Diseases & Conditions

Retrograde ejaculation

Retrograde ejaculation occurs when semen enters the bladder instead of emerging through the penis during orgasm. Although you still reach sexual climax, you may ejaculate very little or no semen. This is called a dry orgasm. Retrograde ejaculation isn't harmful, but it can cause male infertility.

Retrograde ejaculation can be caused by medications, health conditions or surgeries that affect the nerves or muscles that control the bladder opening. If retrograde ejaculation is caused by a drug you're taking, stopping the drug may be an effective treatment. For retrograde ejaculation due to a health condition or as a result of surgery, treatment with drugs may restore normal ejaculation and fertility. But treatment for retrograde ejaculation is generally only needed to restore fertility.

Retrograde ejaculation doesn't affect your ability to get an erection or have an orgasm — but when you climax, semen goes into your bladder instead of coming out of your penis. Retrograde ejaculation signs and symptoms include:

• Dry orgasms, orgasms in which you ejaculate very little or no semen out of your penis
• Urine that is cloudy after orgasm because it contains semen
• Male infertility

When to see a doctor
Retrograde ejaculation isn't harmful and requires treatment only if you're attempting to father a child. However, if you have dry orgasms, see your doctor to be sure your condition isn't caused by an underlying problem that needs attention.

If you and your partner have had regular, unprotected intercourse for a year or longer and have been unable to conceive, see your doctor. Retrograde ejaculation may be the cause of your problem if you ejaculate very little or no semen.

When you see the doctor, he or she will probably:

• Ask you a number of questions about your symptoms and how long you've had them. Your doctor may also ask about any health problems, surgeries or cancers you've had and what medications you take.
• Do a physical examination, which will likely include a full exam of your penis, testicles and rectum.
• Examine your urine with a microscope after you have an orgasm. This procedure is usually done at the doctor's office. Your doctor will check your urine after you reach a climax by masturbating. If sperm are found in your urine, you have retrograde ejaculation.

If you have dry orgasms, 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. If your doctor suspects your dry orgasm is something other than retrograde ejaculation, you may need further tests or a referral to a specialist to find the cause.

Retrograde ejaculation typically doesn't require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause. Drugs may work for retrograde ejaculation caused by certain conditions. Surgery isn't a treatment option for retrograde ejaculation.

• Drugs generally won't help if retrograde ejaculation is due to surgery that causes permanent physical changes of your anatomy. Examples include bladder neck surgery and transurethral resection of the prostate.
• Drugs may work if retrograde ejaculation is due to nerve damage. This can be caused by diabetes, multiple sclerosis, certain surgeries and other conditions and treatments.

If your doctor thinks drugs you are taking may be affecting your ability to ejaculate normally, he or she may have you stop taking them for a period of time. Drugs that can cause retrograde ejaculation include certain medications for mood disorders and alpha blockers — drugs used to treat high blood pressure and some prostate conditions.

Drugs to treat retrograde ejaculation are drugs primarily used to treat other conditions. They include:

• Imipramine, a tricyclic antidepressant
• Chlorpheniramine and brompheniramine, antihistamines sometimes used to treat cold symptoms
• Ephedrine, pseudoephedrine and phenylephrine, used in some decongestant medications

These medications help keep the bladder neck muscle closed during ejaculation. While they're often an effective treatment for retrograde ejaculation, all of these medications can cause side effects. Some of the side effects are minor, but others can be more serious.

• Some medications used to treat retrograde ejaculation can cause serious reactions when combined with other medications.
• Certain medications used to treat retrograde ejaculation can increase your blood pressure and heart rate, which can be dangerous if you have high blood pressure or heart disease.

Infertility
If you have retrograde ejaculation, you'll likely need treatment to get your partner pregnant. In order to achieve pregnancy, you need to ejaculate enough semen to carry your sperm into your partner's vagina and into her uterus.

If medication doesn't allow you to ejaculate semen, you will likely need infertility procedures known as assisted reproductive technology (ART) to get your partner pregnant. With ART, sperm can be recovered from the bladder, processed in the laboratory and used to inseminate your partner (intrauterine insemination). Occasionally, more advanced assisted reproductive techniques may be needed. Most  men with retrograde ejaculation don't have any trouble getting their partner pregnant once they seek treatment.