Retrograde ejaculation is when semen goes into the bladder rather than out of your penis during orgasm. Although you still reach sexual climax, you may ejaculate very little or no semen (dry orgasm). Retrograde ejaculation isn't harmful, but it can cause fertility problems.
Retrograde ejaculation can be caused by medications, health conditions or surgeries that affect the nerves or muscle that control the bladder opening. If retrograde ejaculation is caused by a medication, stopping the medication may be effective. For retrograde ejaculation due to a health condition or as a result of surgery, treatment with medications may restore normal ejaculation and fertility.
Signs and symptoms
Retrograde ejaculation does not affect your ability to get an erection or have an orgasm — but when you climax, semen goes into your bladder instead of coming out of your penis. Retrograde ejaculation can cause:
Dry orgasms or orgasms in which you ejaculate very little semen out of your penis
Urine that is cloudy after orgasm because it contains semen
Male infertility
Causes
Normally during ejaculation, sperm from the testicles is carried through a tube called the vas deferens until it mixes with fluid from the semen glands and prostate. The muscle at the opening of the bladder (bladder neck) should contract or tighten to prevent the semen from entering the bladder as it passes through the tube inside the penis (urethra). This is the same muscle that holds urine in your bladder until you urinate. With retrograde ejaculation, the bladder neck muscles don't tighten properly. As a result, sperm can enter the bladder instead of being ejected out of the penis.
Several conditions can cause problems with the muscle that closes the bladder during ejaculation. These include:
Surgery such as retroperitoneal lymph node dissection, bladder neck surgery or prostate surgery
Side effect of certain medications used to treat high blood pressure, prostate enlargement and mood disorders
Nerve damage caused by a medical condition such as diabetes, multiple sclerosis or a spinal cord injury
Risk factors
You're at increased risk of retrograde ejaculation if:
You have diabetes, especially if you have diabetic nerve damage
You have had prostate or bladder surgery
You take certain medications for high blood pressure or a mood disorder
You sustained a spinal cord injury
When to seek medical advice
If you ejaculate very little or no semen when you have an orgasm, see a doctor. You may have retrograde ejaculation. This condition is not harmful and only requires treatment if you are attempting to father a child. However, dry orgasm, or orgasm with little semen, can also be an early symptom of an underlying medical condition that requires treatment.
Screening and diagnosis
To diagnose retrograde ejaculation, your doctor will look for sperm in your urine with a microscope after you ejaculate.
If you have a dry orgasm, 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.
Complications
Retrograde ejaculation is not harmful. The only complication is difficulty getting your partner pregnant. Some men with retrograde ejaculation may find orgasm less pleasurable.
Treatment
Retrograde ejaculation typically doesn't require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause. If retrograde ejaculation is the side effect of a certain medication, it may improve when that medication is stopped or changed.
Retrograde ejaculation can sometimes be reversed with medications that are primarily used to treat other conditions, including:
Imipramine, a tricyclic antidepressant
Retrograde ejaculation can be caused by medications, health conditions or surgeries that affect the nerves or muscle that control the bladder opening. If retrograde ejaculation is caused by a medication, stopping the medication may be effective. For retrograde ejaculation due to a health condition or as a result of surgery, treatment with medications may restore normal ejaculation and fertility.
Signs and symptoms
Retrograde ejaculation does not affect your ability to get an erection or have an orgasm — but when you climax, semen goes into your bladder instead of coming out of your penis. Retrograde ejaculation can cause:
Dry orgasms or orgasms in which you ejaculate very little semen out of your penis
Urine that is cloudy after orgasm because it contains semen
Male infertility
Causes
Normally during ejaculation, sperm from the testicles is carried through a tube called the vas deferens until it mixes with fluid from the semen glands and prostate. The muscle at the opening of the bladder (bladder neck) should contract or tighten to prevent the semen from entering the bladder as it passes through the tube inside the penis (urethra). This is the same muscle that holds urine in your bladder until you urinate. With retrograde ejaculation, the bladder neck muscles don't tighten properly. As a result, sperm can enter the bladder instead of being ejected out of the penis.
Several conditions can cause problems with the muscle that closes the bladder during ejaculation. These include:
Surgery such as retroperitoneal lymph node dissection, bladder neck surgery or prostate surgery
Side effect of certain medications used to treat high blood pressure, prostate enlargement and mood disorders
Nerve damage caused by a medical condition such as diabetes, multiple sclerosis or a spinal cord injury
Risk factors
You're at increased risk of retrograde ejaculation if:
You have diabetes, especially if you have diabetic nerve damage
You have had prostate or bladder surgery
You take certain medications for high blood pressure or a mood disorder
You sustained a spinal cord injury
When to seek medical advice
If you ejaculate very little or no semen when you have an orgasm, see a doctor. You may have retrograde ejaculation. This condition is not harmful and only requires treatment if you are attempting to father a child. However, dry orgasm, or orgasm with little semen, can also be an early symptom of an underlying medical condition that requires treatment.
Screening and diagnosis
To diagnose retrograde ejaculation, your doctor will look for sperm in your urine with a microscope after you ejaculate.
If you have a dry orgasm, 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.
Complications
Retrograde ejaculation is not harmful. The only complication is difficulty getting your partner pregnant. Some men with retrograde ejaculation may find orgasm less pleasurable.
Treatment
Retrograde ejaculation typically doesn't require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause. If retrograde ejaculation is the side effect of a certain medication, it may improve when that medication is stopped or changed.
Retrograde ejaculation can sometimes be reversed with medications that are primarily used to treat other conditions, including:
Imipramine, a tricyclic antidepressant
Chlorpheniramine and brompheniramine, antihistamines sometimes used treat cold symptoms
Ephedrine, pseudoephedrine and phenylephrine, used in some decongestant medications
These medications help keep the bladder neck muscle closed during ejaculation. While they're often effective treatment for retrograde ejaculation, all of these medications can also cause numerous side effects. Some of the side effects are minor, but others can be more serious.
Before prescribing medications, your doctor will want to know about any other medications you're currently taking. Some medications used to treat retrograde ejaculation can cause serious reactions when combined with other medications. Your doctor will also want to know about any health problems you may have. Some of these medications can increase blood pressure and heart rate, which can be dangerous in men who have high blood pressure or heart disease.
If medications are not effective and you're attempting to father a child, doctors may be able to artificially inseminate your partner with sperm recovered from your bladder after you ejaculate.
Prevention
If you need to have surgery that may affect the bladder neck muscle, such as prostate or bladder surgery, or if you have a spinal injury, there's little you can do to prevent retrograde ejaculation. However, there are things you can do to prevent retrograde ejaculation caused by nerve damage from diabetes or the use of certain medications.
If you have diabetes, work with your doctor to keep your blood sugar under control.
If you're taking medications for high blood pressure or a mood disorder, ask your doctor if they may cause retrograde ejaculation. You may be able to take another medication instead, or change doses.
Before prescribing medications, your doctor will want to know about any other medications you're currently taking. Some medications used to treat retrograde ejaculation can cause serious reactions when combined with other medications. Your doctor will also want to know about any health problems you may have. Some of these medications can increase blood pressure and heart rate, which can be dangerous in men who have high blood pressure or heart disease.
If medications are not effective and you're attempting to father a child, doctors may be able to artificially inseminate your partner with sperm recovered from your bladder after you ejaculate.
Prevention
If you need to have surgery that may affect the bladder neck muscle, such as prostate or bladder surgery, or if you have a spinal injury, there's little you can do to prevent retrograde ejaculation. However, there are things you can do to prevent retrograde ejaculation caused by nerve damage from diabetes or the use of certain medications.
If you have diabetes, work with your doctor to keep your blood sugar under control.
If you're taking medications for high blood pressure or a mood disorder, ask your doctor if they may cause retrograde ejaculation. You may be able to take another medication instead, or change doses.
Adapted from: Mayo foundation for Medical Education and Research
