Retrograde Ejaculation – What Is It and How To Treat It

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In the world of male sexual health, the topic of retrograde ejaculation gets little attention. According to a 2016 review of the subject, one reason may be that it requires a “willingness to engage in thinking outside of the standard established treatment paradigm,” and that so far, research is “almost uniformly … limited to small series and rare randomized trials.” However, that does not mean there’s nothing to share about retrograde ejaculation.

What is retrograde ejaculation?

Retrograde ejaculation is when semen travels into the bladder rather than exiting through the penis during orgasm. Men who experience retrograde ejaculation may release very little or no semen, which is why it is also known as a dry orgasm. Even though there are no harmful consequences of retrograde ejaculation, it can cause male infertility.

Signs and symptoms of retrograde ejaculation, in addition to the lack of released semen, may include cloudy urine after orgasm (because it contains semen) and an inability to get a woman pregnant.

Retrograde ejaculation occurs when the bladder neck muscles fails to tighten properly.  This failure in turn causes sperm to enter the bladder instead of being released through the penis.

Causes of retrograde ejaculation

Several situations can cause retrograde ejaculation, including:

  • Surgeries that involve the bladder neck, retroperitoneal lymph nodes for testicular cancer, prostate surgery, aorto-iliac vascular surgery, abdominoperineal resection, or lumbar sympathectomy
  • Use of alpha-adrenergic blockers or psychotropic medications
  • Congenital conditions such as posterior urethral valves, utricular cysts, extrophy
  • Medical procedures, such as transurethral bladder neck incision, transurethral resection of prostate, radiation to the pelvic area
  • Medical conditions, such as multiple sclerosis, myelodysplasia, cerebrovascular accident, Parkinson’s disease, or diabetic autonomic neuropathy

Diagnosing and treating retrograde ejaculation

Although men may feel embarrassed about retrograde ejaculation, it should not be ignored, as it can be associated with an undiagnosed medical condition or it can cause male infertility. Diagnosing retrograde ejaculation involves your doctor asking questions about your symptoms and any health problems, surgeries, or medical procedures you have undergone. He or she will conduct a physical examination of your penis, testicles, and rectum and check your urine for semen after you have an orgasm. If you experience dry orgasms and your doctor doesn’t detect semen in your bladder, this indicates a possible problem with semen production, in which case you may be referred to a specialist.

Generally, retrograde ejaculation does not require treatment unless it is interfering with fertility. In such cases, the choice of treatment depends on the cause. Men who have nerve damage associated with diabetes, surgery, multiple sclerosis, or other conditions may be prescribed medication. Among the drugs that may be prescribed are imipramine, midodrine, chlorpheniramine, brompheniramine, ephedrine, pseudoephedrine, and phenylephrine. All of these medications help close the bladder neck muscle during ejaculation. However, some of the drugs may boost blood pressure and heart rate, which means they should likely be avoided by men who have hypertension or heart disease.

For men with infertility as a consequence of retrograde ejaculation and who have not responded to medication, sperm may be harvested from the bladder and used to inseminate a woman to achieve pregnancy. This technique is not successful in all cases, however, and often is not covered by health insurance.

References

Mayo Clinic. Retrograde ejaculation, symptoms and causes

Parnham A, Serefoglu EC. Retrograde ejaculation, painful ejaculation and hematospermia. Translational Andrology and Urology 2016 Aug; 5(4): 592-601

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