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Retrograde Ejaculation

Definition


Disease: Retrograde Ejaculation Retrograde Ejaculation
Category: Sexual diseases
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Disease Definition:

When semen enters the bladder instead of emerging through the penis during orgasm, retrograde ejaculation occurs. The patient may ejaculate very little or no semen, although he still reaches sexual climax. This is called a dry orgasm. Retrograde ejaculation can cause male infertility but it isn't harmful.

Health conditions, medications or surgeries that affect the nerves or muscles that control the bladder opening can cause retrograde ejaculation. Stopping the drug may be an effective treatment if retrograde ejaculation is caused by a drug the patient is taking. Treatment with drugs may restore normal ejaculation and fertility in case retrograde ejaculation is due to a health condition or is a result of surgery. However, treatment for retrograde ejaculation is only needed to restore fertility.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Retrograde ejaculation doesn't affect a person’s ability to get an erection or have an orgasm. Retrograde ejaculation may cause some of these signs and symptoms:

  • Urine that is cloudy after orgasm because it contains semen
  • Male infertility
  • Dry orgasms, orgasms in which the person ejaculates very little or no semen out of his penis.


Only if the patient is attempting to father a child does retrograde ejaculation requires treatment. To be sure the condition isn't caused by an underlying problem that needs attention, the patient should see his doctor if he has dry orgasms.

If the patient and his partner has had regular, unprotected intercourse for a year or longer and have been unable to conceive, he should see a doctor because this condition may be the cause of infertility if he ejaculates very little or no semen.

Causes:

Sperm is released from each of the testicles during a male orgasm, which then travels through a tube called the vas deferens from each testicle. The vas deferens leads into the prostate, where sperm mixes with semen. To prevent semen from entering the bladder as it passes into the tube inside the penis (urethra), the muscle at the opening of the bladder (bladder neck) tightens. This is the same muscle that holds urine in the bladder until the person urinates. The bladder neck muscles don't tighten properly in retrograde ejaculation. As a result, instead of being ejected out of the body through the penis, sperm can enter the bladder.  

Problems with the muscle that closes the bladder during ejaculation may be caused by several conditions, such as:

  • Nerve damage caused by a medical condition such as a spinal cord injury, multiple sclerosis or diabetes.
  • Side effect of certain medications used to treat prostate enlargement, mood disorders and high blood pressure.
  • Surgery such as bladder neck surgery or prostate surgery.


The primary sign of retrograde ejaculation is a dry orgasm. However, dry orgasm can also be caused by other conditions that include:

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

The risk of retrograde ejaculation increases if the person:

  • Has had prostate or bladder surgery.
  • Had a spinal cord injury.
  • Has diabetes or multiple sclerosis.
  • Takes certain drugs for high blood pressure or a mood disorder.

Complications

Complications:

Potential complications of retrograde ejaculation may be:

  • Semen in the urine.
  • Inability to get the partner pregnant (male infertility).
  • Less pleasurable male orgasm.

Treatments:

Unless the retrograde ejaculation interferes with fertility, it doesn't require treatment. In those cases, treatment will depend on the underlying cause. For retrograde ejaculation caused by certain conditions, drugs may work. Additionally, this condition can’t be treated with surgery.  

  • If retrograde ejaculation is due to surgery that causes permanent physical changes of the patient's anatomy, medications won't be of help. Bladder neck surgery and transurethral resection of the prostate are some examples of those surgeries.  
  • If retrograde ejaculation is due to nerve damage, drugs may work. This can be caused by certain surgeries, diabetes, multiple sclerosis and other conditions and treatments.

The doctor may have the patient stop taking certain drugs for a period of time if he/she thinks that these drugs may be affecting the patient's ability to ejaculate normally. Certain medications for mood disorders and alpha blockers, which are drugs used to treat high blood pressure and some prostate conditions, are included in the drugs that can cause retrograde ejaculation.

The medications that are used to treat retrograde ejaculation are primarily used to treat other conditions and they include:

  • Ephedrine, pseudoephedrine and phenylephrine, used in some decongestant medications.
  • Imipramine, a tricyclic antidepressant.
  • Chlorpheniramine and brompheniramine, which are antihistamines sometimes used to treat cold symptoms.


During ejaculation, these medications can help keep the muscle of the bladder neck closed. All of these medications can cause side effects despite the fact that they're often an effective treatment for retrograde ejaculation. Some of the side effects are minor, while others can be more serious:

  • Certain medications used to treat retrograde ejaculation can increase blood pressure and heart rate, which can be dangerous if the patient has heart disease or high blood pressure.
  • When combined with other medications, some medications used to treat retrograde ejaculation can cause serious reactions.


INFERTILITY:
A person will likely need treatment to get his partner pregnant if he has retrograde ejaculation. A person needs to ejaculate enough semen to carry his sperm into his partner's vagina and into her uterus in order to achieve pregnancy.
So in order to get his partner pregnant, the patient will likely need infertility procedures known as assisted reproductive technology (ART) if medication doesn't allow him to ejaculate semen. Sperm can be recovered from the bladder, processed in the laboratory and used to inseminate the partner (intrauterine insemination) with ART. But in some cases, more advanced assisted reproductive techniques may be needed. Men who have retrograde ejaculation and seek treatment usually don’t have trouble getting their partner pregnant.

Prognosis:

Not available

Expert's opinion

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