Ejaculation is the ejection of semen out of the urethra (passageway inside the penis) when a man has an orgasm. Under normal circumstances, ejaculation propels semen forward through a man's urethra and out the tip of his penis. This is because a tiny sphincter (circular muscle) at the entrance to the bladder shuts the opening to the bladder and prevents semen from entering. Retrograde ejaculation is when the semen travels backwards into the bladder.
In retrograde ejaculation, the muscle that shuts the bladder does not function normally. This allows all or part of the semen to travel backward (retrograde) into the bladder at the time of ejaculation. When this happens, less semen comes out the tip of the penis.
Retrograde ejaculation has several possible causes, including:
- Damage from surgery to the muscles of the bladder, or to the nerves that control these muscles — This damage can occur as a complication of the following surgical procedures:
- Prostate surgery — Men who have had a transurethral prostatectomy (removal of prostate tissue through the urethra) have a 10-15 % chance of retrograde ejaculation. A prostatectomy (surgery to remove the entire prostate gland, either for cancer or benign enlargement) results in a higher risk of retrograde ejaculation after the procedure.
- Surgery on certain parts of the bladder
- Extensive pelvic surgery, especially to treat cancer of the prostate, testicles, colon or rectum
- Staging surgery for cancer in the pelvis or lower abdomen (this surgery removes lymph nodes in the pelvis and lower abdomen to help determine how far cancer has spread)
- Certain types of surgery on the discs and vertebrae of the lower spine
- Nerve damage caused by medical illness — This is especially common in men with multiple sclerosis or with long-term, poorly controlled diabetes.
- Side effects of medication — Medications that may cause retrograde ejaculation include drugs to treat:
- Symptoms related to an enlarged prostate gland — tamsulosin (Flomax), alfuzosin (Uroxatral), or terazosin (Cardura)
- Depression -- especially selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft) and several others
- Psychosis -- such as chlorpromazine (Thorazine), thioridazine (Mellaril) and risperidone (Risperdal)
Retrograde ejaculation does not interfere with a man's ability to have an erection or to achieve orgasm, but it can cause infertility because the sperm cannot reach the woman's uterus. Retrograde ejaculation is responsible for about 1% of all cases of male infertility in the United States.
Symptoms
Normally, a healthy adult male ejaculates one-half to one teaspoonful of semen during orgasm, but the amount varies widely. In men with retrograde ejaculation, the amount of semen is decreased dramatically or there is a dry climax (orgasm without semen).
Diagnosis
In most cases, the diagnosis will be made by a primary care 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 many sperm are found in a urine sample after ejaculation.
Expected Duration
How long this problem lasts depends on the cause. If your retrograde ejaculation is a side effect of medication, the problem may go away when your doctor switches you to a different drug. On the other hand, if your retrograde ejaculation is caused by severe nerve or muscle damage, the condition may be permanent.
Prevention
There now are innovative, minimally invasive forms of prostate surgery for enlarged prostates (not cancer) that may cause less retrograde ejaculation than the standard procedures. These newer procedures include transurethral needle ablation of the prostate (TUNA) and transurethral microwave thermotherapy (TUMT). Even if these procedures cause fewer cases of retrograde ejaculation, however, they may not be appropriate for all patients.
Treatment
Most men who have retrograde ejaculation do not need specific treatment. If the condition is a side effect of medication, your doctor may be able to switch you to a different drug that does not cause the problem. In other men, all that is needed is reassurance that retrograde ejaculation is not a serious medical problem and that it is not a sign of a serious condition.
In some men, retrograde ejaculation requires treatment because it interferes with fertility. This treatment varies depending on the cause. If your retrograde ejaculation is a side effect of medication, your doctor probably will switch you to a drug that does not affect ejaculation. If your retrograde ejaculation appears to be related to a mild nerve or muscle problem involving the bladder, then your doctor may discuss treatment with a drug — such as pseudoephedrine (Sudafed) or imipramine (Tofranil) — to help improve muscle tone where the bladder and urethra join.
If your retrograde ejaculation is the result of severe damage to the nerves or muscles of your bladder, then it may not be possible to restore normal ejaculation. If this is the case, and you are hoping to father a child, a fertility specialist may be able to help. In cases of retrograde ejaculation, three of the more commonly used assisted fertilization procedures are:
- Intrauterine insemination (using a small catheter to put washed sperm inside your partner's uterus at the time of ovulation)
- In-vitro fertilization (incubating eggs and sperm together in the laboratory to produce fertilization)
- Intracytoplasmic sperm injection (injecting a single sperm into your partner's egg to cause fertilization)
When To Call A Professional
Contact your doctor if you produce little or no semen when you ejaculate, especially if you are hoping to father a child.
Prognosis
Simple therapies have a good chance of decreasing retrograde ejaculation enough to allow conception.
In men who do not respond to medication, fathering a child may still be possible with the help of assisted fertilization procedures.
Additional Info
National Institute of Diabetes and Digestive and Kidney Disorders
//www.niddk.nih.gov/
American Urological Association
//www.urologyhealth.org/
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Men usually need no treatment unless infertility is a concern. About one third of men with retrograde ejaculation improve after treatment with drugs that close the bladder neck (such as pseudoephedrine or imipramine). However, men who use these drugs should be alert and periodically checked by their doctor for increases in heart rate and blood pressure. Use of these drugs is limited to men seeking fertility.
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Normally, semen exits the penis when a man ejaculates. Retrograde ejaculation causes some semen to travel backward into the bladder.
Normal ejaculation forces semen—sometimes called ejaculate—through the man’s urethra and out of the penis. The ejaculate can move out of the penis because a small muscle, called the bladder sphincter, closes the opening to the bladder, preventing the semen from entering the bladder.
When the bladder sphincter does not work correctly, the bladder may not close completely, which can cause ejaculate to travel into the bladder rather than coming out of the penis.
It is also called a dry orgasm. Some men with retrograde ejaculation still ejaculate but notice less fluid than they once did.
In some men, retrograde ejaculation causes infertility. When very little or no ejaculate exits the body, the chances of sperm fertilizing an egg range from low to zero. However, retrograde ejaculation is responsible for just 0.3–2 percent of infertility cases.
Retrograde ejaculation is not dangerous and is not painful. Men with the condition who ejaculate small quantities of semen might not even notice they have the condition.
Some men report cloudy urine immediately after ejaculating, which is likely because semen has mixed with urine. Men with retrograde ejaculation may also have trouble getting their partners pregnant.
Because retrograde ejaculation can affect a man’s experience of sex, some men may opt to treat the condition even if it has no serious underlying cause.
Men who want to get their partners pregnant still have options. Treatment usually begins with removing the sperm after ejaculation; this may involve isolating sperm from the bladder.
Some medications attempt to encourage forward (antegrade) ejaculation. If these attempts fail, a doctor may try to extract sperm without requiring the man to ejaculate. Surgical procedures for removing the sperm include:
- Testicular sperm aspiration (TESA): This procedure is performed under local anesthesia, and uses a needle to remove sperm from the testicles.
- Percutaneous epididymal sperm aspiration (PESA): This procedure, which uses local anesthesia, relies on a needle to remove sperm from the epididymis—the duct that connects to the testes.
- Testicular sperm extraction (TESE): Like TESA, TESE removes sperm directly from the testicles under sedation. Unlike TESA, TESE requires an incision in the testicle.
Share on PinterestOnce semen has been removed, IVF may be used to help a man’s partner get pregnant.
After a doctor has successfully removed semen, they can then help a man’s partner to get pregnant in one of two ways:
- In vitro fertilization (IVF): This procedure involves removing an egg from the woman and then fertilizing it in a petri dish. When an embryo grows, a doctor implants it into the woman’s uterus.
- Intrauterine insemination (IUI): With this procedure, a doctor injects semen directly into a woman’s uterus while she is ovulating.
Treatment for retrograde ejaculation depends on the cause of the problem. When men experience retrograde ejaculation due to medication, changing medications usually resolves the problem. When retrograde ejaculation is due to severe nerve damage, it may not be reversible.
Retrograde ejaculation may be caused by:
- Diabetes: Blood sugar that remains uncontrolled for a long time can damage the organs and nerves, affecting the muscles of the bladder.
- Damage to the nervous system: Injuries and illnesses that damage the nervous system, such as multiple sclerosis and spinal cord injuries, can damage the nerves and muscles of the bladder. Surgery on the lower spine may have a similar effect.
- Surgery: Surgery on the prostate, testicles, colon, rectum, bladder, or the lower spine may cause retrograde ejaculation.
- Medication: Some medications can interfere with ejaculation. Those include drugs for an enlarged prostate, some antidepressants, and some anti-psychotic drugs.
Prostate removal and retrograde ejaculation
Removal of part of the prostate through surgery is one of the most common causes of retrograde ejaculation. About 10 to 15 percent of people who undergo this surgery can expect to experience retrograde ejaculation because surgery may damage the muscles and nerves of the bladder.
Men who have had a radical prostatectomy—prostate removal—cannot ejaculate at all. This is distinct from retrograde ejaculation and occurs because ejaculate can no longer travel to the penis.
Share on PinterestA doctor should be consulted if ejaculate is not present following an orgasm or if there is less ejaculate than usual after an orgasm.
Retrograde ejaculation is neither dangerous nor painful and does not always require treatment. It can, however, be a symptom of another medical condition.
Consult a doctor about retrograde ejaculation when:
- ejaculate is not present following an orgasm
- there is consistently less ejaculate than usual following an orgasm
- a couple has still not gotten pregnant after a year of trying
A 2017 study detailed a case in which retrograde ejaculation was the first and only symptom of type 1 diabetes. So men who experience retrograde ejaculation should talk to their doctors.
Retrograde ejaculation is not entirely preventable.
Men who need treatment for an enlarged prostate should consider surgeries that are less invasive, such as transurethral microwave thermotherapy (TUMT) or transurethral needle ablation (TUNA) of the prostate. These surgeries are less likely to cause nerve and muscle damage.
Controlling medical conditions that can cause nerve damage may also prevent retrograde ejaculation. Men with diabetes should take the medications their doctors prescribe and should implement appropriate lifestyle changes as recommended by a doctor.
Retrograde ejaculation is not always reversible. However, the infertility it can cause is treatable. Even when a man cannot ejaculate at all, a fertility specialist may be able to help.
Men with retrograde ejaculation may have other symptoms due to an enlarged prostate, diabetes, or prostate surgery. So even if a man believes his condition is untreatable, he should report symptoms such as painful ejaculation, blood in the ejaculate, frequent urination, or erectile dysfunction to a doctor. These symptoms point to another diagnosis and are not due to retrograde ejaculation.
Most men associate ejaculation with orgasm, but not all orgasms involve ejaculation. It can be unnerving to orgasm without ejaculating, but it is not harmful—changing expectations may be all it takes to live comfortably with retrograde ejaculation.