Retrograde ejaculation
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Retrograde ejaculation happens when semen is redirected into the bladder rather than being expelled through the penis during orgasm, often resulting in little to no semen during ejaculation, a condition also known as a dry orgasm. While it doesn’t pose health risks, it can lead to male infertility. Treatment is typically pursued to regain fertility.
Symptoms
Retrograde ejaculation is a condition where semen enters the bladder instead of exiting through the penis during orgasm. This does not impact the ability to achieve an erection or experience an orgasm, but it does affect ejaculation. Here are the key signs and symptoms of retrograde ejaculation:
- Dry orgasms: Little to no semen is ejaculated out of the penis during climax.
- Cloudy urine post-orgasm: The presence of semen in the urine after orgasm makes it appear cloudy.
- Male infertility: Difficulty in conceiving a child due to insufficient semen expulsion.
Retrograde ejaculation is not harmful and generally only needs treatment if you are trying to conceive a child. However, experiencing dry orgasms should prompt a consultation with a doctor to rule out any underlying health issues.
If you and your partner have been trying to conceive through regular, unprotected intercourse for a year or more without success, it is advisable to consult a doctor. Retrograde ejaculation could be a contributing factor to fertility issues.
Causes
In the male reproductive system, during orgasm, the vas deferens carries sperm to the prostate, where they combine with other fluids to form semen (ejaculate). The muscle located at the opening of the bladder, known as the bladder neck muscle, contracts to prevent semen from entering the bladder as it moves from the prostate into the urethra, the tube inside the penis. This muscle serves the same function of holding urine in the bladder until urination occurs.
Retrograde ejaculation occurs when semen travels backward into the bladder rather than exiting the body through the penis. This happens due to the failure of the bladder neck muscle to tighten properly, allowing sperm to enter the bladder instead of being expelled through the penis.
Various conditions can disrupt the function of the muscle responsible for closing the bladder during ejaculation. These conditions include:
- Surgery, such as prostate, retroperitoneal lymph node dissection, or neck surgery for testicular cancer
- Adverse effects of several drugs for depression, enlarged prostate, and high blood pressure
- Nerve damage resulting from a medical condition, such as spinal cord injuries, multiple sclerosis, diabetes, or Parkinson’s disease
The main indicator of retrograde ejaculation is a dry orgasm. However, experiencing a dry orgasm, characterized by the release of minimal or no semen, can also result from other conditions, such as:
- Radiation therapy for pelvic cancer treatment
- Surgical excision of the bladder (cystectomy)
- Surgical excision of the prostate (prostatectomy)
Risk factors
A higher chance of retrograde ejaculation exists if:
- You have diabetes or multiple sclerosis
- You take some medications for high blood pressure or a mood problem
- Your spinal cord was injured.
- You have had surgery on your bladder or prostate
Diagnosis
To identify retrograde ejaculation, your doctor could:
- Inquire about your symptoms and their duration, along with any pertinent medical history, surgeries, or instances of cancer, as well as your current medications.
- Conduct a physical examination, typically encompassing an assessment of your penis, testicles, and rectum.
- Evaluate your urine for semen presence post-orgasm. This process usually occurs at the doctor’s office, where you’ll be instructed to empty your bladder, achieve climax through masturbation, and provide a urine sample for laboratory assessment. If a significant amount of sperm is detected in your urine, retrograde ejaculation is diagnosed.
If you experience dry orgasms and no semen is detected in your bladder upon examination by your doctor, it could indicate an issue with semen production. This might stem from damage to the prostate or the glands responsible for semen production, often resulting from surgery or radiation therapy for pelvic area cancer.
If your doctor suspects that your dry orgasm is due to a cause other than retrograde ejaculation, additional tests or a referral to a specialist may be necessary to identify the underlying reason.
Treatment
Retrograde ejaculation typically does not require intervention unless it affects fertility. The choice of treatment hinges on the underlying cause.
Medication treatment options:
Medications may be effective for retrograde ejaculation resulting from nerve damage due to conditions like diabetes, multiple sclerosis, or certain medical procedures. However, if retrograde ejaculation stems from surgeries that permanently alter anatomical structures, such as bladder neck surgery or transurethral resection of the prostate, medications are generally ineffective.
Potential medications include:
- Imipramine: An antidepressant.
- Midodrine: A drug that constricts blood vessels.
- Chlorpheniramine and brompheniramine: Antihistamines for allergy relief.
- Ephedrine, pseudoephedrine, and phenylephrine: Common cold symptom relievers.
These medications work by helping to keep the bladder neck muscle closed during ejaculation. However, they may have side effects and can interact adversely with other medications. Particularly, they can raise blood pressure and heart rate, posing risks for those with cardiovascular conditions.
Impact of other drugs:
If current medications are suspected to disrupt normal ejaculation, a temporary discontinuation may be suggested. Drugs known to potentially cause retrograde ejaculation include certain antidepressants and alpha blockers, which are prescribed for high blood pressure and some prostate issues.
Infertility treatment:
For men experiencing fertility issues due to retrograde ejaculation, direct ejaculation of semen may not be feasible. In such cases, assisted reproductive technology becomes necessary. This may involve recovering sperm from the bladder, preparing it in a lab, and then using it for intrauterine insemination. More advanced techniques may also be required, and many men find success in conceiving with their partners after seeking appropriate treatment.
