Retrograde Ejaculation

Understanding Dry Orgasms Including Causes and Treatment

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Retrograde ejaculation is a condition in men where semen enters the bladder during ejaculation instead of leaving the body through the penis. Normally, when a man ejaculates, semen is propelled down through the urethra and out of the body. Retrograde ejaculation means that semen is propelled up the urethra, and moves back into the bladder. The semen later exits the body during urination.

Retrograde ejaculation can result in infertility, but it doesn't affect the ability to have an erection or orgasm.

Sometimes it is called a dry orgasm.

Causes

Normally, the opening of the bladder closes during ejaculation to prevent backflow of the ejaculate. Retrograde ejaculation is seen in:

  • Diabetes (diabetic autonomic neuropathy)
  • High blood pressure medications (alpha-adrenergic blockers such as Cardura and Minipress)
  • Medication for prostate enlargement (Flomax, Cardura)
  • Mood-altering drugs including SSRIs such as Prozac and Zoloft and antipsychotic medications such as Thorazine, Mellaril, and Risperdal.
  • Spinal cord injuries and spinal surgery
  • Multiple sclerosis
  • Surgery that involves the prostate, urethra, or bladder, including transurethral resection of prostate (TURP) and prostatectomy
  • Damage to the prostate tissue by radiation therapy or other types of nerve damage in the pelvic area can also cause retrograde ejaculation.

Signs and Symptoms

Retrograde ejaculation is typically not painful and is only noted by a decrease in the amount of semen that is produced during orgasm.

Your urine may also be cloudy after an orgasm. Many men elect not to seek treatment unless they are concerned about their fertility.

Diagnosis

Your doctor will take your history and do a physical exam. You will provide a urine sample immediately after having an orgasm, which is usually done at the medical clinic with masturbation.

If there is a large amount of sperm seen in the urine, it indicates retrograde ejaculation.

If sperm is not seen, the lack of ejaculate may be due to problems with the glands that produce semen and you may need further tests.

Treatment

Many men are simply relieved to find a reason for their dry orgasms and don't need or want treatment unless they have concerns about infertility. If your retrograde ejaculation is likely to be caused by medication, changing or discontinuing the medication can correct the issue. Normal ejaculation will usually return.

If you have a mild condition that is affecting the nerves or muscles involving the bladder, you may be treated with a medication such as Tofranil (imipramine) that will improve the muscle tone. This may be the case with diabetes, multiple sclerosis, or some surgeries.

If the cause of retrograde ejaculation is prostate surgery or a problem with anatomy, medication will not help the condition. Surgery is not a treatment option in the vast majority of cases, but there are procedures that can be performed.

Living With Retrograde Ejaculation

If retrograde ejaculation cannot be corrected, infertility treatments can be used to recover the sperm and use it for intrauterine insemination or in-vitro fertilization.

Sources:

Parnham A, Serefoglu EC. Retrograde ejaculation, painful ejaculation, and hematospermiaTranslational Andrology and Urology. 2016;5(4):592-601. doi:10.21037/tau.2016.06.05.

Retrograde Ejaculation. Mayo Clinic. 

Retrograde Ejaculation. MedlinePlus. 

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