Retrograde Ejaculation

Occurring in less than 1% of men with fertility problems, retrograde ejaculation can make it very difficult for a couple to conceive. While it has no health implications, men affected by this condition have their sperm diverted from their ejaculate to the bladder during orgasm.

Retrograde ejaculation can be caused by diabetes, prostate or bladder surgery, spinal cord injuries, or taking certain medications, like high blood pressure or mood altering medications. Because these conditions or medications can weaken the nerves in the bladder neck, the bladder fails to close during climax. Instead of exiting through the urethra as it would normally, the semen enters the bladder.

Signs of this condition include having cloudy urine after ejaculating, little to no semen during ejaculation and possibly infertility. Depending on the cause of the retrograde ejaculation, the condition may or may not be treatable. If certain medications are the reason for the ejaculatory problems, discontinuing their usage will often restore fertility.

However, when retrograde ejaculation is the result of a chronic condition or surgery, little can be done to treat it. Pregnancy may still be possible, though, through intracytoplasmic sperm injection and in vitro fertilization.

Definition

Retrograde ejaculation is when semen goes into the bladder rather than out of your penis during orgasm. Although you still reach sexual climax, you may ejaculate very little or no semen (dry orgasm). Retrograde ejaculation isn't harmful, but it can cause fertility problems.

Retrograde ejaculation can be caused by medications, health conditions or surgeries that affect the nerves or muscle that control the bladder opening. If retrograde ejaculation is caused by a medication, stopping the medication may be effective. For retrograde ejaculation due to a health condition or as a result of surgery, treatment with medications may restore normal ejaculation and fertility.

What Is It?

Affecting less than 1% of infertile men, retrograde ejaculation refers to a condition whereby sperm flows backwards into the bladder, rather than forward and out of the body, during ejaculation. Normally during climax, the bladder neck is closed off to stop sperm from flowing into the bladder while at the same time preventing urine from mixing with the ejaculate.

In men that suffer from retrograde ejaculation, the nerves that help the bladder neck to close off are weakened, resulting in the failure to close off the bladder neck when a man orgasms. Therefore, semen enters into the bladder rather than exiting the body through the urethra.

Symptoms

Retrograde ejaculation does not affect your ability to get an erection or have an orgasm ó but when you climax, semen goes into your bladder instead of coming out of your penis. Retrograde ejaculation can cause:

  • Dry orgasms or orgasms in which you ejaculate very little semen out of your penis

  • Urine that is cloudy after orgasm because it contains semen

  • Male infertility

Normally during ejaculation, sperm from the testicles is carried through a tube called the vas deferens until it mixes with fluid from the semen glands and prostate. The muscle at the opening of the bladder (bladder neck) should contract or tighten to prevent the semen from entering the bladder as it passes through the tube inside the penis (urethra). This is the same muscle that holds urine in your bladder until you urinate. With retrograde ejaculation, the bladder neck muscles don't tighten properly. As a result, sperm can enter the bladder instead of being ejected out of the penis.

Causes

Several conditions can cause problems with the muscle that closes the bladder during ejaculation. These include:

  • Surgery such as retroperitoneal lymph node dissection, bladder neck surgery or prostate surgery

  • Side effect of certain medications used to treat high blood pressure, prostate enlargement and mood disorders

  • Nerve damage caused by a medical condition such as diabetes, multiple sclerosis or a spinal cord injury

Retrograde ejaculation has several possible causes, including:

  • Damage from surgery to the muscles of the bladder, or to the nerves that control these muscles ? This damage can occur as a complication of the following surgical procedures:

  • Prostate surgery ? Men who have had a transurethral prostatectomy (removal of prostate tissue through the urethra) have a 10-15 percent chance of retrograde ejaculation. A prostatectomy (surgery to remove the entire prostate gland, either for cancer or benign enlargement) has a 40 percent to 90 percent chance of retrograde ejaculation after the procedure.

  • Surgery on certain parts of the bladder

  • Extensive pelvic surgery, especially to treat cancer of the prostate, testicles,colon or rectum

  • Staging surgery for cancer in the pelvis or lower abdomen (this surgery removes lymph nodes in the pelvis and lower abdomen to help determine how far cancer has spread)

  • Certain types of surgery on the discs and vertebrae of the lower spine

Nerve damage caused by medical illness?

This is especially common in men with multiple sclerosis or with long-term, poorly controlled diabetes.

Side effects of medication?

Certain medications can interfere with the function of nerves that control the muscles involved in ejaculation. They include:

  • Psychiatric medications ? amitriptyline (Elavil), amoxapine (Asendin), chlorpromazine (Thorazine), thioridazine (Mellaril)

  • Drugs for treating prostate enlargement ? tamsulosin (Flomax) or terazosin (Cardura)

  • Certain drugs to treat high blood pressure ? guanethidine (Ismelin), reserpine (Serpasil)

  • Retrograde ejaculation does not interfere with a man's ability to have an erection or to achieve orgasm, but it can cause infertility. because the sperm cannot reach the woman?s uterus. Retrograde ejaculation is responsible for about one percent of all cases of male infertility in the United States.

Risk Factors

You're at increased risk of retrograde ejaculation if:

  • You have diabetes, especially if you have diabetic nerve damage

  • You have had prostate or bladder surgery

  • You take certain medications for high blood pressure or a mood disorder

  • You sustained a spinal cord injury

Complications

Retrograde ejaculation is not harmful. The only complication is difficulty getting your partner pregnant. Some men with retrograde ejaculation may find orgasm less pleasurable.

Tests And Diagnosis

To diagnose retrograde ejaculation, your doctor will look for sperm in your urine with a microscope after you ejaculate.

If you have a dry orgasm, but your doctor doesn't find semen in your bladder, you may have a problem with semen production. This can be caused by damage to the prostate or semen-producing glands as a result of surgery or radiation treatment for cancer in the pelvic area

Prevention

If you need to have surgery that may affect the bladder neck muscle, such as prostate or bladder surgery, or if you have a spinal injury, there's little you can do to prevent retrograde ejaculation. However, there are things you can do to prevent retrograde ejaculation caused by nerve damage from diabetes or the use of certain medications.

If you have diabetes, work with your doctor to keep your blood sugar under control.

If you're taking medications for high blood pressure or a mood disorder, ask your doctor if they may cause retrograde ejaculation. You may be able to take another medication instead, or change doses.

 In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events and psychological factors, including a strict religious background that causes the person to view sex as sinful. Premature ejaculation, the most common form of sexual dysfunction in men, often is due to nervousness over how well he will perform during sex. Certain drugs, including some anti-depressants, may affect ejaculation, as can nerve damage to the spinal cord or back.

Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backward and into the bladder. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medications, particularly those used to treat mood disorders, may cause problems with ejaculation. This generally does not require treatment unless it impairs fertility.

Treatment

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