Retrograde Ejaculation

Retrograde Ejaculation

Retrograde ejaculation occurs when semen enters the bladder instead of emerging through the penis during orgasm. Although you still reach sexual climax, you might ejaculate very little or no semen. This is sometimes called a dry orgasm.

Retrograde ejaculation isn't harmful, but it can cause male infertility. Treatment for retrograde ejaculation is generally only needed to restore fertility.

Symptoms

Retrograde ejaculation doesn't affect your ability to get an erection or have an orgasm — but when you climax, semen goes into your bladder instead of coming out of your penis. Retrograde ejaculation signs and symptoms include:

• Orgasms in which you ejaculate very little or no semen out of your penis (dry orgasms)

• Urine that is cloudy after orgasm because it contains semen

• Inability to get a woman pregnant (male infertility)

Causes

Retrograde ejaculation

During a male orgasm, a tube called the vas deferens transports sperm to the prostate, where they mix with other fluids to produce liquid semen (ejaculate). The muscle at the opening of the bladder (bladder neck muscle) tightens to prevent ejaculate from entering the bladder as it passes from the prostate into the tube inside the penis (urethra). This is the same muscle that holds urine in your bladder until you urinate.

With retrograde ejaculation, the bladder neck muscle doesn't tighten properly. As a result, sperm can enter the bladder instead of being ejected out of your body through the penis.

Several conditions can cause problems with the muscle that closes the bladder during ejaculation. These include:

• Surgery, such as bladder neck surgery, retroperitoneal lymph node dissection surgery for testicular cancer or prostate surgery

• Side effect of certain medications used to treat high blood pressure, prostate enlargement and depression

• Nerve damage caused by a medical condition, such as diabetes, multiple sclerosis, Parkinson's disease or a spinal cord injury

A dry orgasm is the primary sign of retrograde ejaculation. But dry orgasm — the ejaculation of little or no semen — can also be caused by other conditions, including:

• Surgical removal of the prostate (prostatectomy)

• Surgical removal of the bladder (cystectomy)

• Radiation therapy to treat cancer in the pelvic area

Risk factors

You're at increased risk of retrograde ejaculation if:

• You have diabetes or multiple sclerosis

• You've had prostate or bladder surgery

• You take certain drugs for high blood pressure or a mood disorder

• You had a spinal cord injury

Complications

Retrograde ejaculation isn't harmful. However, potential complications include:

• Inability to get a woman pregnant (male infertility)

• Less pleasurable orgasm due to worries about absent ejaculate

Prevention

If you take medications or have health problems that put you at risk of retrograde ejaculation, ask your doctor what you can do to lower your risk.

If you need to have surgery that might affect the bladder neck muscle, such as prostate or bladder surgery, ask about the risk of retrograde ejaculation. If you plan to have children in the future, talk with your doctor about options for preserving semen before the surgery.

To diagnose retrograde ejaculation, your doctor may:

• Ask questions about your symptoms and how long you've had them. Your doctor might also ask about any health problems, surgeries or cancers you've had and what medications you take.

• Do a physical exam, which will likely include an exam of your penis, testicles and rectum.

• Examine your urine for the presence of semen after you have an orgasm. This procedure is usually done at the doctor's office. Your doctor will ask you to empty your bladder, masturbate to climax and then provide a urine sample for laboratory analysis. If a high volume of sperm is found in your urine, you have retrograde ejaculation.

If you have dry orgasms, but your doctor doesn't find semen in your bladder, you might have a problem with semen production. This can be caused by damage to the prostate or semen-producing glands as a result of surgery or radiation treatment for cancer in the pelvic area.

Treatment

Retrograde ejaculation typically doesn't require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause.

Medications

Medications might work for retrograde ejaculation caused by nerve damage. This type of damage can be caused by diabetes, multiple sclerosis, certain surgeries, and other conditions and treatments.

Drugs generally won't help if retrograde ejaculation is due to surgery that causes permanent physical changes of your anatomy. Examples include bladder neck surgery and transurethral resection of the prostate.

If your doctor thinks drugs you are taking might be affecting your ability to ejaculate normally, he or she might have you stop taking them for a period of time. Drugs that can cause retrograde ejaculation include certain medications for depression and alpha blockers — drugs used to treat high blood pressure and some prostate conditions.

Drugs to treat retrograde ejaculation are drugs primarily used to treat other conditions, including:

• Imipramine, an antidepressant

• Midodrine, a medicine that constricts blood vessels

• Chlorpheniramine and brompheniramine, antihistamines that help relieve allergies

• Ephedrine, pseudoephedrine and phenylephrine, medicines that help relieve symptoms of the common cold

These medications help keep the bladder neck muscle closed during ejaculation. While they're often an effective treatment for retrograde ejaculation, medications can cause side effects or adverse reactions with other medications. Certain medications used to treat retrograde ejaculation can increase your blood pressure and heart rate, which can be dangerous if you have high blood pressure or heart disease.

Infertility treatment

If you have retrograde ejaculation, you'll likely need treatment to get your female partner pregnant. In order to achieve a pregnancy, you need to ejaculate enough semen to carry your sperm into your partner's vagina and into her uterus.

If medication doesn't allow you to ejaculate semen, you will likely need infertility procedures known as assisted reproductive technology to get your partner pregnant. In some cases, sperm can be recovered from the bladder, processed in the laboratory and used to inseminate your partner (intrauterine insemination).

Sometimes, more-advanced assisted reproductive techniques are needed. Many men with retrograde ejaculation are able to get their partners pregnant once they seek treatment.