Halachic Implications of Prostate Surgery

Background

The treatment of urinary symptoms in males, such as difficulty urinating, a persistent sensation of incomplete bladder emptying, or urinary retention, usually begins with medical management. When medication does not provide adequate relief, surgery may be considered for benign prostatic hyperplasia (BPH). The most common procedure is TURP (Transurethral Resection of the Prostate).

During TURP, part of the inner prostate tissue is removed through the urethra, without an external incision, to relieve the obstruction and improve urine flow. This procedure raises two primary halachic questions: whether it affects a person’s marriage eligibility, and whether it creates a concern of wasting seed during marital relations.

            A member of our Beis Midrash, Rabbi Itiel Katz, has clearly summarized the issue. It is important to clarify the medical issues first, and we will then consider the halachic implications in their broader context.

Retrograde Ejaculation

Under normal circumstances, during ejaculation, a muscular mechanism closes the passage between the bladder and the urethra, directing the semen outward. In some cases, this is affected by the surgery. As a result, during orgasm, the semen flows backward into the bladder rather than exiting through the urethra. This condition is known as retrograde ejaculation.

In such cases, marital relations take place in the usual manner, and the individual experiences a normal orgasm. The semen, however, enters the bladder and is later expelled during urination. There is no intentional act of destroying or wasting semen; rather, this is an involuntary anatomical and physiological change that affects the route by which the semen leaves the body.

Krus Shafcha

The Torah prohibits a man who is classified as a Petzu’a Daka or Kerus Shafcha from marrying a halachically eligible Jewish woman: “No one whose testes are crushed or whose male organ is severed may enter the congregation of the Lord (Devarim 23:2).” These terms refer to men whose reproductive system – either the testes or the male organ – has been injured in a manner that renders them incapable of reproduction.

The Mishna in Yevamos (8:2) explains:

Who is considered a Petzu’a Daka? Anyone whose testicles have been injured, even if only one of them. And who is a Kerus Shafcha? Anyone whose organ has been severed. If even a hair’s breadth of the corona remains, he remains fit.

Based on a discussion in the Gemara (Yevamos 75b), the Shulchan Aruch (E.H. 5:2) rules:

Who is considered a Petzu’a Daka? Anyone whose testicles have been injured. And who is a Kerus Shafcha? Anyone whose organ has been severed. A male may become disqualified through injury to one of three organs: the organ itself, the testicles, or the channels in which semen develops, known as the spermatic ducts. If any one of these three organs is injured, severed, or crushed, he is disqualified. How so? If the organ is injured, crushed, or if the corona is removed – or anything above it – he is disqualified. However, if part of the corona remains, even as little as a hair’s breadth completely encircling the organ, he remains fit.

This indicates that damage to the “channels in which semen develops” renders a person a Petzu’a Daka, forbidding him to marry within the nation.

According to the Cheshev haEfod (2:8), any injury to the seminal ducts is included in the disqualification. However, the Chelkas Yaakov (E.H. 29) argues that this is subject to a Machlokes Rishonim.

The Chazon Ish zt”l maintained (E.H. 12:7) that modern physiological knowledge differs from the anatomical understanding reflected in the Mishna. Based on this, he concluded that a Petzu’a Daka is only one in which the external reproductive channels are damaged, not the internal ducts.^[1]

R’ Shmuel Wosner zt”l (Shevet haLevi 8:266:3) rules that one may rely on the view of the Chazon Ish.^[2] Accordingly, damage to the internal seminal ducts does not disqualify a person. The same conclusion is presented in Pischei Da’as (Even haEzer p102).

Accordingly, even if surgery for benign prostatic enlargement may affect a man’s reproductive function, there is a strong basis to rule leniently and not disqualify him, since the procedure is performed on structures that are located within the body.

The Prohibition of Wasting Seed – Halachic Background

Although the prohibition against wasting seed (“Hashchasas Zera”) is not stated explicitly in the Torah, the Gemara and halachic literature treat it as a very serious prohibition.

The Gemara in Yevamos (34b) and Nida (13a) derives this prohibition from the account of Yehuda’s sons (Bereishis 38:9):

Onan knew that the offspring would not be considered his; therefore, whenever he came to his brother’s wife, he spilled his seed on the ground so as not to provide offspring for his brother.”

The Gemara (Nida 13b) interprets the commandment “You shall not commit adultery” (Shemos 20:13) as teaching: “There shall be no adultery among you, whether with the hand or foot.”^[3]

In Avoda Zara (20b), the Gemara interprets the Pasuk “Guard yourself from every evil thing” (Devarim 23:10) to mean: “A person should not entertain improper thoughts during the day, lest they lead to impurity at night.”

Chaza”l employed exceptionally strong language to emphasize the gravity of the prohibition. For instance, in Maseches Nida 13a:

Whoever emits semen in vain is liable to death … it is as though he sheds blood … and it is as though he worships idols.

This approach is reflected in the ruling of the Shulchan Aruch (E.H. 23:1):

It is forbidden to emit semen in vain, and this sin is more severe than all the transgressions in the Torah.

According to the Sma”k (292) and Or Zarua (1:124), the prohibition of wasting seed is of Torah origin. This also appears to be the view of the Magen Avraham (3:14) and Igros Moshe (E.H. 3:14).^[4]

Other authorities maintain that it is an Issur d’Rabbanan. For example, the Rivash (171) understood the severe language of Chaza”l as deliberate rhetorical emphasis intended to distance a person from sin.^[5]

This also seems to be the view of the Rambam in Peirush haMishnayos (Sanhedrin 7:4), where he writes that the Chachamim. “Wrote at length to warn and frighten anyone who deliberately stimulates himself and emits semen in vain.” This approach was also adopted in Teshuvos Pnei Yehoshua (44) and Mei Nida (195).^[6]

Marital Relations When Conception Is Impossible

The Gemara in Yevamos (12b) states that three categories of women are permitted to use a contraceptive barrier (“Moch”) to avoid becoming pregnant: a minor, a pregnant woman, and a nursing mother.

Based on this, the Rema rules (E.H. 23:5):^[7]

It is permissible to have marital relations with a minor or with an infertile woman (Ailonis), since the relations take place in the ordinary manner.

The Maharsha”l (Yam Shel Shlomo, Yevamos 1:8) explains the basis for permitting the use of a Moch in these cases:

This is not comparable to casting seed onto wood (the floor), because ultimately this is the regular manner of marital relations, where one body derives benefit from the other. It is comparable to relations with a minor…”

From this, a broader principle may be inferred: When marital relations occur in the normal manner, there is no prohibition of the destruction of seed, even when conception is not actually possible.

Vaginal Obstruction and Condom Use

The Rosh (Teshuvos, 33:3) discusses a case of a woman who has an Otem baRechem – an obstruction in the vaginal canal that prevents semen from entering and, at times, may even prevent complete intercourse. The Rosh rules that marital relations are prohibited in such a case because the semen is “always deposited outside,” and the act is therefore not considered to take place “in the ordinary manner.”

This is codified by the Shulchan Aruch (E.H. 23:5):

A woman who has an obstruction in the vaginal canal, such that when her husband has relations with her the semen is deposited outside – it is prohibited.

On this basis, the Maharsha”m ruled (Shu”t 1:53; 3:268, gloss) that the use of a condom is prohibited, even in circumstances where pregnancy would pose a danger to the woman.^[8]

A similar conclusion is reached by the Teshuvos Dovev Meisharim (1:20), where the author writes concerning the Maharsha”m:

It is well known how great and authoritative this Torah giant was in his power to rule leniently. If even he was reluctant to render a lenient ruling in this case, I too am hesitant to be lenient in this matter.

The overwhelming majority of contemporary halachic authorities have adopted this position. See, among others, Teshuvos Minchat Shlomo (3:103:16), Teshuvos Shevet haLevi (9:265), Nishmas Avraham citing R’ Elyashiv (5:16:2, p143), and Shemesh uMagen (4:75).

However, in cases involving serious danger, some authorities have argued for a more lenient approach. For example, in Teshuvos Achiezer (3:24:5), the author maintains:

At any rate, one may say that there is no Torah prohibition involved, and it is only rabbinic in nature. Because of the Mitzva of marital relations (Onah), the Chachamim permitted it.

Additional authorities who are inclined toward this position include Teshuvos Tzafnas Pane’ach (164) and Teshuvos Tzitz Eliezer (9:51, 2:2; 20:50).^[9] I have also heard this view from Mori v’Rabi, R’ Yisrael Ganz Shlit”a.

An Involuntary Medical Condition

This brings us to our question regarding retrograde ejaculation resulting from medical treatment. When semen is diverted into the bladder rather than entering the woman’s reproductive tract, does this constitute the prohibition of wasting seed, since the semen ultimately does not reach the womb?

I found that two leading halachic authorities addressed this issue directly. In Teshuvos Minchat Yitzchak (10:130), the author leans toward permitting it, concluding that there is no concern of wasting seed. The same ruling was issued by the Tzitz Eliezer (14:95).

The principal grounds for leniency are:

1. Marital relations take place in the normal and natural manner.^[10]
2. The couple fulfills the mitzvah of Onah through these relations. ^[11]
3. The semen is not intentionally discharged onto the ground.^[12]
4. The individual has no control over the outcome of the ejaculation and is therefore acting under compulsion with respect to its result.^[13]
5. Semen that is incapable of producing offspring is not subject to the same prohibition against destruction.^[14]
6. Semen that does not leave the body in the ordinary manner is not included within the prohibition.^[15]

Conclusions

A man who has undergone prostate surgery is not disqualified from marriage.

Furthermore, if retrograde ejaculation causes semen to enter the bladder during marital relations, this does not constitute a violation of the prohibition against wasting seed. Accordingly, the couple may continue their marital life without halachic concern on this account.

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[1] See Igros Moshe (E.H. 4:28), where R’ Moshe Feinstein explains the Chazon Ish’s reasoning.

[2] See also K’hal Hashem, pp20–21.

[3] [Editor’s note: i.e., masturbation]

[4] Many authorities adopt this position, including: the Bach (O.C. 3:6); Pri Megadim (O.C. 3, Eshel Avraham 14); Toras Chesed (E.H. 43:1–2); Chaim v’Shalom (2:18); Ezras Kohen (32); Teshuvos S’ridei Eish (1:162); Teshuvos Minchas Yitzchak (1:50); and Teshuvos Divrei Yatziv (E.H. 31).

[5] The Rivash writes: The Chachamim greatly emphasized the severity of this sin, as they often did with other transgressions. For example, they taught (Shevuos 39a) that regarding all transgressions in the Torah it is said, “and He will forgive,” whereas here it is said, “He will not forgive”; and that punishment is exacted not only from the sinner but from the entire world. Yet they never said that one must be killed rather than transgress, as is the rule for the three cardinal sins. Such an idea never entered anyone’s mind. Rather, it is the way of the Chachamim to employ strong language in describing sins so that people will be more careful to avoid them.

This is evident from other rabbinic expressions as well. For example, the term “liable to death” is used regarding one who eats before davening Ma’ariv (Brachos 4b) and one who issues a halachic ruling in the presence of his teacher (ibid. 31b). Likewise, the Chachamim state (Nedarim 40a) that one who fails to visit the sick is considered “as though he has shed blood.”

[6] This approach is also found in: Teshuvos Heichal Yitzchak (2:17); Teshuvos Meshivas Nefesh (18); Olas Yitzchak (E.H. 2:243); Ezer miKodesh (E.H. 23:2); P’sakim u’Kesavim of R’ Isaac Herzog (7:62, sections 1 and 16); Teshuvos B’eir Moshe (5:163:12); and Teshuvos Bnei Banim (4:19).

[7] This is also the view of the Shulchan Aruch; see Beis Shmuel (23:2).

[8] The Maharsha”m distinguishes between the use of a condom, which he prohibits, and the use of a Moch, which may be permitted in certain circumstances:

In the case of a Moch, the semen is deposited within the woman’s body and merely comes to rest on the absorbent material. In the present case, however, the semen is emitted into a pouch that completely covers the organ. The pouch acts as a barrier on all sides, and the semen never comes into contact with the woman’s body at all. This constitutes actual wasting of seed. There is no basis for leniency other than a concern for preservation of life, and the present case does not qualify as such, since the woman may refrain from marital relations and the husband has the option of divorce. Therefore, Heaven forbid that one should rule leniently in this matter. One who does so will ultimately be held accountable. Although the Torah permits the Divine Name to be erased to preserve marital harmony, this cannot serve as a precedent here, because that allowance applies to a one-time occurrence and not to a practice repeated on a regular basis. As the Ran states in his commentary to Yoma, repeatedly violating a prohibition can be more severe than committing even a capital offense on a single occasion.

[9] There appears to be a contradiction within the Teshuvos of R’ Moshe Feinstein regarding the use of condoms in situations involving medical danger. In Igros Moshe (E.H. 1:63), he appears inclined toward a lenient ruling when a significant danger is present. However, elsewhere (E.H. 3:21 and 4:67), he rules unequivocally that condom use is prohibited.

[10] Teshuvos Minchas Yitzchak (10:130).

[11] Teshuvos Tzitz Eliezer (14:95).

[12] Chazon Ish (Nashim 36:2); Teshuvos Tzitz Eliezer (14:95).

[13] Based on Teshuvos Igros Moshe (E.H. 1:63:3).

[14] Imrei Esh (Y.D. 69); Shevet Sofer (E.H. 1); Teshuvos Levushei Mordechai (third edition, O.C. 51).

[15] Teshuvos Tzitz Eliezer (14:95).