Ejaculatory Duct Obstruction

What is ejaculatory duct obstruction?

Ejaculatory duct obstruction (EDO) refers to a blockage of the ejaculatory duct (sperm duct) if you’re someone with anatomy typically described as male. EDO can be a cause of infertility that your healthcare provider may often be able to treat.

What is an ejaculatory duct?

Each of your two testicles has a vas deferens that joins with each of your seminal vesicle ducts to form your ejaculatory ducts (EDs). The EDs move through your prostate and pick up prostatic fluid to add to the semen. The fluid empties into your urethra. This fluid is what carries sperm outside of your body when you ejaculate because of sexual arousal.

How common is ejaculatory duct obstruction?

An estimated 5% of people with azoospermia have ejaculatory duct obstruction. It’s estimated that azoospermia, the condition of not having sperm in your semen, affects about 1% of all people assigned male at birth.

What are the types of ejaculatory duct obstruction?

There are types of ejaculatory duct obstruction (EDO), including:

• Complete or classic EDO: In this type, both ducts are blocked.
• Incomplete or partial EDO: In this type, there’s a complete blockage in one duct or partial blockage in both ducts.
• Functional EDO: This is similar to complete EDO, but in this type, there’s no physical blockage.

What are the signs and symptoms of ejaculatory duct obstruction?

If you have ejaculatory duct obstruction (EDO), you may also have:

• Low volume of ejaculate (less than 1.5 milliliters).
• Low sperm output and/or low sperm count.
• Pain during or after sex.
• Pain in your prostate.
• Blood in your semen (this is called hematospermia).
• Blood in your urine (blood in your pee is called hematuria).
• Infertility.

Certain signs and symptoms may occur more with one type than with another.

What causes ejaculatory duct obstruction?

Causes of EDO include:

• Genes, like those involved in cystic fibrosis, cause a structural difference that you’re born with. For instance, the ducts may be absent (atresia) or atrophic (collapsed).
• Scar tissue from previous pelvic surgery or damage to the urethra.
• Stones (also called calculi).
• Cysts.
• Previous frequent urinary tract infections (UTIs).
• Prostatitis that is chronic (lasts for a long time).
• Epididymitis (inflammation of the epididymis, the cord that transports sperm located at the back of each testis).

Issues with the seminal vesicle may seem to be a blockage in your ejaculatory ducts.

What tests will be done to diagnose ejaculatory duct obstruction?

Your healthcare provider is likely to order some or all of the following tests to diagnose ejaculatory duct obstruction (EDO):

• Semen analysis.
• Semen fructose analysis.
• Transrectal ultrasound.
• X-ray of the vas deferens.
• Injection of dye into the vas deferens. This is called a vasogram.

What medications and/or treatments are used for ejaculatory duct obstruction?

Medical procedures used to treat EDO include:

• Transurethral resection of the ejaculatory ducts (TURED): This refers to cutting out whatever is blocking the duct, such as cysts.
• Seminal vesiculoscopy: This is another minimally invasive procedure that uses a small telescope to enter your prostate to reach and remove the duct blockage.

Surgeons may sometimes combine the two procedures. You’ll have to take antibiotics to help prevent infection in either case.

Your provider may suggest that you freeze semen before you have these types of procedures since the treatments aren’t always successful.

How long does it take to recover from ejaculatory duct obstruction treatment?

These are generally outpatient procedures. You’ll have a Foley catheter in your penis to help you pee for two to three days.

You may have blood in your urine and semen for a time after the procedure. You shouldn’t engage in sexual activity until you see your provider for your post-operative appointment. Your provider will remove the catheter then.

Don’t do any heavy lifting (objects over 10 pounds) for about two weeks.

Take prescribed medication, usually pain relievers and antibiotics, as your provider suggests.

You can return to work when your provider says it’s safe.

Complications/side effects of transurethral resection of ejaculatory ducts (TURED)

Some of the potential complications or side effects of TURED are that:

• You may emit watery fluid when you orgasm.
• You may develop epididymitis.
• The blockage may return.
• You may have an injury to your rectum.
• You may develop urinary incontinence.

Complications/side effects of seminal vesiculoscopy

This procedure has had few side effects. Most have been short-term, like pain. However, some people who have had the procedure have mentioned:

• Feeling that you've ejaculated a lower volume of semen.
• Feeling that your sexual function or performance had changed.

How can I prevent ejaculatory duct obstruction?

There’s currently no way to prevent a blockage in your ejaculatory duct. If you’re worried about any genetic issues, you can make an appointment with a genetic counselor who’ll be able to work with you.

Some medications can affect ejaculation but aren’t a cause of obstruction. You may be able to improve ejaculation if you avoid:

• Medications called alpha blockers (for example, tamsulosin)
• Blood pressure medications, including thiazides, prazosin and phentolamine.
• Antipsychotic medications, including thioridazine (Mellaril®), haloperidol (Haldol®) and chlordiazepoxide (Librium®).
• Antidepressants, including imipramine and amitriptyline.

Don’t stop taking any of these medications without first talking to your healthcare provider.

What can I expect if I have ejaculatory duct obstruction?

In many cases, you’ll find out if you have ejaculatory duct obstruction if you're having difficulty starting a family. You may also get a diagnosis if you experience recurring pain. By itself, ejaculatory duct obstruction may be uncomfortable, but it’s not fatal and not contagious. In many cases, your provider will be able to treat EDO successfully and restore fertility.

When should I see my healthcare provider?

See or call your healthcare provider if you have any issues that concern you, including:

• New or increased bleeding.
• New or increased pain.
• A fever of 102 degrees Fahrenheit.
• Chills or shaking.
• Swelling or pain in your legs or near the incision.
• An allergic reaction to your medication.

A note from Cleveland Clinic

If you are trying to start a family and haven’t been able to be a partner in pregnancy, you may ask your provider to help you find the issue. If you have ejaculatory duct obstruction, your provider may suggest procedures to unblock your ducts. These procedures do have some success. Having honest communication with your provider helps you make the best decisions about your health.