Retrograde ejaculation

Some features of retrograde ejaculation that may be observed and experienced by the patient include the following:

• Dry orgasms or absence of semen even after reaching orgasm.
• Cloudy urine: The presence of semen in urine can make it appear turbid or cloudy. Urine may especially appear cloudy right after sexual intercourse.
• Male infertility: Inability to have a child after prolonged attempts at conception by regularly engaging in unprotected sexual intercourse can be described as infertility. The female partner is tested for infertility as well as the male. If the female partner is found to not be infertile, the suspicion of male infertility is strengthened.

(Read more: Sexual health)

Retrograde ejaculation can occur due to many reasons including systemic diseases or nervous injuries. It can also occur as complications following surgeries done for other health issues. Some of the causes of retrograde ejaculation include:

• Congenital: Anomalies in the male reproductive tract and urinary bladder valve can be present from birth in some males. This can result in retrograde ejaculation later in life. Examples of congenital anomalies associated with retrograde ejaculation are:
  • Posterior urethral valves: Abnormal presence of valves in the urethra that can impede the expulsion of semen.
  • Utricular cysts: Utricle is a structure in the prostate gland. Anomalous cysts can be present in it since birth.
  • Exstrophy of urinary bladder: It is a rare congenital anomaly of the urinary bladder and the abdominal wall. The abdominal wall does not form and close properly in the womb, resulting in a gaping hole exposing the urinary bladder to the outside world.
• Complications following surgery: Nerve injury, especially to the thoracolumbar nerves T10-L2, following surgical operations in the region can lead to urinary bladder neck sphincter failure during ejaculation, precipitating retrograde ejaculation. Following surgeries can lead to retrograde ejaculation:
  • Urinary bladder surgery
  • Prostate cancer surgery
  • Aortoiliac vascular surgery: For abdominal aortic aneurysm repair.
  • Retroperitoneal lymph node dissection (RPLND): Following resection of a cancerous tumour, the lymph nodes that drain it may need removal. 
  • Abdominoperineal resection: A type of surgical treatment carried out for rectal cancer tumour resection.
  • Transurethral prostate resection (TURP): A special surgery done for the treatment of enlarged prostate or benign prostate hypertrophy (BPH) in which the scope inserted through the urethra can cause damage to the nerves supplying the urinary bladder neck and sphincter.
• Spinal cord trauma: Trauma to the spinal cord, especially in the lower back region (thoracolumbar spine) can damage the spinal nerves that emerge from those spinal segments. This includes the nerves which control the emission phase of ejaculation and thus the urinary bladder neck sphincter contraction.
• Systemic diseases: Diseases that affect the entire body, or have a more widespread distribution, can also affect the urinary bladder neck sphincter by exerting a detrimental effect on nerve supply. The following diseases are known to cause neuropathy and demyelination damage to nerves and have also been noted to increased the risk of developing retrograde ejaculation:
  • Diabetes mellitus
  • Multiple sclerosis
  • Parkinson’s disease
  • Myelodysplasia
  • Cerebrovascular accidents like stroke may have caused paralysis in segments supplied by the affected nerves.
• Medications: Some medicines used to treat other unrelated conditions can exert a negative effect on the urinary bladder sphincter and potentially lead to retrograde ejaculation. Some culpable medicines include, but may not be limited to: 
  • Antidepressants: Sertraline, fluoxetine, amitriptyline, etc. Used to manage mental health conditions like depression, anxiety, etc. 
  • Alpha-blockers: Prazosin, tamsulosin, etc. Alpha-blockers are drugs mainly used to treat benign prostate hypertrophy (BPH) but are also used for the treatment of hypertension sometimes.

It is important to note that while some antidepressants have the side effect of retrograde ejaculation, the condition itself is not related to psychological problems or anxiety.

Although not harmful to the patient’s health, the lack of semen on reaching orgasm could also imply some other (more serious) causes besides retrograde ejaculation. In order to rule out other causes of the absence of semen and differentiate anejaculation from retrograde ejaculation, medical assessment is necessary. If a patient has been experiencing dry orgasms for a prolonged period or has recently developed the problem, it would be prudent to speak with a doctor. Upon meeting with a doctor, a thorough medical history will be taken (laying emphasis on any past history of cancer, surgery, illnesses as well as regular medicine use) followed by a thorough physical examination (including neurological testing and assessment of the genitals to rule out any structural defects like urethral strictures). To differentiate between anejaculation and retrograde ejaculation, a urine test is conducted.

The diagnosis is mostly clinical but in order to differentiate the lack of semen at orgasm from other more serious causes, the following investigations may be carried out:

• Urinalysis: The patient is asked to masturbate in order to reach climax and then urinate immediately afterwards in order to collect a urine sample. The urine sample is tested for the presence of sperm. If sperm is present in urine, retrograde ejaculation is diagnosed and no further action may be necessary unless the patient is attempting to conceive a child with his partner, in which case, medical therapy can be attempted. However, if sperm is not present in the urine, retrograde ejaculation is highly unlikely.

There are no serious health risks or disadvantages of retrograde ejaculations. Besides dry orgasms, the act of sexual intercourse remains completely unchanged and there is no negative impact on pleasure. Retrograde ejaculation does not need to be treated unless the patient is attempting to conceive a child with his partner. The treatment outcomes are variable and depend on the underlying cause of retrograde ejaculation. While cases occurring as side effects to drug therapy can be easily reversed, those resulting from surgical complications or injuries cannot be remedied. In case the doctor suspects an offending drug is the cause of retrograde ejaculation, it may be stopped and replaced with a different medication. Some medicines have shown promising results in the treatment of reversible retrograde ejaculation.

Medical management: Some medicines that are routinely used for other conditions have found to be promising in the treatment of reversible retrograde ejaculation. By helping the urinary bladder neck sphincter to retain its tone, the following medicines help prevent the backflow of semen into the urinary bladder while ejaculating:

• Imipramine: A type of tricyclic antidepressant (TCA) that is used for the treatment of depression, panic attacks, anxiety and bedwetting. 
• Midodrine: A type of alpha-agonist (opposite action to alpha-blockers) that is used to treat autonomic nervous system dysfunction and postural hypotension (fall in blood pressure on standing). 
• Chlorpheniramine and brompheniramine: Both drugs are types of antihistamines used to treat allergies and cold.  
• Ephedrine: A central nervous system stimulant used to treat various problems. 
• Pseudoephedrine: A stimulant drug used to relieve nasal congestion.
• Phenylephrine: A common drug used to treat nasal congestion and dilate pupils of the eye.

Managing infertility: While some men are able to regain the ability to expel sufficient semen at ejaculation after medical therapy and impregnate their female partners in order to conceive children successfully, assisted reproductive technology (ART) may be needed in other cases. Treatment options vary depending on the couple and their needs and preferences. Sperm produced by men with retrograde ejaculation is generally viable and can sometimes even be extracted from the urinary bladder, processed in the laboratory and then used for artificial insemination of the female partner (intrauterine insemination). If it is not possible to retrieve the male partner’s sperm or they are unviable, another option is to seek sperm from a sperm donor. Sperm banks store and provide sperm from donors to couples in need.

(Read more: Male Fertility Test)

Retrograde ejaculation is not a health concern for the male and it does not interfere with sexual experience or pleasure. However, due to the lack of semen deposited in the female partner after sexual intercourse, problems of infertility usually arise while attempting to conceive. Male infertility related to retrograde ejaculation does not imply the unviability of sperms.

(Read more: Pregnancy)

The outcome of treatment for retrograde ejaculation depends on the underlying cause. For instance, retrograde ejaculation caused as a result of side effects from medication can be reversed by discontinuing and substituting the offending drug. However, permanent damage to the nerves (by complications of surgery or disease) cannot be reversed. However, retrograde ejaculation does not invalidate the viability of sperms and infertility treatments can help conceive a child by other means.

(Read more: In Vitro Fertilization)