Symptoms, Causes, and Treatment of Retrograde Ejaculation

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Symptoms, Causes, and Treatment of Retrograde Ejaculation

What is Retrograde Ejaculation

Retrograde ejaculation is a condition where semen enters the bladder instead of passing through the penis during intercourse.

Although a man can be a climax sexually, he may ejaculate very less or nothing at all. It is also called dry orgasm. Although not harmful, retrograde ejaculation can cause male infertility because there is not enough semen to fertilize the eggs and treatment

 of the condition is all that is needed to restore fertility.

Symptoms of Retrograde Ejaculation

Although retrograde ejaculation does not affect a man’s ability to erect or have an orgasm, at climax semen moves into the bladder instead of coming out of the penis.

Signs and symptoms of retrograde include:

  • Male infertility or the male inability to get his partner pregnant
  • Orgasms with very little or no ejaculation
  • Cloudy urine after intercourse due to the presence of semen

Retrograde Ejaculation Causes

A tube called the vas deferens carries sperm to the prostate during intercourse.

Sperms are mixed with other fluids there to produce liquid semen. The bladder opening has a muscle called the bladder neck muscle that tightens the bladder to prevent ejaculation (semen) from entering the bladder as it passes from the prostate into the tube inside the penis called the urethra.

This is the muscle that stops urinating in the bladder until the person urinates. 

In retrograde ejaculation, the bladder fails to tighten the neck muscles properly, resulting in sperm entering the bladder instead of exiting the man’s body through the penis.

Problems with the muscles that close the bladder during ejaculation can be caused by:

  • Surgery of the bladder neck, colon, testicles, anus, retroperitoneal lymph node dissection surgery for testicular cancer, bladder, or lower spine.
  • Side effects of some medications which are used to treat high blood pressure, prostate enlargement and depression, and some antipsychotic medications.
  • Some injuries and diseases that damage the nervous system and bladder muscles, such as multiple sclerosis, Parkinson’s or a spinal cord injury.
  • Prolonged uncontrolled blood sugar can damage organs and nerves, affect bladder muscles.
  • Surgical removal of part of the prostate due to damage to bladder muscles and nerves.

Effects on Fertility

Retrograde ejaculation is known to impact a man’s fertility. However, it is not a common cause of infertility as it only causes 0.3 to 2 percent of infertility problems.

Retrograde ejaculation also does not mean that a man’s sperm is not viable. This causes infertility because the sperm does not make it to its partner.

When to See a Doctor?

Since retrograde ejaculation is neither dangerous or painful, it usually does not require treatment. However, it may be a symptom of another underlying medical condition.

Although one should seek medical help when

  • There is no ejaculation after orgasm
  • Consistently lower than normal ejaculation after an orgasm
  • Unable to get pregnant partner even after trying for a year

Some studies have also shown that retrograde ejaculation is the first and only symptom of type 1 diabetes, so men experiencing retrograde ejaculation should consult a doctor to discuss anxiety.

Diagnosis For Retrograde Ejaculation

Retrograde ejaculation usually requires treatment if the man wants to be the father of a child. Dry orgasms are a sign to consult a doctor and ensure that the condition is not due to any underlying condition that needs attention.

Physical examination by a doctor is possible to check for obvious abnormalities. Further assessment of situations made by access to signs and symptoms such as:

  • Absence of ejaculation during orgasm
  • Cloudy urine after orgasm
  • Infertility

The doctor should be told that:

  • How long and how often they are having dry orgasms
  • Any other symptoms that may have been noticed
  • Any medicines are being taken.
  • Any pre-existing chronic disease or injury
  • Previous treatment and type of treatment for cancer

Urine tests are usually done to find out if the lack of ejaculation is because of retrograde ejaculation. Patients may be asked to masturbate before giving a urine sample. The presence of high amounts of sperm in the urine sample is a diagnostic factor for retrograde ejaculation.

For patients experiencing infertility, the absence of semen in the urine indicates semen production or some other problem. In such cases, it is advisable to consult an infertility specialist and have further investigations.

Treatment of Retrograde Ejaculation

Even though intercourse without ejaculation does not present any serious risk to health or necessarily interfere with sex life, there are plenty of reasons to consult a doctor to diagnose the cause and rule out an underlying disease.

Treatment is usually not needed unless someone is trying to be the father of a child. In such a situation, it becomes necessary to consult a fertility specialist.Although retrograde ejaculation poses no risk to health or sexual satisfaction, there are some remedies available that can be tried.

  1. If it is caused by a medication, stopping the medication should solve the problem.

However, do not stop taking prescription medicines without first talking to your doctor. However, do this after ensuring safety.

  1. The doctor considers overall health, including other conditions that may occur, before changing or prescribing medication for retrograde ejaculation. Medicines that help keep the muscles of the bladder neck constrict during ejaculation include:
  • Polaramine
  • Ephedrine
  • Brompheniramine
  • Chlorpheniramine
  • Phenylephrine 
  • Pseudoephedrine
  • Imipramine (Tofranil)
  • Midodrine

However, medications are not usually effective for severe nerve or muscle injury caused by surgery. 

Dr. Shivani Bhutani at Eva Hospital says that for couples experiencing reproductive problems due to retrograde ejaculation and where medications fail to help, it is important for a fertility specialist to obtain sperm for artificial abortion or in vitro fertilization.

The fertility specialist starts treatment after removing the sperm. If medications fail to help the man ejaculate, the doctor tries to remove the sperm without the need to ejaculate the man with surgical procedures that include:

  • Testicular sperm aspiration (TESA): A needle used under local anesthesia to remove sperm from the testicles.
  • Percutaneous epididymal sperm aspiration (PESA): Also performed under local anesthesia, the procedure relies on a needle to remove sperm from a tube that attaches to the testes known as the epididymis.
  • Testicular sperm extraction (TESE): TESE, like TESA, removes sperm directly from the testicles. However, it does require an incision in the testicles.

After successful removal of the semen, the doctor tries to help the man’s partner become pregnant in one of two ways:

  • In vitro fertilization (IVF): An egg is removed from a female and then fertilized in a petri dish. Once the fetus has grown, the doctor implants it into a woman’s uterus.
  • Intrauterine insemination (IUI): Semen is injected directly into the woman’s uterus when the woman is ovulating.

Prevention on Retrograde Ejaculation

Although retrograde ejaculation cannot be completely prevented, there are a few things to keep in mind: 

  1. Men who need treatment for an enlarged prostate should choose less invasive surgery which is less likely to cause nerve and muscle damage, like transurethral microwave thermotherapy of the prostate.
  2. Controlling nerve-damaging medical conditions can also help prevent retrograde ejaculation.
  3. Men with diabetes should manage their blood sugar levels with medication prescribed by their doctor and with appropriate lifestyle changes.


Although ejaculation is related to orgasm, not all orgasms involve ejaculation. It is not a disease or any serious threat to human health. To live comfortably with retrograde ejaculation one must learn to accept the condition and adjust to expectations.

However, sometimes retrograde ejaculation can also be a sign of an enlarged prostate, diabetes, or prostate surgery, so symptoms such as painful ejaculation, blood in the ejaculate, frequent urination, or erectile dysfunction should be reported to the doctor.  Although man has no desire to be a father of a child.

Retrograde ejaculation or dry organism is not always reversible, but the infertility it causes is treatable. Even men who can’t ejaculate at all, a fertility specialist can help. At Eva Hospital, Dr. Shivani Bhutani has extensive experience in sperm procurement

 and artificial insemination, which can help couples with reproductive problems to have a healthy baby.

Call for Appointment with Best Gynecologist in Ludhiana.

About The Author

Dr Shivani Bhutani
A doctor with a rich background and high success rate, Dr. Shivani Bhutani offers the boon of parenthood to couples dealing with infertility. She has opulent knowledge and expertise in offering successful treatment for infertility in females, gynecological disorders and family planning consultation services. Highly dedicated, concerned and attentive, Dr. Shivani understands the bliss of parenthood and offers appropriate medical help.