Retrograde Ejaculation: Means, Treatment, Causes & Symptoms

Retrograde ejaculation means semen going backwards into the bladder instead of leaving the body through the tip of the penis during an orgasm. In males, the urethra (a tube that connects the urinary bladder to the exterior of the body) helps in both the passing of urine and the ejaculation of sperm. 

Patients with retrograde ejaculation don’t face any problems regarding erection or reaching climax. It only affects the patient’s ability to ejaculate. Retrograde ejaculation symptoms include:

1. Dry Orgasms - Little or no ejaculation upon orgasm
2. Cloudy urine after orgasm due to the presence of semen
3. Male infertility - Inability to get a woman pregnant

Before learning about retrograde ejaculation causes, it is important to understand how ejaculation occurs. 
How Does an Ejaculation Occur? 

1. Ejaculation is triggered during sexual climax and is controlled by the central nervous system. One of the critical phases of the male orgasm involves the contraction of the vas deferens (the long muscular tube that transports the mature sperm to the urethra for ejaculation) to move the sperm to the prostate gland, which releases other secretions. These secretions and sperm together make semen. 
2. Near the neck of the bladder, there is a muscle or sphincter that contracts at the time of orgasm to prevent the semen from entering the bladder so that it can pass through the tip of the penis. In case of retrograde ejaculation, this muscle fails to contract, and the semen gets pushed back into the bladder. 

The failure of this muscle to contract can happen due to many reasons, such as, 

1. The patient has undergone any of the following surgeries:
   1. Bladder neck surgery
   2. Retroperitoneal lymph node dissection for cancer treatment 
   3. Prostate surgery 
   4. Pelvic or rectal surgery 
   5. Transurethral resection of the prostate - causes damage to the bladder valve
2. Nerve damage caused due to any of the following conditions:
   1. Diabetes 
   2. Multiple sclerosis
   3. Parkinson’s disease
   4. Spinal cord injury 
3. Structural issues related to the urethra. 
4. Side effects of certain medications used to treat high blood pressure and some prostrate conditions.  
5. Dry orgasm is usually the symptom of Retrograde ejaculation, but there could be several other underlying reasons, such as:
   1. Prostatectomy - surgical removal of the prostate 
   2. Cystectomy - surgical removal of the bladder 
   3. Radiation therapy used to treat cancer in the pelvic region 

Risk factors for retrograde ejaculation may include even the most common health conditions like diabetes. Other than the health conditions, any factor that hinders the bladder neck (internal vesical sphincter) contraction can lead to dry orgasm. 
The following risk factors can inhibit the contraction of the bladder neck, causing retrograde ejaculation:

1. Diabetes or multiple sclerosis 
2. Prostate or bladder surgery 
3. Taking anti-depressants or medicines that are used to treat high blood pressure 
4. A spinal cord injury 

There is no specific way to prevent retrograde ejaculation. But managing the health conditions and finding substitutes for medicines that increase the risk of retrograde ejaculation can be helpful in its prevention. To prevent retrograde ejaculation, one must strictly follow the guidelines mentioned below:

1. In the case of diabetes, it is crucial to maintain steady blood sugar levels. 
2. If the patient takes medications that can lead to retrograde ejaculation, he must consult a doctor to find substitutes to reduce the risk.
3. If the patient needs to undergo any surgery that can affect the bladder neck muscle, such as prostate or bladder surgery, he must consult the doctor about the risks involved. 
4. If the surgery can increase the risk of retrograde ejaculation, the patient can talk to the doctor about preserving semen so that future attempts for conception don’t get affected.

Retrograde ejaculation is not a life-threatening condition, but it may be psychologically distressing, especially for those planning to have children. As mentioned earlier, dry ejaculation may be the symptom of some other underlying medical condition. So, if the patient has been experiencing frequent dry orgasms, it is better to consult a doctor for a diagnosis. The diagnosis of retrograde ejaculation may involve:

1. Physical examination :  to check for any abnormalities in the penis, testicles, and rectum. 
2. Urine Sample : The doctor may ask the patient to provide a sample of his urine right after orgasm to identify the presence of semen in it. This examination is usually carried out in the hospital or doctor’s office. For the test, the patient needs to empty the bladder, masturbate to reach the climax, and provide a urine sample for examination. If the laboratory tests detect any presence of fructose in the urine, it may indicate the risk of retrograde ejaculation. The lab also counts the number of sperms in the urine to confirm the condition.
3. Semen samples : The doctor may also ask for a semen sample. If there is little or no production of semen in at least two samples, the patient can have retrograde ejaculation. 

However, if during the examination of urine, the doctor doesn’t detect the presence of semen in the urine, it may indicate some other unaddressed health condition that is inhibiting semen production. These conditions may include damage to the prostate or other semen-producing glands due to surgery. In this case, the patient may require other tests to diagnose the problem.

The patient doesn’t require any treatment for retrograde ejaculation unless he is trying to conceive with his partner. To treat dry orgasms and improve fertility, the doctor suggests treatment depending on the underlying cause. The treatment often involves non-invasive techniques, either with the help of certain drugs or other infertility treatment options discussed later in this section. 

1. Home Remedies :The patient can try Kegel exercises to strengthen the muscles that control urination. These exercises are done by squeezing and releasing the muscles that help in ejaculation and urination. The patient can identify these muscles by stopping and starting the flow of urine while peeing. 
2. Medication: 
   1. Retrograde ejaculation treatment often involves medications if it is caused due to nerve damage. Diabetes, multiple sclerosis, and some surgeries can lead to this nerve damage. The medicines help in contracting the bladder neck muscles during ejaculation. 
   2. However, in some cases, surgeries like bladder neck treatment or the transurethral resection of the prostate can cause permanent alterations or damage to the patient’s anatomy. In this case, medications will not be able to treat the condition.  
   3. Medications are often considered the most effective treatment for retrograde ejaculation, but these medications can cause side effects like increase in blood pressure and heart rate. 
   4. If these medicines don’t help treat retrograde ejaculation, the patient can discuss other infertility treatment options with the doctor. 
3. Infertility Treatment 
   1. There are other ways to treat retrograde ejaculation if medicines are not helping semen ejaculation. If the patient is trying for a baby, the ejaculation of a sufficient amount of semen is vital to carry sperm in the uterus of the female partner through the vagina. For this, the patient may require infertility procedures known as assisted reproductive technology to achieve pregnancy. 
   2. These methods can involve recovering sperms from the bladder and processing them in the laboratory to inseminate the partner. This method is known as intrauterine insemination. There are more advanced methods of treatment available to achieve pregnancy. 

Retrograde ejaculation doesn’t hinder orgasm or erection. The patient having this condition would not cause any pain or distress while having an orgasm. But there may be some potential complications, such as:

1. Emotional Distress - If dry ejaculation causes the patient to worry, it can interfere with sexual pleasure. 
2. Male Infertility - Inability to achieve pregnancy with a female partner. 

When to consult a doctor for Retrograde Ejaculation?

1. If the patient is experiencing frequent dry orgasms, consulting a doctor becomes necessary to rule out any underlying health condition that may need medical attention. 
2. If the patient and his partner have been trying for a child for more than a year and have been unsuccessful in conceiving, they must talk to a doctor to identify if retrograde ejaculation is the reason. 

As already mentioned in the article, retrograde ejaculation is not a life-threatening condition. However, it can cause male infertility. The stress that is caused due to dry orgasms can also lower emotional and physical satisfaction.