Ejaculatory Duct Obstruction

An ejaculatory duct obstruction (pronounced “ih-JAK-yuh-luh-tawr-ee” “duhkt” “uhb-STRUHK-shuhn”) is a blockage in your ejaculatory ducts.

Most males have two testicles. In healthy males:

• Each testicle makes sperm.
• Sperm travel from the testicles through a vas deferens.
• The vas deferens joins with ducts from the seminal vesicle to form your ejaculatory ducts (ED).
• During ejaculation, sperm move through the EDs and enter the urethra as it passes through the prostate gland (the prostatic urethra).
• Fluids from the seminal vesicles and prostate mix with sperm to form semen.
• Semen then leaves your body through your urethra.

Ejaculatory duct obstruction (EDO) prevents sperm from entering your semen and leaving your body. It can prevent males from being able to have biological children (male infertility).

About 1 to 5 out of every 100 males who don’t have sperm in their semen (azoospermia) have an EDO. About 1 out of every 100 males has azoospermia. Surgery can treat EDO.

Types

There are three types of ejaculatory duct obstruction:

• Complete or classic EDO: In this type of EDO, a blockage affects both ejaculatory ducts.
• Incomplete or partial EDO: There’s a complete blockage in one ejaculatory duct or a partial blockage in both ducts.
• Functional EDO: This type is similar to a complete EDO. But in this type, there’s no physical blockage.

Symptoms of ejaculatory duct obstruction

Signs and symptoms of ejaculatory duct obstruction may include:

• Low semen volume (less than 1.5 milliliters or about one-tenth of a tablespoon)
• Low sperm output and/or low sperm count (oligospermia)
• Not being able to get your female partner pregnant after a year of trying (infertility)
• Pain during or after sexual intercourse (dyspareunia)
• Pain in your prostate
• Blood in your semen (hematospermia)
• Blood in your pee (hematuria)

Causes

EDO causes may include:

• Genetic disorders that affect your ejaculatory ducts at birth. For example, you may not have ducts (absent) or they may have collapsed (atrophic)
• Scar tissue from surgery in your pelvis or damage to your urethra
• Stones (calculi)
• Cysts
• Frequent urinary tract infections (UTIs)
• Chronic (long-term) prostate inflammation (prostatitis)
• Inflammation in your epididymis (epididymitis)

Complications

Not being able to get your partner pregnant can affect your thoughts and emotions. These feelings may include:

• Anxiety
• Depression
• Failure
• Grief
• Inadequacy

If you or your partner have these feelings, it’s a good idea to talk to a therapist or psychologist.

How doctors diagnose an EDO

A healthcare provider will review your medical history, ask questions about your symptoms and conduct a physical exam. If they suspect you have an ejaculatory duct obstruction, they’ll recommend tests like:

• Semen analysis, including measuring how much fructose (sugar) is in your semen (semen fructose analysis). Fructose helps give your sperm energy to swim.
• Imaging tests, including a transrectal ultrasound, X-rays of your vas deferens and injecting a contrast dye into your vas deferens (vasography).

How do you treat an obstructed ejaculatory duct?

If a healthcare provider diagnoses an ejaculatory duct obstruction, they’ll recommend surgery. The surgical options include:

• Transurethral resection of the ejaculatory ducts (TURED): A surgeon removes the blockage, which allows sperm to enter your semen.
• Seminal vesiculoscopy: A surgeon inserts a long, thin tool (ureteroscope) into your prostate to remove the blockage.

Surgeons may combine these two procedures.

Sometimes, these surgeries aren’t successful. Before surgery, your provider may suggest banking your sperm if you wish to have biological children.

Recovery time

TURED and seminal vesiculoscopy are outpatient procedures. That means you can go home the same day as the procedure.

You’ll need to use a Foley catheter to drain your pee for at least a few days after surgery. You should also avoid sexual activity, including masturbation, until your provider says it’s OK. Most people make a full recovery after about two weeks.

When should I see my healthcare provider?

Contact a healthcare provider if you notice any pain in the area or any changes to your semen. You should also reach out to a provider if you and your partner haven’t been able to get pregnant after a year of trying.

If you have surgery to treat an EDO, reach out to a provider if you have any symptoms like:

• New or increased bleeding
• New or increased pain
• Signs of infection, including a fever, chills or swelling or pain in your legs or around your groin
• An allergic reaction to your medication

During your appointment, you may wish to ask the following questions:

• What kind of ejaculatory duct obstruction do I have?
• What treatment do you recommend?
• What’s the success rate of your recommended treatment?
• Are there any side effects of your recommended treatment?
• Should I see a urologist?

What can I expect if I have an ejaculatory duct obstruction?

In many cases, you’ll find out you have an ejaculatory duct obstruction if you’re having trouble getting your partner pregnant. But some find out they have an EDO because they have pain in the area.

An EDO can be uncomfortable. But it’s not fatal. If you don’t have any pain or discomfort and you don’t want a biological child, you may not need treatment. If you decide to get surgery, the success rate is good.

Can an EDO be prevented?

No, you can’t prevent a blockage in your ejaculatory duct. But if you have a biological family history of ejaculatory duct obstruction, you may wish to consider genetic counseling. A genetic counselor can help you decide if genetic testing is a good choice for you. Genetic testing can identify genetic mutations that can cause EDO. They can also explain your risks, and if there are steps you can take to protect your health or lower your chances of passing EDO on to your biological children.