Mr. Rao, a 60-year-old gentleman, came to the clinic with an unusual concern. For the past year, he had been experiencing normal erections but no orgasm or ejaculation. This was puzzling and distressing to him. He had no diabetes, no psychological issues, and was otherwise healthy.
He had consulted a “sexologist” who tested his testosterone levels, which was normal. He recommended a few medicines, which did not help him. He was referred to a psychologist for counselling, even though he denied any psychological issues. This did not help either.
Assuming his problem to be related to a “nerve issue”, Mr Rao consulted me.
On further questioning, it turned out that he was on silodosin (Sildoo 8 mg daily), prescribed by his urologist for his prostate enlargement (benign prostatic hyperplasia, BPH).
Silodosin belongs to the class of medicines called alpha-1 blockers, which relax the muscles of the prostate and bladder neck, making it easier to pass urine. It is a very effective drug and often improves urinary symptoms dramatically.
However, silodosin is known to cause a specific side effect: problems with ejaculation. This problem was not communicated to him by his treating urologist, and it did not cross Mr Rao’s mind to check with his doctor regarding this.
Unlike erectile dysfunction, where a man cannot get or maintain an erection, here the problem is different. Men taking silodosin often report that they can get an erection and may even feel orgasmic pleasure, but no semen comes out; sometimes described as “dry orgasm.” This happens because silodosin blocks the signals to the muscles of the vas deferens and bladder neck that normally help push semen out during ejaculation.
In fact, studies show that 20–30% or more men taking silodosin experience reduced or absent ejaculation. It is important to note that this is a side effect of the drug, not a disease or permanent damage.
When Mr. Rao was advised to skip one dose of silodosin before sexual activity (so that the time gap since the last dose was at least 36 hours), he was delighted to report that his ejaculation returned to normal. This is because, as the drug’s effect wears off, the normal pathways for ejaculation are restored.

✅Key Messages for the Public

1. Medicines can affect sexual function. Drugs used for prostate problems, especially silodosin, can cause ejaculation problems even if erections remain normal.
2. This is reversible. Ejaculatory issues due to silodosin usually disappear if the medicine is stopped or doses are adjusted.
3. Don’t stop medicines abruptly. If you face such side effects, talk to your doctor. There are safe strategies, like skipping a dose before sexual activity or switching to another medicine.

✅Key Messages for Young Doctors

1. Always counsel men starting silodosin about possible ejaculatory side effects. This prevents anxiety and builds trust.
2. If a patient complains of “loss of orgasm/ejaculation but normal erection,” think of drug-induced causes before looking for psychiatric or endocrine reasons.
3. Practical solutions include dose timing, skipping before intercourse, or switching to tamsulosin/alfuzosin if side effects are intolerable.

Sexual side effects are often under-reported because patients hesitate to discuss them. A sensitive ear and the right advice can make a world of difference to a patient’s quality of life.