Retrograde ejaculation is a condition where semen is redirected backward into the bladder instead of being expelled out of the penis during orgasm. This occurs when the muscles at the base of the bladder do not function properly, allowing semen to flow into the bladder rather than out through the urethra. It can lead to male infertility, as the sperm does not reach the female reproductive tract. Treatment options vary depending on the underlying cause.

What is retrograde ejaculation?

Retrograde ejaculation is a medical condition in which semen flows backward into the bladder instead of being expelled out of the penis during ejaculation. Normally, during orgasm, muscles in the bladder neck contract to prevent semen from entering the bladder and direct it out through the urethra. However, in retrograde ejaculation, these muscles do not function properly, causing the semen to take the wrong path. Its known as a dry ejaculation.

What are the causes of retrograde ejaculation

Retrograde ejaculation can be caused by various factors that affect the muscles and nerves involved in the ejaculation process. Some common causes include:

• Surgery: Procedures involving the prostate, bladder, or urethra can damage the muscles or nerves controlling ejaculation, leading to retrograde ejaculation. This is common after prostate surgery (such as transurethral resection of the prostate, or TURP) or bladder neck surgery.
• Medications: Certain medications can interfere with the normal functioning of the muscles at the bladder neck. These include drugs used to treat high blood pressure, enlarged prostate (benign prostatic hyperplasia), and depression. Common examples are alpha-blockers, antidepressants, and antipsychotics.
• Diabetes: Long-term diabetes can damage the nerves that control the muscles in the bladder and reproductive organs, leading to retrograde ejaculation. This is due to diabetic neuropathy, a condition where high blood sugar levels damage nerves over time.
• Nerve Damage: Any condition or injury that affects the spinal cord or nerves controlling the bladder and reproductive system can lead to retrograde ejaculation. This can include spinal cord injuries, multiple sclerosis, or other neurological disorders.
• Congenital Abnormalities: Some men are born with structural abnormalities in the bladder neck or urethra that can cause retrograde ejaculation.
• Radiation Therapy: Radiation treatment for cancers in the pelvic area, such as prostate or bladder cancer, can damage the nerves and muscles involved in ejaculation.

Diagnosis

Diagnosing retrograde ejaculation involves a combination of medical history review, physical examination, and specific tests to confirm the condition. Here’s how it is typically diagnosed:

• Medical History: The doctor will ask about symptoms such as the volume of semen during ejaculation, any changes in ejaculation, and the presence of cloudy urine after orgasm. A review of past surgeries, particularly involving the prostate or bladder, as well as any current medications, is important, as these can be contributing factors.
  • Physical Examination: A physical exam, particularly of the genital area, may be conducted to check for any structural abnormalities or signs of nerve damage.
  • Urine Analysis: Post-Ejaculation Urinalysis: This is the most definitive test for retrograde ejaculation. After ejaculation, the patient is asked to provide a urine sample. The urine is then analyzed for the presence of sperm. If a significant amount of sperm is found in the urine, it indicates that the semen is entering the bladder instead of being expelled normally.
  • Additional Tests: In some cases, if the diagnosis is unclear or if there are concerns about underlying conditions, additional tests like urodynamic studies, which assess how the bladder and urethra are functioning, or imaging studies (e.g., ultrasound) may be performed.
  • Neurological Evaluation: If a neurological cause is suspected (such as nerve damage due to diabetes or spinal cord injury), a more detailed neurological examination may be conducted.

The combination of these approaches helps the doctor confirm the diagnosis of retrograde ejaculation and determine the underlying cause.

Treatment

The treatment of retrograde ejaculation depends on the underlying cause and the patient’s desire for fertility. Here are common treatment approaches:

• Medication Adjustment:

Change or Discontinue Medications: If the retrograde ejaculation is caused by a medication (such as alpha-blockers or certain antidepressants), your doctor may adjust the dosage, switch to a different drug, or discontinue the medication to restore normal ejaculation.

• Medications:

ympathomimetic Drugs: Medications like pseudoephedrine, ephedrine, or imipramine may be prescribed to strengthen the bladder neck muscles and prevent semen from flowing into the bladder. These drugs stimulate the muscles that control the bladder neck, helping them to close properly during ejaculation.

• Surgical Treatment:

Corrective Surgery: If retrograde ejaculation is due to structural issues or damage from previous surgeries, surgical options may be considered to correct the problem, particularly if fertility is a concern.

• Assisted Reproductive Techniques (ART):

Sperm Retrieval: For men with retrograde ejaculation who wish to father children, sperm can be retrieved from the urine after ejaculation and used in assisted reproductive techniques such as intrauterine insemination (IUI) or in vitro fertilization (IVF).

IVF or ICSI: In vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) can be used to achieve pregnancy, using sperm collected from the post-ejaculation urine.

• Lifestyle Modifications:

Management of Underlying Conditions: For conditions like diabetes, controlling blood sugar levels and managing overall health can help improve the condition. Lifestyle changes, such as regular exercise and a healthy diet, may also support nerve function and overall reproductive health.

• Behavioral Therapy: If retrograde ejaculation is related to psychological factors or anxiety, counseling or behavioral therapy might be recommended.
• Observation: In cases where retrograde ejaculation does not cause discomfort and fertility is not a concern, treatment may not be necessary. The condition is often harmless and does not require intervention unless it is affecting quality of life or fertility.

Treatment is personalized based on the individual’s health, the cause of the condition, and their fertility goals. Consulting with a urologist is essential to determine the most appropriate approach.

Summary

Retrograde ejaculation is a condition where semen flows backward into the bladder instead of being expelled during ejaculation. It can be caused by different etiologies. Diagnosis typically involves a medical history review and a post-ejaculation urine analysis. Treatment options include adjusting medications, prescribing drugs to strengthen bladder muscles, or using assisted reproductive techniques for those seeking to conceive.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE