Retrograde Ejaculation: Signs, Symptoms, Causes, Treatment, Risk Factors, Prevention, Diagnosis

What is Retrograde Ejaculation?

Retrograde ejaculation also known as ‘Dry Orgasm’ is a term used to refer to a condition in men in which the semen goes into the urinary bladder instead of going out through the urethra. The sphincter muscles of the urinary bladder contract at the time of ejaculation, thus preventing the semen from entering into it and it goes out through urethra but if for any reason, the sphincter muscles fail to contract the semen goes into the urinary bladder leading to retrograde ejaculation.

Retrograde ejaculation can cause infertility in men. It also leads to little to no semen release during orgasm and hence is also known as dry orgasm. Retrograde ejaculation was used by males in earlier times as a primitive method of birth control which was called coitus saxonicus.

What is Retrograde Ejaculation?

Signs and Symptoms of Retrograde Ejaculation

If a person is suffering from retrograde ejaculation, he can still get an erection and have an orgasm. The three main signs and symptoms of retrograde ejaculation include:

  1. Male infertility

    Male infertility is one of the symptoms of retrograde ejaculation. So if you have been having unprotected sex with your partner for more than a year and couldn’t get her pregnant, you should see a doctor as it is likely that you may be suffering from retrograde ejaculation.

  2. Dry Orgasms

    Dry orgasms mean when you discharge little to no semen during orgasms. If such is the case, then you may be suffering from retrograde ejaculation and should definitely see a doctor. Seeing a doctor will help you in knowing whether or not it is due to retrograde ejaculation. It will also help you in rooting out any other underlying causes for your dry orgasms. Even though retrograde ejaculation is not necessarily harmful, some other conditions which also cause dry orgasms are harmful for your health.

  3. Cloudy Urine

    If your urine is cloudy especially after sexual intercourse then it could also mean you are having retrograde ejaculation. This is because the semen goes into urinary ladder during retrograde ejaculation and therefore, the next time you urinate it contains semen making it cloudy in appearance.

Causes of Retrograde Ejaculation

To understand the causes of retrograde ejaculation, you should first understand the functioning of the male reproductive system a little. In males, semen is basically made when prostate fluid from the prostate gland, seminal fluids from the seminal vesicles and lubricants from bulbourethral glands mix with sperms which get transported through vas deferens from epididymis. Mixing together these things makes semen. When a man reaches the climax during sexual intercourse, sphincters muscles of urinary bladder tighten preventing semen from entering into the urinary bladder. The semen, in turn, chooses the path of least resistance and is ejected out through urethra, a tube present inside the penis.

So retrograde ejaculation only occurs when the sphincter muscles do not work properly and this usually happens when the sphincters muscles get weak or if the nerves controlling them get damaged somehow.

Malfunctioning urinary bladder sphincter muscles may be caused by one of the following medical conditions:

Autonomic Nervous System Dysfunction or Dysautonomia

It is a condition in which the Autonomic Nervous System does not work properly which causes malfunctioning of many organs including urinary bladder which may lead to retrograde ejaculation.

Prostate Surgery

Retrograde ejaculation may occur due to transurethral resection of prostate in which prostate is removed in slices with the help of a resectoscope passed along the urethra.

Medications

Use of certain medications such as those used to treat high blood pressure, depression, anxiety and enlargement of prostate gland can cause retrograde ejaculation.

Damaged Nerves

Retrograde ejaculation may also be caused by the damaging of nerves. Nerve damage can occur as a result of injuries such as spinal cord injury. It can also be caused by Parkinson’s disease, multiple sclerosis and diabetes etc.

Other Surgeries

Some other surgeries may also result into retrograde ejaculation such as retroperitoneal lymph node dissection surgery for testicular cancer or bladder neck surgery.

Even though dry orgasms are one of the signs and symptoms of retrograde ejaculation, they can also be caused by other problems such as surgical removal of prostate gland known as prostatectomy, removal of the urinary bladder also known as cystectomy and it may also be a side effect of radiation therapy used to treat cancer especially in the pelvic area.

Diagnosis of Retrograde Ejaculation

Diagnosis of the retrograde ejaculation is most commonly done in three steps even though urinalysis is the test that can positively confirm the problem. These steps are as follows:

  • When you first consult a doctor to diagnose retrograde ejaculation, he/she will ask you about your medical history like any medical conditions that you may have such as diabetes, high blood pressure or any surgeries such as prostatectomy or cystectomy etc. He will also ask you about any cancer treatment such as radiation therapy you may have gone through or any medications that you are currently taking or may have taken in the recent past.
  • Next he will do a physical exam especially of your reproductive organs such as your penis and testicles etc.
  • Finally he will do a urinalysis to detect the presence of semen in your urine. For this purpose the doctor will ask you to empty your bladder then masturbate till you get an orgasm and then urinate again to provide a sample of your urine. This urine sample will be tested by the lab to detect the presence of semen which, if found, will mean that you are suffering from retrograde ejaculation.

If no semen or very little semen is found in you urine sample then it means your dry orgasms are due to some other problem.

Treatment of Retrograde Ejaculation

Even though retrograde ejaculation is not particularly harmful, it may cause less pleasurable orgasms due to inability to ejaculate. It may also lead to worries and performance anxiety when a man is unable to release semen during sex.

Besides these complications, retrograde ejaculation also leads to male infertility so if a couple is trying to have a baby, it will be especially problematic for them. Here are some treatments of retrograde ejaculation that may be used to treat it:

  • In most of the cases of retrograde ejaculation, certain medications are used to treat the problem.
  • If the problem of retrograde ejaculation is due to some surgical procedures such as transurethral resection of prostate or bladder neck surgery, then the medications will most probably not be effective as they are irreversible processes.
  • If the problem of retrograde ejaculation is arising due to the use of certain drugs that have been known to cause the problem of retrograde ejaculation then stopping to use those drugs will stop the problem in most of the cases. Your doctor may ask you to stop taking those drugs or they may replace them with some other drugs.
  • As discussed earlier the problem of retrograde ejaculation can also be caused by nerve damage. If retrograde ejaculation is happening due to nerve damage caused by diabetes, multiple sclerosis or some other conditions then there are certain drugs that can be used to treat the problem. These medications include Imipramine (Tofranil), Midodrine, Chlorpheniramine (Chlor-Trimeton, others), Brompheniramine (Veltane, others), Ephedrine (Akovaz, others), Pseudoephedrine (Sudafed, others) and Phenylephrine (Vazculep, others).
  • Even though these medications are helpful in treating retrograde ejaculation by keeping the urinary bladder closed with the help of sphincters muscles, they may cause some side-effects such as increased blood pressure or heart rate which may be quite dangerous for certain people such as those already suffering from these conditions.
    These adverse effects may arise due to the use of these drugs or may happen if you use these drugs in combination with some other medications.
  • In order to treat infertility caused by the problem of retrograde ejaculation, you may get fertile simply by using the above mentioned methods or you may not. If latter is the case, you can opt for various treatments used nowadays to cure infertility known as Assisted Reproductive Technology.
  • One such method to treat infertility caused by retrograde ejaculation is Intrauterine Insemination in which the male’s ejaculate is taken and centrifuged to isolate the sperms. These sperms are then injected directly into the female.
  • Sometimes, if the above mentioned methods are not enough, more advanced methods are used such as IVF or In-Vitro Fertilization commonly known as test tube baby. Many men suffering from retrograde ejaculation have been known to regain their fertility potential after getting treatment.

Risk Factors and Prevention of Retrograde Ejaculation

People who have following problems are at an increased risk of having retrograde ejaculation:

  • People who have diabetes.
  • Those who have had a prostate or urinary bladder surgery in the past.
  • Those who have multiple sclerosis.
  • People who have had a spinal cord injury or any other type of nerve damage especially of autonomic nervous system.
  • Those who have been taking medications for high blood pressure or depression or any other kind of mood disorder.
  • But even those people who are at a higher risk of retrograde ejaculation can prevent it by observing some precautions. Some of these are as follows:
  • Avoid drugs that have been known to cause retrograde ejaculation.
  • Maintaining your blood sugar levels if you have diabetes will also be helpful in preventing retrograde ejaculation.

Consult your doctor immediately if you get any of the above mentioned problems.

Intentional Use of Retrograde Ejaculation

Even though retrograde ejaculation is considered a problem by modern doctors, it is also used intentionally sometimes. Some of the cases of intentional use of retrograde ejaculation are as follows:

In Alternative Medicines

The practice of retrograde ejaculation was used in alternative medicines and Taoism. They believed that keeping the sperm inside nourishes the brain and conserves energy by preventing it to go outside unnecessarily. But modern doctors discard this belief because now we know that the semen does not go to the brain and is, in fact, excreted out with urine and therefore, in no way conserves energy.

As Contraception

As discussed earlier it was also used as a primitive contraceptive measure. This was done by applying pressure on the perineum (space between anus and scrotum) or by squeezing urethra at the base during orgasm. It is called coitus saxonicus and was practiced by many communities such as Oneida community, a community that originated in Oneida, New York.

But this type of practice is not very effective compared to modern contraceptive methods as the female can still get pregnant by pre-ejaculate and it also does not prevent sexually transmitted diseases. It is also very difficult to apply pressure at the right place during sex not to mention there is also a risk of causing numbness in penis if pudendal nerve gets pressurized.

So, if you are having dry orgasms and are having fertility issues, you should definitely consult a doctor and get urinalysis to rule out retrograde ejaculation.

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