Retrograde Ejaculation

What is Retrograde Ejaculation?

Retrograde ejaculation is the reverse entry of semen into the bladder instead of being expelled through the penis during male sexual climax and ejaculation. This condition is relatively uncommon and may occur either partially or completely, which means that a male might reach sexual climax but may ejaculate very little or no semen (this is sometimes called a “dry orgasm”).

Under normal circumstances, the ejaculate is propelled forward in the urethra and out of the body through the head of the penis. This is because the sphincter muscle or the bladder neck muscle located at the entrance of the bladder closes the opening to the bladder and prevents semen from entering. During retrograde ejaculation, the sphincter does not function properly and allows some or all of the ejaculate to travel backwards into the bladder. Although most cases of retrograde ejaculation are not linked to any harmful illnesses, it could be symptomatic of a more serious medical condition.

Symptoms

Symptoms of retrograde ejaculation include little or no semen discharged during sexual climax, cloudy urination after sexual intercourse, and possible infertility. 1  The most recognizable indicator of retrograde ejaculation is having little or no ejaculate during the male orgasm. This condition is referred to as hypospermia, or aspermia in the complete absence of ejaculate.2 The National Institute of Heath defines hypospermia as a condition of having less than 2 mL of semen in at least two semen analyses.3 Cloudy urination is caused by the backchannel of ejaculate into the bladder during sexual climax. Presence of semen in the bladder is relatively harmless because the semen that enters a male’s bladder during retrograde ejaculation will be excreted out of the body during urination. Retrograde ejaculation is also an uncommon cause of infertility and makes up around 0.3 to 2 percent of infertility problems.4 In cases of retrograde ejaculation, infertility is not caused by inviable sperm. Instead, it occurs because semen is not effectively transferred to the female. Retrograde ejaculation does not inhibit a male’s ability to have an erection or achieve orgasm. However, the lack of ejaculate may be a cause of psychological distress, which can interfere with sexual pleasure.

Causes

Factors that inhibit the release of semen through the penis are broadly categorized as anatomic, neurogenic, or pharmacological. These can typically happen for a variety of reasons:

  • Surgical damage to the prostate, bladder, or lower pelvic region.
  • Nerve damage caused by prolonged medical conditions such as diabetes or multiple sclerosis.
  • Medications that treat an enlarged prostate gland, high blood pressure, or mood disorders.5 

Some complications can be treated by simply switching a medication but others may require seeking professional help with an endocrinologist or a urologist. However, most cases of retrograde ejaculation only need to be treated if the patient is struggling with infertility.

Anatomic Causes

The process of ejaculation requires a complex coordination between the epidiymides, vas deferens, prostate, seminal vesicles, bladder neck and bulbourethral glands. Any surgical damage to those areas may result in retrograde ejaculation. However, dry orgasms are most commonly attributed to procedures involving the prostate, which is a gland that produces seminal fluid in males. This seminal fluid makes up a large portion of semen. Nearly 70 percent of males over the age of 70 have prostate related problems.6 Surgeries to reduce or remove the prostate, such as the transurethral resection of the prostate (TURP) and prostatectomy, often result in the long-term effect of semen being released in the bladder rather than out of the penis.7

Cancers and cancer treatments in the pelvic region can also cause retrograde ejaculation. Oftentimes, in operations such as a cystectomy or the removal of the bladder, the muscles surrounding the bladder neck are removed and then the ejaculate is either excreted or reabsorbed into the body. These procedures typically cause other sexual dysfunctions alongside retrograde ejaculation.8

Neurogenic Causes

The bladder neck muscle is an involuntary muscle that is controlled by the sympathetic nervous system. Occasionally, nerve damage to the spine or the pelvic region can weaken both the muscles that control the sphincter at the bladder neck and the periureteral contractions that propel the ejaculate out of the penis. Diabetes can be a more serious cause of retrograde ejaculation, in which poor long-term blood sugar control can lead to autonomic neuropathy of the bladder neck muscles. Autonomic neuropathy is a nerve disorder that affects the nerves which control involuntary actions such as digestion and sexual organ functions. Prolonged exposure to higher-than-normal glucose levels in combination with high blood pressure, smoking, alcohol use, or certain vitamin deficiencies can cause nerve damage and lead to retrograde ejaculation. 9

Retrograde ejaculation is also a common condition for males with multiple sclerosis. Multiple sclerosis is an autoimmune disease that deteriorates the central nervous system.10 Symptoms of the disease can lead to problems with bladder control and sexual function. Retrograde ejaculation can be a common side effect of nerve damage in the bladder.

Pharmacological Causes

Certain medications may interfere with the functioning of the nerves that control the muscles involved in ejaculation. This is especially applicable for psychiatric medication. Such medications can include but are not limited to amitriptyline, amoxapine, chlorpromazine, and thioridazine. Certain drugs that treat high blood pressure, like guanethidine and reserpine, can also cause retrograde ejaculation.11 If a prescription drug is the cause of the problem, removal of that specific drug may resolve the condition. However, retrograde ejaculation does not necessarily require treatment and does not typically interfere with sexual pleasure. Changing or removing any medication should always be supervised and directed by a medical health professional.

Treatments and Preventions

Retrograde ejaculation does not generally pose any health risks and treatment is often unnecessary. There are certain types of medications that can keep the bladder neck muscles constricted during ejaculation, although they do not typically work for males with severe muscle or nerve damage from surgery.

Most treatments for retrograde ejaculation focus on restoring fertility in males who are having difficulties conceiving with their partner. In cases where males do not respond to medication, fatherhood may still be possible through assisted-fertilization techniques. Some techniques have been recently developed to combat infertility caused by retrograde ejaculation:

  • Centrifugation and resuspension: A technique that improves the viability of the sperm inside the bladder by increasing the intake of water to dilute or alkalize the urine. A catheter is then placed through the urethra and into the bladder to collect a urine sample after the male has experienced an orgasm. The sperm is washed using a centrifuge and inseminated into a female using either intrauterine or in-vitro fertilization techniques.
  • The Hotchkiss method: A technique that involves emptying the bladder prior to ejaculation and using a catheter to collect a sperm sample. The pregnancy rate using this method is around 24 percent.12

Infertility can be a distressing complication for individuals who are hoping to conceive. However, retrograde ejaculation is not a symptom of having inviable sperm and can be resolved through different assisted-fertility techniques.

While retrograde ejaculation does not introduce any serious health risks, it is important to consult a doctor about dry orgasms to rule out potential underlying illnesses. If you suspect that you may have retrograde ejaculation, it is recommended that you schedule an appointment with your healthcare provider. Typically, the diagnosis will be made by a urologist (a doctor that specializes in urinary-tract problems and reproductive disorders). Your doctor may begin by asking you questions about your medical and sexual history and then perform a thorough physical examination. A urinalysis will be performed, during which a sample of your urine will be obtained shortly after ejaculation and tested for large amounts of semen

 

Concluding Remarks

Retrograde ejaculation is an uncommon issue that occurs during the male sexual response cycle. While it does not interfere with maintaining an erection or achieving orgasm, retrograde ejaculation can be a symptom of a more serious health problem. Males over the age of 50 can take preventative measures against ejaculatory disorders by consulting their doctors about getting regular prostate exams or rectal screening exams.13 If intercepted early, retrograde ejaculation can be avoided or minimized by using minimally invasive procedures and medications. By being aware of risk factors and taking precautionary measures, males can significantly decrease their chances of getting retrograde ejaculation.

References

  1. LeVay, Simon, Janice I. Baldwin, and John D. Baldwin. Discovering Human Sexuality. Sunderland, MA: Sinauer Associates, 2009. Print
  2. Parnham, Arie, and Ege Can Serefoglu. “Retrograde Ejaculation, Painful Ejaculation and Hematospermia.” Translational Andrology and Urology, University College London Hospitals, Bagcilar Training & Research Hospital, Aug. 2016.
  3. Robin, G, et al. “Why and How to Assess Hypospermia?” Gynecologie, Obstetrique & Fertilite, U.S. National Library of Medicine, Oct. 2008.
  4. Jefferys, Amanda, et al. “The Management of Retrograde Ejaculation: a Systematic Review and Update.” Fertility and Sterility, U.S. National Library of Medicine, Feb. 2012.
  5. Parnham, Arie, and Ege Can Serefoglu. “Retrograde Ejaculation, Painful Ejaculation and Hematospermia.” Translational Andrology and Urology, AME Publishing Company, Aug. 2016.
  6. “Benign Enlarged Prostate: Overview.” InformedHealth.org, U.S. National Library of Medicine, 25 Jan. 2018.
  7. “Transurethral Resection of the Prostate (TURP).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 Dec. 2017.
  8. “Cancer Can Affect a Man's Ability to Ejaculate.” American Cancer Society, 24 Feb. 2017.
  9. “Neuropathy.” Diabetic Neuropathy - Types, Causes, Symptoms & Prevention.
  10. “Multiple Sclerosis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 2 Apr. 2019.
  11. “Retrograde Ejaculation.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 26 Oct. 2016.
  12. Jeffereys, Amanda, et al. “The Management of Retrograde Ejaculation: a Systematic Review and Update.” Fertility and Sterility, Southmead Hospital, Feb. 2012.
  13.  “Retrograde Ejaculation.” Harvard Health Publishing, Harvard Medical School, Dec. 2018.

Last Updated: 18 April 2019.

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