What Is Retrograde Ejaculation? – Causes & Treatment

By BSc, MSc (embryologist), MD (gynecologist) and (invitra staff).
Last Update: 01/28/2021

Men who suffer from retrograde ejaculation do not expel their semen to the outside through the urethra but ejaculate inside the bladder.

This condition does not cause pain in men or pose a risk to male health. However, retrograde ejaculation affects a man's fertility and can also trigger emotional disturbances.

Therefore, it is essential to visit a urologist if he wants to have offspring but has problems with ejaculation. The specialist will request the relevant diagnostic tests and establish the best fertility treatment.

Definition of retrograde ejaculation

Retrograde ejaculation is a post-testicular disorder characterized by the return of semen to the bladder. Therefore, the sperm does not come out through the urethra as is usually the case. This disorder affects a man's reproductive ability but has no additional effect on his health.

Retrograde ejaculation normally happens in men who had previous surgery on the prostate. However, this is not the only reason. Diseases such as diabetes, multiple sclerosis, etc. can also cause retrograde ejaculation.

Nonetheless, retrograde ejaculation is not related to the amount of sexual fulfillment. Therefore, men with retrograde ejaculation will continue to have erections and to reach a climax.

Symptoms

The main symptom of retrograde ejaculation is a lower than normal ejaculate volume. The World Health Organization (WHO) sets a reference value of more than 1.5 mL of seminal volume after several days of abstinence.

However, the seminal volume in those men with retrograde ejaculation may be less than 1 mL or even not have ejaculated after reaching orgasm. When no semen is released after orgasm, we speak of dry orgasm.

Semen that does not go through the urethra takes an alternative route. This means that the semen travels to the bladder and mixes with the urine, so it will be expelled at urination.

In summary, the most common symptoms of retrograde ejaculation are as follows:

  • Dry orgasms.
  • Cloudy urine due to the presence of sperm.
  • Infertility in the male.

Apart from these symptoms, retrograde ejaculation will not cause any other problems in the man's health or in the ability to have an erection and an orgasm.

Causes of retrograde ejaculation

When the man experiences the highest satisfaction in a sexual relationship and reaches orgasm, it is necessary to close the sphincter of the bladder once the semen has passed through it.

Males with retrograde ejaculation have a problem in the bladder sphincter. This sphincter does not close properly, so the semen is not able to pass through the urethra and has to back up into the bladder.

The following are reasons why retrograde ejaculation can occur in men:

  • Nerve damage from diabetes, multiple sclerosis, or spinal cord injury.
  • Side effects of the administration of certain medications used for hypertension and depression.
  • Surgery on the prostate or urethra.

In any case, it is best to consult your doctor if you are taking any of these types of medications or have health problems to reduce the risk of retrograde ejaculation.

Diagnosis

When the male realizes that he is suffering from dry orgasms or that he has little seminal volume in his ejaculations, it is convenient to visit a specialist. Taking a complete medical history that includes the history and symptoms described by the patient is the first step towards a diagnosis. The doctor will then do a physical exam of the penis and testicles.

In addition, other complementary tests may include analyses of neuronal function to assess sensitivity, motor skills, and sexual response. He will also study the urine for sperm after orgasm.

Based on the set of results of all medical tests, the specialist will be able to establish whether the patient has retrograde ejaculation.

Medical treatment

In general, men with retrograde ejaculation do not need specific treatment for this disorder. However, it will be important to assess whether the condition is due to the administration of drugs. In this case, the doctor may indicate withdrawal or change the medication to avoid the side effect of retrograde ejaculation.

When there are spinal and nerve injuries, the specialist may prescribe drugs such as imipramine or pseudoephedrine. The goal of these medications is to maintain the tone of the sphincter muscle of the bladder.

Pregnancy with retrograde ejaculation

Retrograde ejaculation is not considered a disease but a disorder with consequences for male fertility. It is difficult for these men to get their partners pregnant naturally since most or all of their sperm is in the urine.

There are numerous treatment options for achieving pregnancy. The most commonly used in the fertility clinic is that the man, after a few days of abstinence (2 to 4 days) and with an empty bladder, masturbates to see if he can collect some ejaculate in a jar. If he is able to do so, the seminal sample will be analyzed in the laboratory.

In addition, it is recommended that the man consume bicarbonate (about 4 grams) a few days before the sample collection in order to protect the sperm from the urine.

Regardless of whether he has collected a semen sample, the man should obtain the urine after masturbation. This is where most of the sperm is found.

These spermatozoa are separated from the urine and treated in the laboratory so that they can be used in a fertility treatment that is fitted to the patient's concentration and sperm mobility.

Artificial insemination or in vitro fertilization will most likely be sufficient to achieve a pregnancy in those patients suffering from retrograde ejaculation. Otherwise, if the quality of the sperm obtained in the laboratory is poor, another alternative would be to resort to fertility treatment with donor sperm.

FAQs from users

Is pregnancy possible with retrograde ejaculation?

By Sergio Rogel Cayetano MD (gynecologist).

The answer is yes.

When a man suffers from retrograde ejaculation, there is a failure that causes semen to exit the urethra and not enter the bladder. Therefore, these men will be able to achieve orgasm without any problem, but some or usually all of their sperm, will not come out, so the main symptom is the onset of orgasm without ejaculation.

In these situations it will be necessary to resort to assisted reproduction techniques to achieve pregnancy.
Read more

Is retrograde and retarded ejaculation the same thing?

By Marta Barranquero Gómez (embryologist).

No. Retrograde and delayed ejaculation are different terms. In particular, retrograde ejaculation is a condition present when a man masturbates and has sex. His semen does not come out through the urethra, but returns to the bladder and mixes with the urine.

Delayed ejaculation, on the other hand, only occurs when the man has sex. This is a sexual dysfunction in which the man is not able to ejaculate and takes a long time to reach orgasm. However, men with delayed ejaculation have no problems when masturbating unlike in retrograde ejaculation.

Does retrograde ejaculation affect sex life?

By Marta Barranquero Gómez (embryologist).

No. Men who have retrograde ejaculation can achieve erection and climax. However, a man's reproductive capacity is affected.

Furthermore, retrograde ejaculation can also lead to psychological disorders and lower self-esteem.

Can retrograde ejaculation be prevented?

By Marta Barranquero Gómez (embryologist).

The only way to prevent this condition will depend on what is causing the retrograde ejaculation. If this disorder is due to diabetes, it is best to have control of your blood sugar levels.

In cases of retrograde ejaculation caused by taking medication, the doctor may modify the protocol and change these drugs to avoid the condition.

Suggested for you

Retrograde ejaculation is a problem of post-testicular factor male infertility, but it is not the only one. If you want to know about all of them, you can visit this link: Male infertility due to post-testicular factor.

As we have already mentioned, one reproductive option for those males with retrograde ejaculation is In Vitro Fertilization (IVF). If you are interested and want to know the probability of pregnancy of this fertility treatment, you can visit this article: What is the success rate of in vitro fertilization (IVF)?

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Barak S, Baker HWG. Clinical management of male infertility. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 141.

Bolu A, Akgün A, Öznur T, Çelik C. Low-dose clozapine-induced retrograde ejaculation. Psychiatry Clin Neurosci. 2018 Jul;72(7):541-542. doi: 10.1111/pcn.12674.

Hershlag A, Schiff SF, DeCherney AH. Retrograde ejaculation. Hum Reprod. 1991 Feb;6(2):255-8. doi: 10.1093/oxfordjournals.humrep.a137317.

Koren G, Koren D. Retrograde Ejaculation-a Commonly Unspoken Aspect of Prostatectomy for Benign Prostatic Hypertrophy. Am J Mens Health. Mar-Apr 2020;14(2):1557988320910870. doi: 10.1177/1557988320910870.

Niederberger CS. Male infertility. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 24.

Yavetz H, Yogev L, Hauser R, Lessing JB, Paz G, Homonnai ZT. Retrograde ejaculation. Hum Reprod. 1994 Mar;9(3):381-6. doi: 10.1093/oxfordjournals.humrep.a138513.

FAQs from users: 'Is pregnancy possible with retrograde ejaculation?', 'Is retrograde and retarded ejaculation the same thing?', 'Does retrograde ejaculation affect sex life?' and 'Can retrograde ejaculation be prevented?'.

Read more

Authors and contributors

 Cristina Mestre Ferrer
Cristina Mestre Ferrer
BSc, MSc
Embryologist
Bachelor's Degree in Biological Sciences, Genetics & Human Reproduction from the University of Valencia (UV). Master's Degree in Biotechnology of Human Assisted Reproduction from the UV and the Valencian Infertility Institute (IVI). Embryologist at IVI Barcelona. More information about Cristina Mestre Ferrer
 Sergio Rogel Cayetano
Sergio Rogel Cayetano
MD
Gynecologist
Bachelor's Degree in Medicine from the Miguel Hernández University of Elche. Specialist in Obstetrics & Gynecology via M. I. R. at Hospital General de Alicante. He become an expert in Reproductive Medicine by working at different clinics of Alicante and Murcia, in Spain, until he joined the medical team of IVF Spain back in 2011. More information about Sergio Rogel Cayetano
License: 03-0309100
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

Find the latest news on assisted reproduction in our channels.