Dear OncoLink "Ask The Experts,"
I am a survivor of colon cancer. I had a portion of my upper colon removed, went through chemotherapy, and now show no signs of cancer. For that I am extremely grateful, but I now am scheduled to reconnect my colon. I have a symptom from my first surgery called retrograde ejaculation, and am worried that I may lose some other sexual function during this surgery. I understand that retrograde ejaculation is a common result of the surgery, and that it can never be reversed. Are my fears about the reconnect causing some more damage to my sex life valid?
Najjia N. Mahmoud, MD, Assistant Professor of Surgery at the Hospital of the University of Pennsylvania in the Division of Colon and Rectal Surgery, responds:
Retrograde ejaculation is a condition that causes the semen to travel up into the bladder, instead of exiting through the penis. Unfortunately, this is a potential complication of any surgery that includes ligation (tying off) of the inferior mesenteric artery. This is a very important part of a low colorectal cancer resection, but it can result in inadvertent injury to the sympathetic nerves that are responsible for ejaculation. This is true for almost all rectal or sigmoid colon cancer surgeries, not just abdominal perineal resection. The frequency of this condition after surgery is unclear, but is probably less than 10% of the time.
Retrograde ejaculation can occur secondary to either surgery or radiation (or both). It happens when the hypogastric nerves that are located close to the aorta at the base of the inferior mesenteric artery are transected or sustain a traction injury while doing a high ligation of this artery, which is necessary for a good cancer operation. Retrograde ejaculation usually does persist and there are no great treatments for it. However, the good news is that colostomy or ileostomy closure does not worsen the situation at all. There is typically no increased risk at this point. The closure does not necessitate operating around those nerves.
Consulting with an urologist that specializes in erectile dysfunction is a good idea to rule out other possible causes of retrograde ejaculation that can be corrected.