Is Retrograde Ejaculation Harmful?

What is Retrograde Ejaculation?

Retrograde ejaculation occurs when the semen enters the bladder rather than being pushed out through the penis during an orgasm. This, however, does not affect the ability to reach ejaculation; the semen produced is very little in quantity. This occurs when the circular muscle remains open, allowing semen to flow back into the bladder.

Other names for the conditions are -

• Retro Ejaculation
• Retrograde Orgasm
• Dry Orgasm

The condition is somewhat common, and in most cases, this is not harmful, and usually does not require treatment. However, if a person is trying to start a family, it becomes important for them to seek medical help. This is because, though it does not affect the ability to have an orgasm or an erection, it may cause stress and anxiety.

What are the Symptoms of Retrograde Ejaculation?

Semen is a thick, white fluid produced by the prostate gland and seminal vesicles. It is what carries the sperm out of the body. The condition may happen after starting certain medications or any treatment procedure. There are three common symptoms of retrograde ejaculation:

• Minimal or Absent Semen: When a person reaches climax, but there’s little to no semen coming out of the penis, this is known as dry orgasm. Though the physical sensation remains normal, the absence of the fluid is the primary sign that the semen has been redirected into the bladder.
• Cloudy Urine After Climax: One may notice that their urine appears murky or hazy during their first bathroom visit after a sexual activity. This change in the appearance is caused by the semen mixing with the urine inside the bladder.
• Male Infertility: Natural conception may become difficult, as the semen does not reach the partner to fertilise an egg.

What are the Causes of Retrograde Ejaculation?

During ejaculation, sperm are released from the testicles and move through the epididymis, a coiled tube where they mature. They then move through the vas deferens. During this phase, they mix with various seminal fluids along the way to form semen, before entering the urethra to be expelled from the body.

As urine also travels through the urethra, the neck of the bladder constricts during an orgasm. This makes sure that the semen leaves the body and is not misdirected. However, when the bladder neck does not close properly, ejaculate can move upward into the bladder.

Factors causing dysfunctional bladder neck muscles are:

• Prostate or bladder surgeries
• Radiation therapy to treat pelvic cancer
• Nerve damage that is caused by diabetes, multiple sclerosis, or spinal cord injury
• Side effects of medication for high blood pressure, mood disorders, and prostate enlargement can cause the urinary tract muscles, including the sphincter muscle, to contract.

Is Retrograde Ejaculation Harmful?

Retrograde ejaculation is not considered harmful to physical health or overall well-being. It is a functional issue rather than a serious medical condition. Though semen enters the bladder, it does not cause any harm to the urinary tract or the bladder.

However, the “harm” associated with the condition is usually psychological or related to specific life goals. Some may experience anxiety or distress due to a lack of fluid, which leads to stress and concerns when the cause is unclear.

Does Retrograde Ejaculation Impact Fertility?

The major consequences of retrograde ejaculation are its impact on male fertility. As the semen does not come out through the penis, it cannot reach the partner’s reproductive tract. This can significantly reduce the chances of natural conception.

The only instance this is considered and treated as a fertility concern when a person is willing to start a family. Fortunately, this can be managed easily. Specialists can often retrieve viable sperm directly from a post-ejaculatory urine sample or via minor procedures.

Once collected, the sperm can be used in assisted reproductive techniques like Intrauterine Insemination (IUI) or In Vitro Fertilisation (IVF). Thus, allowing many men with the condition to successfully father biological children.

Does Retrograde Ejaculation Go Away?

Whether retrograde ejaculation goes away depends on its underlying cause. It should be noted that the condition does not ‘resolve spontaneously’ like a cold. Rather, it is a functional issue that can either be temporary or permanent.

If the condition occurred due to a medication, it should be discontinued, or a doctor should be consulted to adjust the dosage. Similarly, if it is linked to poorly managed health conditions such as diabetes, managing blood sugar levels can help restore nerve function.

However, if it is caused due to physical changes, for example, due to scarring from prostate or bladder surgery, it is mostly considered permanent.

When to See a Healthcare Provider?

It is advised to see a healthcare provider if a person is -

• Trying to have biological children, but is unable to conceive
• Uncomfortable during orgasm
• Receiving treatment, but it isn’t working

How to Fix Retrograde Ejaculation?

Retrograde ejaculation does not require typical treatment unless a person is concerned about infertility. However, a proper diagnosis is done if an individual suspects issues with fertility. This is done to differentiate it from other conditions that cause “dry” or low-volume orgasms.

Diagnosis for Retrograde Ejaculation

The doctors may conduct a Post-Ejaculatory Urinalysis, which is done in the following steps:

• First, the person is asked to empty their bladder completely. In some cases, a healthcare provider might instill a small amount of pH-buffered solution (like Sodium Bicarbonate) into the bladder to protect the sperm from the naturally acidic environment of urine.
• Next, the person is asked to masturbate to climax. Even if no fluid is visible, it is important to reach a full orgasm.
• Next, a fresh urine sample is required. This is sent to the lab where they use a centrifuge to separate solid matter from the liquid.
• If a high volume of sperm (often defined as more than 1 million per milliliter or a significant presence per microscopic field) is found in the sediment, a diagnosis of retrograde ejaculation is confirmed.

If the urine sample contains no sperm despite a dry orgasm, the healthcare provider assesses other causes. To pinpoint the exact cause, they perform other tests, such as -

• Medical or Surgical History: Doctors may review past surgeries (like TURP or bladder neck procedures). They will also check for chronic conditions, such as Diabetes or Multiple Sclerosis.
• Medication Review: This is done to assess the use of alpha-blockers (e.g., Tamsulosin) or antidepressants that may cause relaxation of the bladder neck.
• Physical Examination: This involves examining the penis and testicles for abnormalities. A digital rectal exam, also known as DRE, may be performed to check the seminal vesicles and prostate for signs of obstruction or enlargement.
• Advanced Imaging: If an obstruction is suspected, a Transrectal Ultrasound (TRUS) may be ordered to visualise the ejaculatory ducts and look for blockages.

Treatments for Retrograde Ejaculation

Treatment is not always necessary. However, if it is necessary, treatments may vary depending on the underlying cause. Here are some treatment options that may be suggested -

Medications

Medication helps tighten the bladder neck and increase the semen output through ejaculation. This can improve the chances of pregnancy. Doctors may prescribe an antidepressant, which is primarily used to treat depression and enuresis (bed wetting), as the first line of treatment. Other medications may include -

• Antihistamine
• Nasal Decongestant
• Medicine for low blood pressure

These drugs are usually taken one to two hours before sex. Though they are quite effective in treating the condition, they may also cause side effects like drowsiness, dizziness, and blurred vision.

Note: If the retrograde ejaculation is caused by permanent damage to the prostate, then medicine may not be effective.

Infertility Treatments

If medicine is unable to help produce enough semen for natural fertilisation, then intrauterine insemination (IUI) may be recommended. The process includes collecting sperm that is transferred to the female uterus.

Sperm can be collected by inducing ejaculation, followed by immediate collection of a post-ejaculatory urine sample in a sterile container. The sample is then processed in a laboratory to isolate viable sperm. The retrieved sperm may subsequently be used for assisted reproductive techniques, such as intrauterine insemination (IUI), timed with ovulation.

While retrograde ejaculation does not make pregnancy impossible, it reduces the chance of conceiving. With procedures like IUI, the pregnancy rate per cycle increases to 24%. If IUI doesn’t work, healthcare providers may suggest IVF (in-vitro fertilisation).

Surgery for Retrograde Ejaculation

While surgery is a primary cause of retrograde ejaculation, it is rarely a treatment to fix it. Because the condition is physically harmless, most medical professionals advise against invasive procedures to reconstruct the bladder neck.

However, in specific cases where the condition is caused by anatomical defects or trauma, a surgeon may perform a bladder neck reconstruction. The procedure involves performing a bladder neck reconstruction, in which the sphincter muscle properly closes during climax.

For men who suffer from infertility, doctors may perform a Testicular Sperm Extraction. This is a minor procedure where the doctors harvest sperm directly from the testicles, which is used in IVF.

Can Retrograde Ejaculation be Prevented?

It is not always possible to prevent retrograde ejaculation. A doctor may explain the cause and the risk of the condition. In case of benign prostatic hyperplasia, minimally invasive surgery, such as prostatic urethral lift and Rezum procedure, can be done. This may reduce the risk of developing the condition.

It is best to talk to a doctor before confirming any treatment plan. Another good idea is to bank the sperm. This involves collecting, freezing, and storing the sperm cells in a healthcare facility.

Conclusion

Retrograde ejaculation outlook is good, and is not harmful to health. However, it may raise concern when a person feels uncomfortable about their performance and inability to have a child. The condition is mostly caused by a blocked bladder neck. This causes the semen to travel back into the bladder, which later comes out with the urine.

Other causes for the condition are medication and surgery. If it is caused by medication, switching or quitting the particular medicine can help reverse the condition. Talk to the healthcare provider to get a better idea of what to expect as per the situation.