Amongst the most important roles a clinician fulfills with patients is that of an educator. Patients may not be aware that erection, orgasm, and ejaculation are all physiologically distinct and while interconnected can occur independently. Educating patients on sexual function will help them understand how BPH procedures may risk dysfunction in one of these processes without affecting another. For instance, men may still have pleasurable sexual activity and orgasm even with retrograde ejaculation.   As part of this educator role, clinicians should be aware of both the prevalence of ED and EjD in the age-adjusted population and the real risks of de novo and sustained adverse events of sexual dysfunction associated with surgical procedures.240 Previous works have demonstrated that clinicians inaccurately identify and counsel patients on risks of ED and EjD with certain BPH medications and procedures.241 While EjD, generally in the form of retrograde ejaculation, is a frequent outcome of ablative BPH therapies, clinicians can confidently counsel patients that de novo and sustained ED are rare after properly performed BPH procedures.242, 243 Clinicians should, however, be aware that capsular perforations during ablative therapies may lead to an increased risk of ED likely due to thermal or direct injury to cavernous nerves.244, 245 Orgasm changes with BPH procedures are an understudied entity largely overshadowed by the focus on EjD. Even in men with changes in ejaculation, orgasm changes may be variable. In one series, men with changes in ejaculation still most frequently reported no change in orgasm quality with others reporting both worsening or improving orgasm quality.246  New onset EjD after BPH procedures is procedure-specific with office-based techniques generally having less incidence compared to traditional operating room-based debulking procedures. Simple prostatectomy and transurethral enucleating procedures have the highest rates of EjD of around 70-90% due to the comprehensive tissue removal.247-252 Classic TURP and PVP left patients with slightly better rates of EjD with rates of 50-70%.247, 251, 253 The modern non-ablative, office-based procedures have rates <10%.254-256 Ideally, clinicians should counsel patients on EjD rates determined from their own practice, but at a minimum, should be aware of quoted rates in the literature to counsel patients appropriately.