How do common medical conditions and medications in older men (e.g., diabetes, prostate surgery, antidepressants) impact ejaculation frequency and quality?
Executive summary
Common chronic conditions and treatments in older men change ejaculation in different ways: diabetes and neuropathies can cause retrograde ejaculation or absent ejaculation; prostate surgery or radiation typically produce “dry” orgasms because seminal vesicles and prostate are removed; and many antidepressants (especially SSRIs/SNRIs) delay or blunt ejaculation and orgasm (e.g., SSRIs increase ejaculatory latency by ~3.1 minutes) [1] [2] [3]. Frequency of sexual activity and ejaculation declines with age overall — for example, nearly half of men aged 70–80 reported orgasm at least once a month in one population study — but underlying disease and drugs explain much of the individual variation [4] [5].
1. Aging itself cuts frequency and force, but not interest
Aging reduces ejaculation volume, force and the ability to ejaculate repeatedly; orgasms tend to be briefer and less forceful and refractory periods lengthen (sometimes to 48 hours), yet most older men retain sexual interest and many still orgasm monthly — 46% of Swedish men aged 70–80 reported orgasm at least once a month [5] [4]. Population-level decline is therefore real, but age alone is an incomplete explanation for a man’s changing sexual function [5].
2. Diabetes and neuropathy: a silent cause of “no ejaculate”
Longstanding diabetes and other neuropathies can damage the autonomic nerves that coordinate emission and the bladder neck closure, producing retrograde ejaculation (semen into the bladder) or outright anejaculation; these problems are often irreversible and mainly matter for fertility rather than immediate health [6] [1]. Clinics and reviews note retrograde ejaculation caused by diabetes often can’t be corrected and that neuropathy is a recognized mechanism for failure to ejaculate [6] [1].
3. Prostate surgery and radiation: the predictable “dry orgasm”
Radical prostatectomy removes the prostate and seminal vesicles — the tissues making most ejaculate — so most men have dry orgasms afterward even if orgasmic sensation remains; radiation can produce similar but often progressive loss of ejaculate over years [2] [1]. Studies and patient guides report anejaculation occurs in all men after radical prostatectomy and that radiation-related anejaculation can rise from 16% at 1 year to 89% by 5 years in some cohorts [1] [2].
4. BPH, its treatments, and ejaculatory trade‑offs
Benign prostatic hyperplasia itself does not necessarily stop ejaculation, but many medical and surgical treatments for BPH do. Alpha‑blockers and 5‑alpha‑reductase inhibitors are associated with anejaculation or reduced volume (reported ranges vary: e.g., alpha‑blockers 4–30%, 5‑ARIs 4–18%); TURP and some endoscopic surgeries carry substantial rates of retrograde ejaculation (TURP 50–70% in pooled reports) [7] [8]. Newer, ejaculation‑preserving procedures exist but may be limited by prostate size or diabetic neuropathy [9] [7].
5. Antidepressants: a large, dose‑dependent drug effect on ejaculation
Antidepressants — particularly SSRIs and SNRIs — commonly delay ejaculation or blunt orgasm; randomized and meta‑analytic data show SSRIs increase ejaculatory latency (mean difference ~3.09 minutes) and are even used to treat premature ejaculation, but many patients discontinue because of side effects [3]. Observational and systematic reviews report broad rates of sexual dysfunction with serotonergic drugs; alternative antidepressants (bupropion, trazodone, vortioxetine, vilazodone) may have lower risks but evidence is evolving [10] [11] [12].
6. Mechanisms: hormones, nerves and neurotransmitters
Ejaculation depends on coordinated autonomic and somatic nerves plus central neurotransmitters. Diabetes and pelvic surgery damage nerve pathways; SSRIs and SNRIs alter serotonin signaling that delays emission and orgasm; and removal of the prostate/seminal vesicles eliminates fluid production and the urethral fullness that contributes to the orgasmic sensation [6] [10] [13].
7. Practical implications for patients and clinicians
Clinicians assessing reduced frequency or absent ejaculation should consider age, comorbidities (diabetes, neurologic disease), recent prostate procedures or radiation, and current medications — especially serotonergic antidepressants and some BPH drugs — because causes and reversibility differ sharply: surgical removal or extensive neuropathy is often permanent, medication effects may reverse on stopping or switching, and some interventions (pelvic floor rehab, nerve‑sparing surgery, medication adjustments) can help in selected cases [6] [2] [12].
Limitations and gaps: available sources summarize risks, mechanisms and some intervention data but do not provide individualized probabilities for every combination of age, disease and drug; they also rely on a mix of trials, observational series and reviews with variable follow‑up [5] [7] [3]. For patient‑level decisions, urology or sexual‑medicine consultation is essential, particularly where fertility or relationship distress is involved [6] [1].