Ejaculation problems

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What is retrograde ejaculation?

Retrograde ejaculation is when semen travels backwards and enters the bladder when you have an orgasm, instead of going forward, out through the penis.

The prevalence of retrograde ejaculation among all men is not known, but about 1 in 200 men with fertility problems have the condition.

Retrograde ejaculation is more likely to occur in men who:

  • Use some types of medications
  • Have undergone some surgical procedures
  • Have medical conditions that affect nerve function.

Symptoms of retrograde ejaculation

If you have retrograde ejaculation, you might notice you have very little or even no ejaculate when you reach orgasm. You might also notice your urine is cloudy when urinating after orgasm.

Causes of retrograde ejaculation

Normally when you orgasm and ejaculate, the muscle at the base of the bladder contracts so semen in the urethra travels out through the penis. If this does not occur, or if the muscle does not close off the bladder outlet completely, semen can flow ‘backwards’ into the bladder.

This can be caused by a number of things, including:

  • Some medicines, including some types of antidepressants and drugs used to treat urinary symptoms associated with benign prostatic hyperplasia (BPH)
  • Neurological conditions such as multiple sclerosis, Parkinson’s disease and stroke
  • Surgical procedures that affect the nerves involved in orgasm and ejaculation
  • Nerve damage due to diabetes
  • Surgery to treat BPH.

In some cases, there are anatomical causes of retrograde ejaculation (for example, developmental abnormalities).

Diagnosis of retrograde ejaculation

To diagnose retrograde ejaculation, your doctor will ask you some questions, perform an examination, and request a urine sample that’s collected after orgasm. This sample, including any semen present, will be sent to a specialised laboratory for testing.

Medical imaging may be used to look for a possible blockage of the reproductive system that’s preventing semen passing through, or reasons why semen production might be affected.

Treatment of retrograde ejaculation

Retrograde ejaculation is usually treated successfully with medications taken in tablet form, but these can cause side effects. Surgery is rarely used to treat retrograde ejaculation.

Health effects of retrograde ejaculation

Retrograde ejaculation does not have serious implications for your health, but it may reduce your fertility.

If your fertility is affected by retrograde ejaculation and medications are not effective, there are several ways of collecting sperm for use in in-vitro fertilisation (IVF).

What to do about retrograde ejaculation

If you have a very small volume (less than 1-2 ml) of ejaculate, or no ejaculate at all, you should see your doctor about it. Although retrograde ejaculation itself is not a serious health problem, it can be caused by conditions that require treatment.

If you have retrograde ejaculation and are having trouble conceiving a pregnancy, your doctor can refer you to someone who can help

What questions should I ask my doctor about retrograde ejaculation?

  • What are the side effects of treating my retrograde ejaculation?
  • Would it be OK if I did nothing about my retrograde ejaculation?
  • What can I do about having a baby if I have retrograde ejaculation?
  • Is there anything I should look out for if I have retrograde ejaculation?