What you should know about retrograde ejaculation

By Zawn Villines

Reviewed by Daniel Murrell, MD

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.

Fast facts on retrograde ejaculation:

• Most men ejaculate more than 1.5 milliliters (ml) of semen.
• Men with retrograde ejaculation may ejaculate nothing at all.
• Retrograde ejaculation is a symptom, not a diagnosis.
• There is no need to treat retrograde ejaculation if a man is not trying to get his partner pregnant.

What is a retrograde ejaculation

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.

Treatment

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.

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.

Causes

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.

When to see a doctor?

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.

Prevention

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.

Takeaway

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.

SOURCE: MEDICAL NEWS TODAY