Retrograde Ejaculation

What is Retrograde Ejaculation?

Retrograde ejaculation is defined as the condition where the semen or sperm does not exit the body but goes back into the bladder at the time of orgasm. Retrograde ejaculation is also referred to as Dry orgasm. Many ejaculatory disorders can have both psychological as well as organic causes but Retrograde ejaculation is purely organic in origin.

In normal ejaculation the semen propels through a man’s urethra and out of the penis as the entry to the bladder is closed by the sphincter(circular muscle or bladder neck). Under Retrograde ejaculation, this circular muscle does not function and allows the semen backward into the bladder so there would be less or no semen out of the penis even after orgasm.

Retrograde ejaculation is not a harmful condition but however, in younger men, it can be a source of infertility. This condition does not affect your ability to have an erection, engage in sexual intimacy, or achieve an orgasm.

Retrograde Ejaculation

Symptoms of Retrograde ejaculation

As this condition is purely physical, the main symptoms for Retrograde ejaculation are

  • Cloudy urine: Men with retrograde ejaculation will observe cloudy urine post-orgasm. This is attributed to the mixing of semen with urine in the bladder.
  • Infertility: Due to lower sperm ejaculation or no sperm after orgasm, it is difficult to impregnate a woman. Retrograde ejaculation can be a reason for infertility.

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  • No semen: The main symptom of Retrograde ejaculation is that The ejaculate out of the penis has little to no semen in it after an orgasm.
Symptoms of Retrograde Ejaculation

Causes of Retrograde ejaculation

Retrograde ejaculation is not a common condition. The main reason for Retrograde ejaculation condition is that the semen enters back into the bladder and that is due to abnormal functioning of the circular muscle, So there can be different causes that can lead to the abnormal functioning of the circular muscle

  • Psychotropic medications used to treat high blood pressure and medication that are used to treat enlarged prostates such as finasteride or Flomax or Rapa flow can be associated with the problem of Retrograde ejaculation. 
  • The medications used to treat mood disorders can also cause dry ejaculate.
  • Surgical procedures on the prostate can injure the area between the bladder and prostate and can cause the fluid to go back into the bladder instead of the penis.

Spinal cord injuries and lumbar sympathectomy are prone to cause the muscle to act abnormally.

  • Nerve damage caused by a medical illness is common in men with multiple sclerosis or poorly controlled diabetes.
  • The use of drugs like antidepressants and alpha-blockers can cause retrograde ejaculation.

Retrograde ejaculation is responsible for about 1% of all male infertility cases in the United States. If this condition is caused due to medication then it will go away once the medication is changed but if it is due to severe nerve damage then this condition may be permanent.

Diagnosis of Retrograde Ejaculation

In most men, the initial diagnosis of Retrograde ejaculation involves the post-ejaculatory Urinalysis to see any presence of the ejaculate in the Urine. The diagnosis can be made by a doctor who specializes in male reproductive disorders and urinary tract problems. The diagnosis is then followed by physical examination, The confirmation of the retrograde condition is done by the sperm count in the urine after ejaculation.

Diagnosis of Retrograde Ejaculation

Treatment

The treatment for retrograde ejaculation varies depending on the cause of the condition whether it is due to medication or due to severe nerve damage. If the retrograde ejaculation condition is caused due to side effects of the medication then stopping those medications or changing them can cure the condition.

In infertile men, this condition requires treatment and also depends on the cause of infertility. If it is due to a muscle problem involving the bladder or mild nerve issue then it can be treated with drugs such as Tofranil or Imipramine taken 30-40 minutes before engaging in sexual activity. These drugs may cause the muscle to constrict and allow the fluid to go forward instead of backward.

Other classifications of antihistamines such as Chlorpheniramine or brompheniramine can be used 30-45 minutes engaging in sexual intimacy and also there are decongestants such as Sudafed, ephedrine, and phenyl efrain that can cause the muscle to contract. These decongestants come with side effects like an increase in blood pressure and heart rate that can be dangerous.

It is not possible to restore normal ejaculation if it is caused by severe damage to the nerve of the bladder. In order to counter infertility in this scenario, it is possible to use assisted reproductive technology(ART) in order to get your partner pregnant. This process involves collecting the sperm from the bladder, processing it in the laboratory, and used to inseminate your partner referred to as intrauterine insemination.

Exercise for Retrograde ejaculation

Kegel exercises are very effective in treating any kind of ejaculation problem. This exercise involves squeezing and releasing the pelvic floor muscle in order to control urination which in turn helps the bladder neck function normally. In order to do these exercises after locating the pelvic floor muscle.

  1. Tighten and hold your pelvic floor muscles for five seconds 
  2. Relax your pelvic muscles. You have just done one Kegel exercise. You should plan to do 10 to 20 Kegel exercises three to four times each day.

Conclusion

Retrograde ejaculation is not a very common urologic problem, it is usually related to medication, surgery, or various medical conditions such as diabetes, multiple sclerosis, or Spinal cord injury. Treatment usually begins with medication and for those with infertility associated with it, assisted reproductive technology is used in order to achieve pregnancy.

The ED Clinic

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