Retrograde ejaculation is one cause of a “dry” orgasm. It occurs when the ejaculate doesn’t exit through the penis but is instead pushed backward into the bladder. It’s often discovered when fertility tests are being performed. Retrograde ejaculation is a potential side effect of certain treatments for prostate health concerns, including some medications and surgery for an enlarged prostate. If you’re not trying to conceive, you may be wondering if you should be worried about it.

What Causes Retrograde Ejaculation, And Should I Worry?

There are many potential causes for retrograde ejaculation. Among them are treatments for benign prostatic hyperplasia, diabetes, and certain medications. Alpha-blockers used for an enlarged prostate, such as tamsulosin and silodosin, are common culprits, and some antidepressants and antipsychotic medications can also affect ejaculation. Those who may experience this condition are those who:

  • Have undergone urethra or prostate surgery
  • Have diabetes or multiple sclerosis.
  • Have had surgery on, or have injured, their spinal cord
  • Have had surgery on their rectum or colon
  • Have deformities in their urethra
  • Are taking certain medications

These have been identified as the most frequent cause of retrograde ejaculation. If you’re wondering if you are experiencing this condition, look for the following symptoms:

  • Low levels of semen produced when ejaculating
  • Your urine is cloudy following an orgasm
  • You’re struggling with fertility issues

The physical cause of retrograde ejaculation occurs with the bladder sphincter. This sphincter closes to ensure that semen can leave the body without combining it with urine. When this sphincter is malfunctioning, this area, known as the bladder neck, remains open. This allows the ejaculate to back up into the bladder rather than exiting the body. This condition is neither harmful nor painful. As a result, your provider may indicate there’s no need for treatment if you’re not trying to conceive.

In cases where it’s determined that treatment is appropriate or desired, the first step is often adjusting or stopping a medication that may be responsible, which frequently restores normal ejaculation. Your provider may also prescribe medications that help close the bladder neck, such as pseudoephedrine, imipramine, or the antihistamine chlorpheniramine. These can help when the cause is nerve-related, as in diabetes, but retrograde ejaculation after prostate surgery often cannot be reversed. For men trying to conceive, sperm can often be retrieved from the urine for assisted reproduction. In most cases, no treatment is required unless the patient is trying to conceive.

Retrograde ejaculation is also closely linked to the treatment of an enlarged prostate. The majority of enlarged prostate cases are the result of a condition known as benign prostatic hyperplasia, a non-cancerous enlargement of the prostate common in aging men. Some BPH medications, particularly alpha-blockers, and surgical procedures such as TURP commonly cause retrograde ejaculation, so if preserving ejaculation matters to you, discuss this with your urologist when choosing a treatment.

Speak To Your Specialist To Learn More

If you’re experiencing symptoms of retrograde ejaculation, it’s time to reach out to your prostate specialist. They’ll proceed to perform a full examination and provide consultation on what the next steps you take should be. Treatment of this condition is often simple and doesn’t require surgery. Because a low volume of semen can occasionally have other causes, such as a blockage of the ejaculatory ducts, a proper evaluation is important. Don’t take chances with your health; get seen if you have symptoms.

Sources

  1. Disorders of Ejaculation: An AUA/SMSNA Guideline (2020). American Urological Association / SMSNA, 2020.
  2. EAU Guidelines on Sexual and Reproductive Health. European Association of Urology.
  3. The role of benign prostatic hyperplasia treatments in ejaculatory dysfunction. Fertil Steril, 2021.
  4. Effects of acute treatment with tamsulosin versus alfuzosin on ejaculatory function in normal volunteers. J Urol, 2006.
  5. Retrograde ejaculation: MedlinePlus Medical Encyclopedia. MedlinePlus (U.S. National Library of Medicine).

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