Retrograde Ejaculation

Overview

What is retrograde ejaculation?

Retrograde ejaculation is a term that refers to semen going backward into your bladder instead of out of your body through your urethra and the tip of your penis during sexual climax. The urethra is the tube that lets urine and sperm leave your body.

Retrograde ejaculation is also called dry orgasm. It can be a factor in infertility.

Who does retrograde ejaculation affect?

Retrograde ejaculation often affects individuals who:

How common is retrograde ejaculation?

Retrograde ejaculation is somewhat common. For instance, it happens after most cases of transurethral resection of the prostate (TURP) surgeries. TURP is used to treat benign prostatic hyperplasia, also called an enlarged prostate.

Conditions that may cause retrograde ejaculation are also somewhat common, such as diabetes. In terms of medications, individuals who take drugs for high blood pressure or depression may develop retrograde ejaculation.

Symptoms and Causes

What are the signs and symptoms of retrograde ejaculation?

You might not notice if you have retrograde ejaculation. Or you might notice the following:

  • You produce little to no semen when you orgasm.
  • You have cloudy urine after you orgasm.
  • You’re having fertility issues.

What causes retrograde ejaculation?

Retrograde ejaculation is caused by a problem with your circular muscle (called the bladder sphincter) that closes to let semen out and keeps urine in your body. Because your sphincter doesn’t work correctly, your bladder neck stays open instead of closing allowing the ejaculate to take the path of least resistance into the bladder.

Diagnosis and Tests

How is retrograde ejaculation diagnosed?

Your provider will ask you questions about your symptoms and will do a physical examination. Then, to diagnose retrograde ejaculation, your healthcare provider may ask you to provide:

  • Semen samples. If you produce a very low volume of semen in at least two samples, you could have retrograde ejaculation.
  • A urine sample taken right after you orgasm. Fructose is present in semen samples. If you have retrograde ejaculation, laboratory tests will find fructose in your urine. The lab will also analyze the number of sperm in your urine.

Management and Treatment

How is retrograde ejaculation treated?

Retrograde ejaculation doesn’t seem to be painful or harmful. If you don’t want children, your provider may suggest that it doesn’t need treatment.

However, if you decide you want treatment, there are medications that help the sphincter close tightly. These include imipramine, an older antidepressant, and antihistamines like pseudoephedrine and chlorpheniramine.

If your condition is actually being caused by the medications you’re on, talk with your provider about making a change to a different type of drug.

If you have retrograde ejaculation and you take imipramine or pseudoephedrine, your healthcare provider will keep an eye on your blood pressure and heart rate. The drugs make increase both blood pressure and heart rate.

If the drugs don’t work to help with retrograde ejaculation, there are still ways to aid fertility. For instance, your provider can collect your sperm so that it can be used for insemination.

Are there exercises that help with retrograde ejaculation?

You may want to work on the muscles that control urination. You can tell which ones these are by stopping and starting your flow while you’re peeing. Exercising them involves squeezing and releasing these muscles. These exercises are often called Kegel exercises.

Prevention

How can I prevent retrograde ejaculation?

There’s no way to prevent retrograde ejaculation. But if you have diabetes, it’s important to keep your blood sugar levels steady. It’s vital for your overall health as well as your penis health.

Outlook / Prognosis

What is the outlook (prognosis) for retrograde ejaculation?

Healthcare professionals don’t believe that retrograde ejaculation is harmful or painful. Your outlook is good, unless you’re trying to have children. Even then, there are treatments for both retrograde ejaculation and infertility.

Living With

When should I see my healthcare provider regarding retrograde ejaculation?

You should contact your healthcare provider if:

  • You’re trying to have children and things aren’t progressing.
  • You’re uncomfortable with how things feel when you orgasm.
  • You’re being treated for retrograde ejaculation, and treatment isn’t working.

Frequently Asked Questions

What does retrograde ejaculation feel like?

Retrograde ejaculation feels the same as antegrade ejaculation. Antegrade ejaculation is the term for semen forcefully being pushed out of the body through the penis, rather than being forcefully pushed back into the bladder. However, if you’re uncomfortable for any reason with the lack of semen during orgasm, contact your healthcare provider.

Does retrograde ejaculation go away?

Retrograde ejaculation can go away with treatment. It can also go away if you’re able to change the medications that cause it.

How common is retrograde ejaculation after transurethral resection of the prostate (TURP)?

The rate of retrograde ejaculation after TURP is estimated to be as high as 70% to 90%. If the bladder neck is preserved during TURP, there may be less risk of retrograde ejaculation.

Are there benefits to retrograde ejaculation?

Some people believe that retaining sperm will increase their testosterone levels or will allow them to live longer. These people make an effort to stop themselves from ejaculating outside the body. However, this is controversial and not recommended by most healthcare providers.

A note from Cleveland Clinic

Retrograde ejaculation is a somewhat common occurrence due to many causes, including medication use, surgery and medical conditions. While healthcare providers don’t see it as being painful or harmful, it can be a problem for people who want to conceive. There are ways to treat retrograde ejaculation. Speak to your healthcare provider about any of your concerns.

Reviewed by a Cleveland Clinic medical professional.

References

  • Alnajjar HM, Muneer A. Retrograde ejaculation and anejaculation. In: Sharif K, Coomarasamy A, eds. Assisted Reproduction Techniques. 1st ed. Wiley; 2021:575-579. Accessed 11/11/2021.
  • Gupta S, Sharma R, Agarwal A, et al. A comprehensive guide to sperm recovery in infertile men with retrograde ejaculation. (https://wjmh.org/search.php?where=aview&id=10.5534/wjmh.210069&code=2074WJMH&vmode=FULL) World J Men Health. 2021;39:e29. Accessed 11/11/2021.
  • Liao J, Zhang X, Chen M, et al. Transurethral resection of the prostate with preservation of the bladder neck decreases postoperative retrograde ejaculation. (https://pubmed.ncbi.nlm.nih.gov/30766635/) Wideochir Inne Tech Maloinwazyjne. 2019;14(1):96-101. Accessed 11/11/2021.
  • Merck Manual Consumer Version. Retrograde Ejaculation. (https://www.merckmanuals.com/home/men-s-health-issues/sexual-dysfunction-in-men/retrograde-ejaculation) Accessed 11/11/2021.
  • National Health Service. Ejaculation Problems. (https://www.nhs.uk/conditions/ejaculation-problems/) Accessed 11/11/2021.
  • Parnham A, Serefoglu EC. Retrograde ejaculation, painful ejaculation and hematospermia. (https://pubmed.ncbi.nlm.nih.gov/27652230/) Transl Androl Urol. 2016;5(4):592-601. Accessed 11/11/2021.
  • Prakash O, Kar SK, Sathyanarayana Rao TS. Indian story on semen loss and related Dhat syndrome. (https://pubmed.ncbi.nlm.nih.gov/25568479/) Indian J Psychiatry. 2014;56(4):377-382. Accessed 11/11/2021.

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