Retrograde Ejaculation

1 What Is Retrograde Ejaculation?

What Is Ejaculation?

Ejaculation is the discharge of semen, which carries sperm from the penis when it becomes erect during intercourse. This is usually accompanied by orgasm. During the climax of intercourse, the muscles at the end of the bladder neck usually tighten to prevent any retrograde flow of semen. This ensures the semen emerges through the erect penis while performing sex instead of going backward into the bladder. This is known as antegrade, or forward, ejaculation.

There are three common problems men come across with regards to ejaculation:

  • Premature ejaculation: This is one of the most common types of ejaculation problems encountered by men. Premature ejaculation occurs when men ejaculate too quickly during intercourse. Occasional episodes of premature ejaculation are not really a cause for concern, but if it happens too often, leaving the partner unsatisfied, it is best to seek treatment. Common physical problems pertaining to premature ejaculation are prostate problems, use of recreational drugs, and thyroid-related problems. There may be other non-physical or psychological issues that could cause premature ejaculation, such as too much stress, depression, problems in relationships, or anxiety about performance during sexual intercourse. There are a number of ways one can treat premature ejaculation, such as using a thick condom to decrease the sensation, having sex with one’s partner from the top position, masturbating an hour or two before having sexual intercourse, or taking breaks during sex and thinking about something boring. There are certain anti-depressants which can also be taken, such as sertraline, fluoxetine, and paroxetine, however, these have their own side effects like fatigue, diarrhea, and excessive sweating.
  • Delayed ejaculation: This is also known as male orgasmic disorder and is often classified as either being unable to ejaculate at all, even if the man wants to and there is a normal erection, or experiencing a lot of delay before ejaculation. Similar to premature ejaculation, delayed ejaculation also has causes which are physical as well as psychological. Psychological causes include stress, depression, childhood traumatic sexual experiences, or problems in the relationship. The physical causes of delayed ejaculation are injury in the spinal cord, increasing age, multiple sclerosis, diabetes, and surgery of the prostate gland or bladder. Also, there are many medications known to cause delayed ejaculation, including medicines used to treat high blood pressure, powerful painkillers such as methadone, muscle relaxants such as baclofen (which is mostly used to treat motor neuron disease), and antidepressants such as serotonin reuptake inhibitors. A man who has not previously had any issues with ejaculation can suddenly start experiencing delayed ejaculation. It can occur in all sexual encounters or in certain cases. For example, a man may face no issues in ejaculating during masturbation, but during sexual intercourse, it may result in delayed ejaculation. The treatment for it is sex therapy, which involves counselling using a combination of psychotherapy and making structured changes in one’s sex life. This will help increase the feeling of enjoyment and having satisfactory sex, which will make ejaculation easier. If SSRIs are the cause of delayed ejaculation, certain medications can help treat it, such as bupropion, amantadine, or yohimbine. These medicines block some of the chemical effects caused by SSRIs.
  • Retrograde ejaculation: This is a rare type of ejaculation problem that happens when the semen travel backwards into the bladder instead of going through the urethra. The symptoms of retrograde ejaculation are cloudy urine and no semen during ejaculation.

What Is Retrograde Ejaculation?

A condition in which the semen enters the bladder instead of emerging through the penis during orgasm is called retrograde ejaculation.

Retrograde ejaculation isn't harmful, but it can cause male infertility. During retrograde ejaculation, you will still reach sexual climax, although you may ejaculate very little or no semen at all (this is called a dry orgasm).

The sperm cell is produced inside the man’s reproductive system. There is no way these sperm cells can exit the body unless they board the fluids that come out of the body. This is called semen, a white fluid that goes out of the penis when a man reaches orgasm. This semen is produced in the prostate and seminal glands. It then passes through the bladder, which is the same tube through which the urine passes.

In retrograde ejaculation, the bladder closes and thus does not facilitate the ejaculation of semen. So, instead of going out of the body, the semen remains stored in the urethra. In such instances, the individual will notice that, although there is orgasm, there is little or no semen coming out of the penis. The semen stays in the bladder and gets mixed with urine. Hence, after orgasm, the individual will notice the urine color has become cloudy and white.

Typically, restoring fertility is the main goal for the treatment of retrograde ejaculation.

2 Symptoms

Signs and symptoms of retrograde ejaculation are as follows:

  • Orgasms in which you ejaculate very little or no semen
  • Dry orgasms
  • Urine that is cloudy after orgasm
  • Inability to get a woman pregnant

Retrograde ejaculation doesn't affect your ability to get an erection or achieve sexual climax, but when you have an orgasm, semen goes into your bladder instead of coming out of the penis, hence the cloudy urine after orgasm. Retrograde ejaculation isn't life-threatening or even harmful, but it does require treatment.

Most of the time, a doctor’s consultation is recommended for people with retrograde ejaculation and who are attempting to father a child, since not ejecting semen after orgasm causes infertility.

Normally, if you and your partner have been trying to get pregnant by having unprotected intercourse for a year or longer and have been unsuccessful, it is best to see a doctor.

Having dry orgasms is also a reason to see a doctor, as intercourse may become painful.

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3 Causes

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

Normally, 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 the bladder until one urinates, so if the bladder neck muscle is weak and unable to tightly close, retrograde ejaculation happens.

Conditions that cause problems with the closing of the bladder neck muscle during ejaculation include: surgery, such as bladder neck surgery or prostate surgery; prostate enlargement; mood disorders; nerve damage caused by a medical condition, such as diabetes; multiple sclerosis or a spinal cord injury; or side effects of certain medications used to treat high blood pressure.

The primary sign of retrograde ejaculation is a dry orgasm, which is the ejaculation of little or no semen. This can also be caused by other conditions, such as surgical removal of the bladder (cystectomy), radiation therapy to treat cancer in the pelvic area, and surgical removal of the prostate (prostatectomy).

Certain medicines are also known to be the culprit behind retrograde ejaculation, including:

  • Tamsulosin or terazosin, which is used to treat prostate enlargement problems
  • Selective serotonin reuptake inhibitors (SSRIs), such as sertraline or fluoxetine, which are used to treat depression
  • Risperidone, thioridazine, and chlorpromazine which are used to treat psychosis

4 Making a Diagnosis

To receive a diagnosis of retrograde ejaculation, you'll be recommended to a urologist.

You may need to see a urinary and reproductive specialist (urologist), depending on the likely cause of your dry orgasms and whether you need evaluation and treatment to help get your female partner pregnant.

To ensure all important grounds are covered during your doctor’s appointment with the doctor, it is wise to prepare ahead of time, as certain details may be left out, especially if you are feeling anxious.

Prior to your appointment, start listing down all the symptoms you are experiencing, including any that may seem unrelated to your current condition.

You must also write down your medical history, such as surgeries or pelvic radiation, any major stresses or recent life changes, and medications, vitamins, and supplements you're taking.

Understanding retrograde ejaculation may be the best way for you to cope with it along with the necessary treatment, so it is recommended you have a list of questions to ask the doctor during your appointment.

Here are some examples of questions you may want to ask:

  • What is likely causing my symptoms or condition?
  • Are there other possible causes for my symptoms or condition?
  • What kinds of tests do I need?
  • Is my condition temporary or chronic?
  • Am I at risk for complications from this condition?
  • Does my condition need to be treated?
  • Will I be able to conceive children?
  • Should I see a specialist?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Are there any brochures or other printed material that I can take home with me?
  • What websites do you recommend visiting?

If you are trying to get your female partner pregnant, you may also want to ask:

  • Will medications help me ejaculate normally?
  • Can sperm be retrieved from my bladder and used for fertility treatment?
  • Will my partner and I need to use assisted reproductive technology, such as intrauterine insemination, to achieve pregnancy?
  • What's the best treatment to use to try and get my partner pregnant?

Expect your doctor to ask you several questions to understand the symptoms you’ve been experiencing, such as:

  • Do you have cloudy urine after an orgasm?
  • When did you first begin having dry orgasms?
  • Do you ever ejaculate semen when you have an orgasm, or do you have a dry orgasm every time?
  • What surgeries have you had, if any?
  • Have you had cancer?
  • Do you have diabetes or any other chronic health problems?
  • What medications or herbal remedies do you take?
  • Do you and your partner want to have a baby? If so, how long have you been trying to conceive?

Besides asking medical questions, the doctor will also need to perform a physical examination that includes examining your penis, testicles, and rectum.

Your doctor will determine whether your dry orgasms are retrograde ejaculation or linked to another problem that may need further evaluation. Also, examination of your urine for the presence of semen after you have an orgasm will be done.

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 may 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.

You may have to undergo further diagnostic evaluation and be referred to a specialist if your doctor suspects that your dry orgasm is something other than retrograde ejaculation.

What Is Anejaculation?

Anejaculation is often confused with retrograde, or backward, ejaculation. The doctor will use an intense vibratory stimulation to differentiate between retrograde ejaculation and anejaculation. Ejaculatory duct obstruction and an absent vas deferens can also result in a very low volume of ejaculate. Thus, it is important to meet with a specialist to ensure the right diagnosis is made and treatment is started.

5 Treatment

Treatment of retrograde ejaculation depends on the underlying case, since, typically, it does not require treatment unless it interferes with fertility.

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

Drugs may work for retrograde ejaculation due to nerve damage. This can be caused by diabetes, multiple sclerosis, certain surgeries, and other conditions or treatments.

There are certain drugs that can cause retrograde ejaculation, so, if your doctor thinks these drugs may be affecting your ability to ejaculate normally, he or she may have you stop taking them for a period of time.

Drugs that can cause retrograde ejaculation include certain medications for mood disorders, alpha blockers, and drugs used to treat high blood pressure and some prostate conditions.

On the other hand, drugs that help treat retrograde ejaculation are primarily used to treat other symptoms associated with the condition. These medications help keep the bladder neck muscle closed during ejaculation. While they're often an effective treatment for retrograde ejaculation, they can also cause side effects.

Such medications are as follows:

  • Imipramine (Tofranil)
  • Chlorpheniramine and brompheniramine
  • Ephedrine
  • Pseudoephedrine and phenylephrine

These medications can have some minor side effects, but others can be more serious. 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.

The main reason for seeking medical help is to cure infertility related to retrograde ejaculation. In order to achieve pregnancy, you need to ejaculate enough semen to carry your sperm into your partner's vagina and to 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).

Occasionally, more advanced assisted reproductive techniques may be needed. Assisted reproductive techniques have proven effective, as many men with retrograde ejaculation have been able to get their partners pregnant after undergoing said treatment.

If the retrograde ejaculation is severe and has damaged the muscles or nerves of the bladder, it may not be possible to restore it for normal ejaculation. In this case, if one is planning for a child, a specialist would be helpful. The fertility specialist will collect the sperm from your urine and then use the washed sperm for an assisted fertilization procedure. There are three commonly used fertilization procedures for people suffering from retrograde ejaculation:

  • In-vitro fertilization, wherein the eggs and sperm are incubated together in the laboratory for fertilization
  • Intrauterine insemination, where, with the help of a small catheter, the washed sperm is put inside the partner’s uterus at the ovulation period
  • Intracytoplasmic sperm injection, wherein a single sperm is injected into your partner’s egg to induce fertilization

6 Prevention

If you plan to have children in the future, talk with your doctor about options for preserving semen before surgery.

If you need to have surgery that may affect the bladder neck muscle, such as prostate or bladder surgery, ask about the risk of retrograde ejaculation.

7 Alternative and Homeopathic Remedies

Some of the homeopathic remedies for retrograde ejaculation are:

  • Ashwagandha
  • American Ginseng
  • Bitter Melon
  • Pyrola
  • Sarsaparilla
  • Ostrea Gigas 

8 Lifestyle and Coping

Talking with a counselor may help one cope with retrograde ejaculation, since it can be especially challenging if you and your partner want to conceive a child.

While most men can get their female partners pregnant with infertility treatment, it can be costly and require stressful medical procedures for both you and your partner.

Alterations in orgasm are associated with reductions in emotional and physical satisfaction, which in turn may lead to stress for you and your partner.

Understanding all of your options and communicating with your doctor and partner can help. Know what it will cost. Your insurance may or may not cover the costs of sperm retrieval and artificial insemination of your partner.

You'll need to meet with a urologist who specializes in male infertility.

Most importantly, communicate with your partner. Make sure you and your partner both understand your options and the potential risks of fertility procedures.

You should both attend every consultation appointment, which will also provide emotional support.

9 Risks and Complications

There are several risks and complications associated with retrograde ejaculation.

Diabetes or multiple sclerosis puts you at a greater risk of developing retrograde ejaculation. Other factors that put you at risk for the condition are:

  • Undergoing prostate or bladder surgery
  • Taking certain drugs for high blood pressure or a mood disorder
  • Spinal cord injury

Although retrograde ejaculation isn't harmful, its potential complications include:

  • Inability to get a woman pregnant (male infertility)
  • Less pleasurable orgasm due to worries about absent ejaculate
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