Retrograde Ejaculation: Causes And Treatment

Retrograde ejaculation is a medical condition in which semen is redirected from the urethra (the tube that carries semen out of the penis during ejaculation) into the bladder during orgasm. This occurs when the muscles that normally prevent semen from entering the bladder malfunction or are damaged.

Some common causes of retrograde ejaculation include:

Certain medications: Medications used to treat conditions like high blood pressure, prostate enlargement, and depression can interfere with the muscles that control ejaculation.

Diabetes: High blood sugar levels can damage nerves and muscles that control ejaculation.

Surgery: Surgery on the prostate, bladder, or urethra can damage nerves and muscles that control ejaculation.

Spinal cord injuries: Damage to the spinal cord can interfere with the nerves that control ejaculation.

Congenital conditions: Some men are born with conditions that affect the muscles or nerves that control ejaculation.

While retrograde ejaculation is not harmful, it can interfere with fertility since semen is not expelled from the body during ejaculation. In some cases, treatment may not be necessary, but if the underlying cause can be identified, treating the underlying condition may help to restore normal ejaculation. In some cases, medications or procedures may be recommended to help improve fertility. It’s important to talk to a healthcare provider if you are experiencing symptoms of retrograde ejaculation or have concerns about fertility.

Causes

During a male orgasm, a tube called the vas deferens transports sperm to the semen, where it mixes with other fluids to produce fluid (ejaculate). The muscles in the bladder (the muscles of the neck of the bladder) tighten to prevent ejaculation from entering the bladder as it travels from the prostate gland to the inner tube of the penis (urethra). This is the same muscle that keeps urine in your bladder until you urinate.

With repeated ejaculation, the muscles of the neck of the bladder do not tighten properly. As a result, sperm can enter the bladder instead of being excreted from your body through a penis. Several conditions can cause problems with the muscles that block the bladder during urination.

These include:

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

Dry orgasm is the main sign of ejaculation. However, a dry orgasm – with little or no ejaculation – can be caused by other conditions, including:

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

Risk factors

You are at greater risk of recurrent ejaculation if you:

• You have diabetes or multiple sclerosis
• You have had an orthopedic surgery
• You are taking certain drugs for high blood pressure or mood disorders
• You have injured your spine

Perplexity

Re-ejaculation is not harmful. However, potential problems include:

• Failure to conceive a woman (male infertility)
• Unpleasant orgasm due to concerns about missing ejaculate

Treatment

Restoring ejaculation itself does not require treatment unless it interferes with reproduction. In such cases, treatment depends on the cause.

Medications

Medications may work to reactivate ejaculation caused by nerve damage. This type of damage can be caused by diabetes, multiple sclerosis, certain surgeries, and other conditions and treatments. Drugs usually will not help if pre-ejaculation is due to surgery that causes permanent changes in your body. Examples include bladder neck surgery and prostatethral resection.

If your doctor thinks that the drugs you are taking may affect your ability to ejaculate normally, you may stop taking them for a while. Drugs that can cause retrograde ejaculation include certain antidepressant drugs and alpha-blockers – drugs used to treat high blood pressure and certain conditions of the bladder.

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

• Imipramine (Tofranil)
• Midodrine
• Chlorpheniramine (Chlor-Trimeton, others) and brompheniramine (Veltane, others)
• Ephedrine (Akovaz, others), pseudoephedrine (Sudafed, others), and phenylephrine (Vazculep, others)

These medications help keep the neck muscles of the bladder closed during ejaculation. While it is usually an effective treatment for re-ejaculation, medications can cause side effects or adverse reactions to other medications. Certain medications used to treat 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 relapsed ejaculation, you will need treatment to get your female partner pregnant. To get pregnant, you need to ejaculate enough to carry your sperm into your partner’s vagina and uterus.

If the medicine does not allow you to ejaculate, you will need anonymous birth control methods such as assisted reproductive technology to get your partner pregnant. In some cases, the sperm can be found in the bladder, processed in a laboratory, and used for intrauterine insemination.

Sometimes, more advanced reproductive techniques are needed. Many men with postponed ejaculation are able to conceive their partners if they want treatment.

FAQ