Retrograde ejaculation

Description

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

Retrograde ejaculation is not harmful, but it can cause male infertility. Treatment for retrograde ejaculation is usually only necessary to restore fertility.

Symptoms

The retrograde ejaculation does not affect your ability to have an erection or have an orgasm — but when the climax, the semen enters the bladder instead of out of your penis. Retrograde ejaculation of the signs and symptoms include:

  • Orgasms in which you ejaculate very little or no semen out of your penis (dry orgasms)
  • The urine is cloudy after the orgasm, as it contains the semen
  • The inability to get a woman pregnant (infertility, male)

When to see a doctor

Retrograde ejaculation is not harmful and requires treatment only if you are trying to conceive a child. However, if you have dry orgasms, consult with your doctor to make sure that your condition is not caused by an underlying problem that needs attention.

If you and your partner have had regular, unprotected sexual intercourse for a year or more and have not been able to conceive, consult your doctor. Retrograde ejaculation can 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 carries sperm to the prostate, where it mixes with other liquids to produce liquid semen (ejaculation). The muscle at the opening of the bladder (bladder neck muscle) is taut to avoid the ejaculation of entering the bladder as it passes through the prostate into the tube inside the penis (urethra). This is the same muscle that holds urine in the bladder until you urinate.

With retrograde ejaculation, the bladder neck muscle do not tighten correctly. As a result, the 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
  • A side effect of certain medications used to treat high blood pressure, enlarged prostate, 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 main sign of retrograde ejaculation. But dry orgasm ejaculation of little or no semen can also be caused by other conditions, including:

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

Risk factors

You are at a higher risk of retrograde ejaculation if you:

  • You have diabetes or multiple sclerosis
  • You have had prostate or bladder surgery
  • Taking certain medications for high blood pressure or a mood disorder
  • He had a spinal cord injury

Complications

Retrograde ejaculation is not harmful. However, potential complications include:

  • The inability to get a woman pregnant (infertility, male)
  • Less enjoyable orgasm due to concerns about the absence of ejaculate

Prevention

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

If you need to have a surgery that could affect the bladder, the neck muscles, 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 the options for the preservation of semen prior to surgery.

Retrograde ejaculation

Diagnosis

For the diagnosis of retrograde ejaculation, your doctor may:

  • Questions about your symptoms and how long you have had them. Your doctor may also ask about any health problems, surgeries, or cancers that have had, and what medications you take.
  • Do a physical exam, which is likely to include an examination of your penis, testicles, and rectum.
  • Test your urine to detect the presence of semen after having an orgasm. This procedure is usually performed in the doctor's office. Your doctor will be asked to empty your bladder, masturbate to climax, and then provide a urine sample for laboratory analysis. If a large volume of sperm is found in the urine, you have retrograde ejaculation.

If you have dry orgasms, but your doctor does not find the semen in the bladder, you may have a problem with the production of semen. This can be caused by damage to the prostate or the 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 the retrograde ejaculation, you might need further tests or a referral to a specialist to find the cause.

Treatment

Retrograde ejaculation, in general, do not require treatment unless they interfere with fertility. In such cases, the treatment depends on the underlying cause.

Drugs

Medications that could work for retrograde ejaculation caused by damage to the nerves. This type of damage can be caused by diabetes, multiple sclerosis, certain surgeries, and other conditions, and treatments.

The medicines usually do not help if retrograde ejaculation is due to the surgery that causes permanent physical changes in your anatomy. Examples include the bladder neck surgery and transurethral resection of the prostate.

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

Drugs for the treatment of retrograde ejaculation are drugs that are used primarily for the treatment of other conditions, including:

  • Imipramine, an antidepressant
  • Midodrine, a drug that constricts blood vessels
  • And brompheniramine, an antihistamine that helps relieve allergies
  • Ephedrine, pseudoephedrine and phenylephrine, which are medicines that help to relieve the symptoms of the common cold

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

The treatment of infertility

If you have retrograde ejaculation, is likely to need treatment to his female partner pregnant. In order to achieve a pregnancy, you need to ejaculate is enough semen to carry his sperm in the vagina of your partner and in your uterus.

If the medication does not allow that the ejaculation of the semen, it is likely you will need to 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 his partner (intrauterine insemination).

Sometimes, the most advanced techniques of assisted reproduction are required. Many men with retrograde ejaculation are able to get their partners pregnant once to seek treatment.

Coping and support

Alterations in the orgasm is associated with less emotional and physical satisfaction, which could lead to stress for you and your partner. Retrograde ejaculation can be especially difficult if you and your partner want to conceive a child.

While the majority of men can get their partners pregnant infertility treatment, which can be costly and require medical procedures stressful for you and your partner. Talking with a counselor can help.

To understand all of your options, and communicate with the doctor, and the partner can help.

  • To know what is going to cost you. Your insurance may or may not cover the expenses necessary for semen collection and artificial insemination of his partner.
  • Talk with 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 that you and your partner to understand your options and the potential risks of fertility procedures. You must attend each appointment of the query.

Preparing for your appointment

It is likely to start by seeing your family doctor. Depending on the likely cause of your dry orgasms, and if you need evaluation and treatment to help you get your pair of women pregnant, you may need to see a urinary and reproductive specialist (urologist).

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

What you can do

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

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

When to see your doctor for the dryness of the ejaculation — the main sign of retrograde ejaculation — some basic questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • There are other possible causes of your symptoms or condition?
  • What kinds of tests do I need?
  • Is my condition likely temporary or chronic?
  • Am I at risk of complications of this condition?
  • Can my condition be treated?
  • I'm going to be able to conceive children?
  • You should see a specialist?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Are there brochures or other printed material that I can take my house? What sites do you recommend to visit?

If you are trying to reach out to your partner of the pregnant woman, you may also want to ask:

  • Help the medications I normally ejaculate?
  • Can sperm be retrieved from my bladder and is used for the treatment of fertility?
  • My partner and I likely need to use assisted reproductive technology, such as intrauterine insemination to achieve pregnancy?
  • What is 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, do not hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor will ask you questions about your health and symptoms. Your doctor may also perform a physical examination, including the examination of his penis, testicles, and rectum. Your doctor will want to determine if your dry orgasms are retrograde ejaculation or linked to another problem that may need further evaluation.

Be prepared to answer the questions of your doctor, can save time to go through any of the points that you want to devote more time. Your doctor may ask:

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