Retrograde Ejaculation

Retrograde ejaculation is when semen goes back into your urinary bladder instead of out of your body through your urethra and the tip of your penis during sexual climax (orgasm). During a typical ejaculation, your circular muscle (bladder sphincter or urethral sphincter) closes so semen leaves your body through your urethra. If you have retrograde ejaculation, your circular muscle stays open. It can be a cause of male infertility.

Retrograde ejaculation is somewhat common. For instance, it occurs after most transurethral resection of the prostate (TURP) surgeries. Conditions like diabetes and medications that treat high blood pressure (hypertension) or depression can also cause it.

Other names for retrograde ejaculation include:

• Retro ejaculation
• Dry orgasm
• Retrograde orgasm

Retrograde ejaculation symptoms

Retrograde ejaculation symptoms include:

• Producing little or no semen when you orgasm
• Cloudy pee after you orgasm
• Fertility issues

Can it cause sexual dysfunction?

Retrograde ejaculation won’t affect your ability to get an erection or have an orgasm. But it may cause stress or anxiety, which can affect the pleasure you get from sexual activity. Talk to a healthcare provider if retrograde ejaculation prevents you from enjoying sex.

Why have I stopped ejaculating?

Retrograde ejaculation occurs because of a problem with your circular muscle. Your circular muscle acts like a valve — it closes to let semen out of your body and keep pee in your body. When it doesn’t work as expected, it stays open instead of closing, allowing ejaculate to go into your bladder instead of through your urethra and out of your body.

Many conditions can prevent your circular muscle from closing properly. These include:

• Surgery in the area
• Medications that treat benign prostatic hyperplasia (BPH), high blood pressure or depression
• Nerve damage

How does it leave the body?

If you have retrograde ejaculation, semen leaves your body when you pee.

Who does it affect?

You’re more likely to have retrograde ejaculation if you have:

• Had surgery on your prostate (TURP or prostatectomy)
• Had surgery on your urethra (urethrectomy)
• Diabetes or multiple sclerosis (MS)
• A spinal cord injury
• Had pelvic or rectal surgery
• Structural issues with your urethra

You may also be more likely to have retrograde ejaculation if you take certain types of medications, including some types of:

• Prostate medications
• Blood pressure medications (antihypertensives)
• Antidepressants

How doctors diagnose retrograde ejaculation

A healthcare provider will review your medical history, ask about your symptoms and perform a physical exam. If they suspect retrograde ejaculation, they may ask you to provide:

• Semen samples. If you produce low volumes of semen in at least two samples, you may have retrograde ejaculation.
• A urine sample right after you orgasm. Fruit sugar (fructose) is present in semen — it helps give your sperm the energy they need to swim. Fructose isn’t present in pee. So, if an analyst finds fructose in your pee sample, you likely have retrograde ejaculation. They’ll also analyze the number of sperm you have in your pee sample.

How do you fix retrograde ejaculation?

Retrograde ejaculation isn’t painful or harmful. If you don’t want biological children and don’t have any other symptoms, you may not need treatment.

If you decide to get treatment, some medications can help the circular muscle close tightly. A healthcare provider may recommend:

• Imipramine, which is an older antidepressant
• Antihistamines, including pseudoephedrine and chlorpheniramine
• Midodrine, which typically helps treat low blood pressure

If medications that you’re taking cause retrograde ejaculation, a provider may recommend switching to a different type of drug.

If medications don’t successfully treat retrograde ejaculation and you wish to have a biological child, providers may suggest assisted reproductive technology (ART). They can retrieve sperm through a pee sample or a procedure such as microsurgical testicular sperm extraction (microTESE).

What are the side effects of treatment?

A healthcare provider will monitor your blood pressure and heart rate if you take imipramine or pseudoephedrine to treat retrograde ejaculation. These drugs may increase both your blood pressure and heart rate.

Are there exercises that help?

Some people believe Kegel exercises, which help strengthen your pelvic floor muscles, may help promote ejaculation. Kegels help improve urinary incontinence and fecal incontinence (leaking pee or poop), and they can also give you greater control of when you ejaculate. But they won’t help force your ejaculate through your urethra and out of your penis.

When should I see my healthcare provider?

Contact a healthcare provider if you’re:

• Trying to have biological children and haven’t been able to get pregnant
• Uncomfortable with how you feel when you orgasm
• Receiving treatment for retrograde ejaculation but it isn’t working

You may wish to ask the following questions during your appointment:

• What’s causing retrograde ejaculation?
• How likely am I to have retrograde ejaculation after surgery in the area?
• What treatment do you recommend?
• Should I be aware of any other signs or complications?
• What’s the complete list of medications that cause retrograde ejaculation?
• Should I see a urologist?

Can retrograde ejaculation be prevented?

You can’t always prevent retrograde ejaculation. A healthcare provider will explain your risk if you have a condition or take medications that may cause retrograde ejaculation.

If you have benign prostatic hyperplasia, newer minimally invasive surgical approaches, such as a prostatic urethral lift and the Rezūm procedure, may reduce your chances of developing retrograde ejaculation. Talk to a healthcare provider about whether these approaches may be appropriate for you.

If you require surgery that increases your risk of retrograde ejaculation and are thinking of having biological children in the future, it’s a good idea to talk to a provider about banking your sperm.

What is the prognosis for retrograde ejaculation?

The outlook for retrograde ejaculation is good. Healthcare providers don’t believe that retrograde ejaculation is harmful or painful. If you don’t wish to have biological children, you may not even need treatment. But if you do, treatments are available for both retrograde ejaculation and infertility.

How long does it last?

It depends on the cause. If a medication causes retrograde ejaculation, it should go away shortly after a healthcare provider switches medications. But retrograde ejaculation may be long-lasting or even permanent if a severe condition, such as nerve damage, is the cause. A healthcare provider will give you a better idea of what to expect according to your situation.

What does retrograde ejaculation feel like?

Retrograde ejaculation feels the same as when semen comes out of your urethra (antegrade ejaculation). But for some, the lack of visible semen during an orgasm can feel awkward or disappointing. Contact a healthcare provider if you’re uncomfortable for any reason about the lack of semen.

Can not ejaculating cause problems?

There isn’t any evidence that not ejaculating hurts you or causes any problems. Your body absorbs any sperm you don’t release.

Do you pee out retrograde ejaculation?

Yes, if you have retrograde ejaculation, semen leaves your body when you pee.

At what age do men stop ejaculating?

Many people see a reduction in their sex drive (libido) and sexual activity as they get older. But there’s no specific age at which ejaculation stops. Some people may have difficulty ejaculating in their 30s. But others continue to ejaculate into their 80s.