoms, towels or planned positioning can reduce anxiety. Pelvic-floor rehabilitation may help some men. Penile tension loops and continence surgery may improve climacturia in selected cases, but treatment studies are generally small and heterogeneous.
How strong is the treatment evidence?
Much weaker than the prevalence evidence. The 2025 systematic review demonstrates that the symptom is common, but comparative trials of specific treatments remain limited.1 A treatment should therefore be matched to whether there is also daytime stress incontinence or erectile dysfunction.
Bottom line
Climacturia is common enough that men should be warned about it before prostatectomy and asked about it afterwards. It is not something you have to hide. Conservative strategies can help, and when it coexists with significant stress leakage or ED there may be procedural options worth discussing.
Men rarely raise this and I have learned to ask directly. What strikes me most is the asymmetry: far more men are bothered by it than believe their partner is. Simple measures help a great deal, and where it sits alongside significant daytime leakage or erectile dysfunction there are procedures that address both at once.
If this sounds like you
A first consultation is £295, and follow-up £190. It usually runs at least twenty minutes; allow up to an hour if you are likely to need a scan, a flow test, or blood or urine tests on the day. You do not need a referral to book privately, and you are under no obligation to proceed with anything.
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The 1 studies behind this page▾
- The Prevalence of Climacturia in Patients after Radical Prostatectomy: A Systematic Review — Ferrão JV, Becker AS, Konopka G, et al.. International Brazilian Journal of Urology. 2025. doi:10.1590/s1677-5538.ibju.2024.0406
Mr Musaab Yassin is a Consultant Urological Surgeon and Andrologist practising in Oxford and central London. FRCS (Urol). GMC 6118378. Reviewed August 2026.
This page gives general information and does not replace an individual assessment. Figures quoted come from published research and describe groups of patients rather than any one person — your own history, anatomy and priorities change what they mean for you.