Retrograde Ejaculation: When Semen Goes the Wrong Way
What Is Retrograde Ejaculation?
Retrograde ejaculation is a condition where semen travels backward into the bladder instead of exiting through the penis during orgasm. As a result, little or no semen comes out during ejaculation, even though orgasm still occurs.
What Happens Normally?
During a typical ejaculation:
- Sperm travels from the testicles through the vas deferens
- Seminal fluid is added to create semen
- A muscle at the bladder neck closes tightly to prevent semen from entering the bladder
- Semen exits the body through the urethra
In retrograde ejaculation, that bladder neck muscle doesn’t close properly, so semen flows into the bladder instead of out.
Symptoms
- “Dry orgasm” (little to no semen)
- Cloudy urine after ejaculation (due to semen in the bladder)
- Possible infertility
- Normal sex drive and erection
Causes
Retrograde ejaculation can be caused by:
Medical Conditions:
- Diabetes (especially with nerve damage)
- Multiple sclerosis
- Spinal cord injury
- Prostate surgery (e.g., TURP, bladder neck surgery)
Medications:
- Alpha-blockers (for high blood pressure or prostate issues)
- Certain antidepressants or antipsychotics
Is It Harmful?
Retrograde ejaculation is not dangerous, but it can affect fertility since sperm doesn’t reach the outside of the body.
Diagnosis
A doctor may:
- Review symptoms and medical history
- Examine a urine sample after ejaculation to check for the presence of sperm
- Conduct hormone and fertility tests if pregnancy is a goal
Treatment Options
Treatment depends on the cause and whether fertility is a concern:
If Fertility Is Not an Issue:
- Often no treatment is needed unless symptoms are bothersome.
If Trying to Conceive:
- Medication (e.g., pseudoephedrine or imipramine) may improve bladder neck closure
- Sperm retrieval from the urine can be used for:
• IUI (Intrauterine Insemination)
• IVF with ICSI (Intracytoplasmic Sperm Injection)
If Caused by Medication or Surgery:
- Adjusting medication may help
- Permanent cases (e.g., after prostate surgery) may require assisted reproductive techniques