Retrograde ejaculation

Retrograde ejaculation occurs when semen enters the bladder instead of emerging through the penis during orgasm. Although you still reach sexual climax, you might ejaculate very little or no semen. This is sometimes called a dry orgasm.

Retrograde ejaculation isn't harmful, but it can cause male infertility. Treatment for retrograde ejaculation is generally only needed to restore fertility.

Symptoms

Retrograde ejaculation doesn't affect your ability to get an erection or have an orgasm — but when you climax, semen goes into your bladder instead of coming out of your penis. Retrograde ejaculation signs and symptoms include:

• Orgasms in which you ejaculate very little or no semen out of your penis (dry orgasms)
• Urine that is cloudy after orgasm because it contains semen
• Inability to get a woman pregnant (male infertility)

When to see a doctor

Retrograde ejaculation isn't harmful and requires treatment only if you're attempting to father a child. However, if you have dry orgasms, see your doctor to be sure your condition isn't caused by an underlying problem that needs attention.

If you and your female partner have had regular, unprotected intercourse for a year or longer and have been unable to conceive, see your doctor. Retrograde ejaculation might be the cause of your problem if you ejaculate very little or no semen.

Causes

During a male orgasm, a tube called the vas deferens transports sperm to the prostate, where they mix with other fluids to produce liquid semen (ejaculate). The muscle at the opening of the bladder (bladder neck muscle) tightens to prevent ejaculate from entering the bladder as it passes from the prostate into the tube inside the penis (urethra). This is the same muscle that holds urine in your bladder until you urinate.

With retrograde ejaculation, the bladder neck muscle doesn't tighten properly. As a result, sperm can enter the bladder instead of being ejected out of your body through the penis.

Several conditions can cause problems with the muscle that closes the bladder during ejaculation. These include:

• Surgery, such as bladder neck surgery, retroperitoneal lymph node dissection surgery for testicular cancer or prostate surgery
• Side effect of certain medications used to treat high blood pressure, prostate enlargement and depression
• Nerve damage caused by a medical condition, such as diabetes, multiple sclerosis, Parkinson's disease or a spinal cord injury

A dry orgasm is the primary sign of retrograde ejaculation. But dry orgasm — the ejaculation of little or no semen — can also be caused by other conditions, including:

• Surgical removal of the prostate (prostatectomy)
• Surgical removal of the bladder (cystectomy)
• Radiation therapy to treat cancer in the pelvic area

Risk factors

You're at increased risk of retrograde ejaculation if:

• You have diabetes or multiple sclerosis
• You've had prostate or bladder surgery
• You take certain drugs for high blood pressure or a mood disorder
• You had a spinal cord injury

Complications

Retrograde ejaculation isn't harmful. However, potential complications include:

• Inability to get a woman pregnant (male infertility)
• Less pleasurable orgasm due to worries about absent ejaculate

Prevention

If you take medications or have health problems that put you at risk of retrograde ejaculation, ask your doctor what you can do to lower your risk.

If you need to have surgery that might affect the bladder neck muscle, such as prostate or bladder surgery, ask about the risk of retrograde ejaculation. If you plan to have children in the future, talk with your doctor about options for preserving semen before the surgery.

Diagnosis

To diagnose retrograde ejaculation, your doctor may:

• Ask questions about your symptoms and how long you've had them. Your doctor might also ask about any health problems, surgeries or cancers you've had and what medications you take.
• Do a physical exam, which will likely include an exam of your penis, testicles and rectum.
• Examine your urine for the presence of semen after you have an orgasm. This procedure is usually done at the doctor's office. Your doctor will ask you to empty your bladder, masturbate to climax and then provide a urine sample for laboratory analysis. If a high volume of sperm is found in your urine, you have retrograde ejaculation.

If you have dry orgasms, but your doctor doesn't find semen in your bladder, you might have a problem with semen production. This can be caused by damage to the prostate or semen-producing glands as a result of surgery or radiation treatment for cancer in the pelvic area.

If your doctor suspects your dry orgasm is something other than retrograde ejaculation, you might need further tests or a referral to a specialist to find the cause.

Treatment

Retrograde ejaculation typically doesn't require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause.

Medications

Medications might work for retrograde ejaculation caused by nerve damage. This type of damage can be caused by diabetes, multiple sclerosis, certain surgeries, and other conditions and treatments.

Drugs generally won't help if retrograde ejaculation is due to surgery that causes permanent physical changes of your anatomy. Examples include bladder neck surgery and transurethral resection of the prostate.

If your doctor thinks drugs you are taking might be affecting your ability to ejaculate normally, he or she might have you stop taking them for a period of time. Drugs that can cause retrograde ejaculation include certain medications for depression and alpha blockers — drugs used to treat high blood pressure and some prostate conditions.

Drugs to treat retrograde ejaculation are drugs primarily used to treat other conditions, including:

• Imipramine, an antidepressant
• Midodrine, a medicine that constricts blood vessels
• Chlorpheniramine and brompheniramine, antihistamines that help relieve allergies
• Ephedrine, pseudoephedrine and phenylephrine, medicines that help relieve symptoms of the common cold

These medications help keep the bladder neck muscle closed during ejaculation. While they're often an effective treatment for retrograde ejaculation, medications can cause side effects or adverse reactions with other medications. Certain medications used to treat retrograde ejaculation can increase your blood pressure and heart rate, which can be dangerous if you have high blood pressure or heart disease.

Infertility treatment

If you have retrograde ejaculation, you'll likely need treatment to get your female partner pregnant. In order to achieve a pregnancy, you need to ejaculate enough semen to carry your sperm into your partner's vagina and into her uterus.

If medication doesn't allow you to ejaculate semen, you will likely need infertility procedures known as assisted reproductive technology to get your partner pregnant. In some cases, sperm can be recovered from the bladder, processed in the laboratory and used to inseminate your partner (intrauterine insemination).

Sometimes, more-advanced assisted reproductive techniques are needed. Many men with retrograde ejaculation are able to get their partners pregnant once they seek treatment.

Coping and support

Alterations in orgasm are linked with lower emotional and physical satisfaction, which might lead to stress for you and your partner. Retrograde ejaculation can be especially challenging if you and your partner want to conceive a child.

While most men can get their female partners pregnant with infertility treatment, it can be costly and require stressful medical procedures for both you and your partner. Talking with a counselor might help.

Understanding all of your options and communicating with your doctor and partner can help.

• Know what it will cost. Your insurance may or may not cover the costs necessary for sperm retrieval and artificial insemination of your partner.
• Talk to your doctor. Ask about all your options. You'll need to meet with a urologist who specializes in male infertility.
• Communicate with your partner. Make sure you and your partner both understand your options and the potential risks of fertility procedures. You should both attend every consultation appointment.

Preparing for an appointment

You're likely to start by seeing your family doctor. Depending on the likely cause of your dry orgasms and whether you need evaluation and treatment to help you get your female partner pregnant, you might need to see a urinary and reproductive specialist (urologist).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that might seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including prior surgeries or pelvic radiation, any major stresses, or recent life changes.
• Make a list of all medications, vitamins and supplements that you're taking.
• Write down questions to ask your doctor.

Preparing a list of questions before your appointment can help you make the most of your time together.

When seeing your doctor for dry ejaculation — the primary sign of retrograde ejaculation — some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Are there other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• Am I at risk of complications from this condition?
• Does my condition need to be treated?
• Will I be able to conceive children?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

If you're trying to get your female partner pregnant, you might also want to ask:

• Will medications help me ejaculate normally?
• Can sperm be retrieved from my bladder and used for fertility treatment?
• Will my partner and I likely need to use assisted reproductive technology, such as intrauterine insemination, to achieve pregnancy?
• What's the best treatment to use to try to get my partner pregnant?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your doctor will ask you questions about your health and symptoms. Your doctor might also do a physical exam that includes examining your penis, testicles and rectum. Your doctor will want to determine whether your dry orgasms are retrograde ejaculation or linked to another problem that may need further evaluation.

Being ready to answer your doctor's questions might save time to go over any points you want to spend more time on. Your doctor might ask:

• Do you have cloudy urine after an orgasm?
• When did you first begin having dry orgasms?
• Do you ever ejaculate semen when you have an orgasm, or do you have a dry orgasm every time?
• What surgeries have you had?
• Have you had cancer?
• Do you have diabetes or any other chronic health problems?
• What medications or herbal remedies do you take?
• Do you and your partner want to have a baby? If so, how long have you been trying to conceive?

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