Overview
Retrograde ejaculation occurs when semen goes into the bladder instead of leaving the penis during ejaculation. Retrograde ejaculation isn't harmful but it can impair fertility since it affects the delivery of sperm to the uterus during intercourse. The condition is relatively uncommon, accounting for only 0.3% - 2% of male fertility problems.
During normal ejaculation, internal muscles, called sphincters, close off the opening of the bladder to prevent semen from entering as it passes through the urethra. In retrograde ejaculation, the bladder opening doesn't close properly and some or all of the semen is allowed to enter the bladder instead of being ejected out the tip of the penis. As a result, semen mixes with urine in the bladder and later leaves the body during normal urination without harming the bladder.
Retrograde ejaculation does not interfere with a man’s ability to have an erection or an orgasm. Men often first become aware that they have retrograde ejaculation when fertility problems arise. A common sign indicating retrograde ejaculation is if a man's urine appears cloudy after sexual climax.
Symptoms
Retrograde ejaculation may occur either partially or completely. Men with incomplete retrograde ejaculation may notice a decrease in semen that comes out during ejaculation. Complete retrograde ejaculation can also be called dry orgasm or dry ejaculation since there is orgasm without the discharge of semen. Dry orgasm is not exclusive to retrograde ejaculation, though, since dry orgasm can also be caused by other problems. For example, dry orgasms can be caused by prostate removal, or from a lack of semen production. Therefore, dry ejaculation alone is not a clear indication of retrograde ejaculation.
Causes
Retrograde ejaculation occurs when semen goes into the bladder instead of leaving the penis during ejaculation. Causes of retrograde ejaculation can include:
- Damage to the muscles of the bladder or to the nerves that control these muscles due to prostate surgery, some types of bladder surgery, surgery on the discs and vertebrae of the lower spine, among others
- Nerve damage caused by medical illness, such as diabetes and multiple sclerosis
- Radiation therapy to the pelvic area
- Side effect of certain medications, including some psychiatric drugs and medications used to treat high blood pressure and prostate enlargement
- Bladder neck muscles that are open since birth and do not contract normally
Diagnosis
In most cases, the diagnosis will be made by a family doctor or a urologist, a doctor who specializes in male reproductive disorders and urinary tract problems. The doctor will ask questions about your medical history, previous surgery, sexual history and current medications. These questions will be followed by a thorough physical examination. The diagnosis usually can be confirmed if sperm are found in a urine sample obtained after ejaculation.
Treatment
Since retrograde ejaculation isn't harmful, it typically doesn't require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause.
If your doctor discovers that a prescribed medication is the cause, switching to a comparable medication or discontinuation of the drug often restores normal ejaculation.
Unfortunately, if retrograde ejaculation is caused by surgery or diabetes, it is often not correctable. However, some medications have been shown to improve muscle tone of the bladder neck and therefore reduce the loss of semen into the bladder during ejaculation. These medications include epinephrine sulfate and epinephrine-like drugs (such as pseudoephedrine, imipramine, midodrin, desipramine and brompheniramine maleate). All of these medications are used off-label, meaning that they are not approved by the Food and Drug Administration for this condition. They are effective approximately 40-60% of the time and may require trial and error to see which works most effectively.
Alternatively, men are sometimes encouraged to ejaculate when their bladder is full since having a full bladder can increase bladder neck closure.
If the above measures are not options or are not successful and fertility is still a concern, it is also possible for a urologist to retrieve sperm from a man's urine following an orgasm and use it for artificial insemination or in vitro fertilization.
It is also possible for men, prior to receiving treatments or surgeries that bring the risk of retrograde ejaculation, to have their semen frozen (cryopreserved) for insemination at a later date.
Condition overview written by Petar Bajic, MD
