Some men experience retrograde ejaculation, where semen enters the bladder instead of exiting through the penis during orgasm. This can happen for various reasons, including medications, nerve damage, prostate surgery, spinal cord injuries, diabetes, high blood pressure, and psychological issues. During retrograde ejaculation, the man may feel little to no pleasure, and his urine may be cloudy. To diagnose it, the doctor will examine him and order tests to check for abnormalities in hormones, sperm count, prostate function, and neurological response. Treatment options include lifestyle changes such as quitting smoking, losing weight, and avoiding caffeine; medication adjustments; pelvic floor exercises; penile rehabilitation; and surgery. Retrograde ejaculation does not usually affect fertility, but if the man wants to father children, he may need to undergo IVF. The condition is uncommon, occurring in approximately 1% of all males. It is more likely after age 50, and those with diabetes or multiple sclerosis are at higher risk. Men should talk to their healthcare provider about any concerns regarding retrograde ejaculation.
What is Retrograde Ejaculation?
Retrograde ejaculation occurs when semen travels backward into the bladder instead of out of the body. When a man has an orgasm, muscles in the pelvis tighten, causing a valve called the internal urethral sphincter to close off the opening between the bladder and urethra, preventing urine from entering the penis while allowing sperm to pass through during ejaculation. However, in some cases, this process goes awry, and the semen enters the bladder rather than exiting the penis. This can happen due to various reasons, including nerve damage, spinal cord injury, prostate surgery, high blood pressure, diabetes, and medications like antidepressants, antipsychotics, alpha-blockers, and certain sedatives.
Why Does Retrograde Ejaculation Occur?
The causes of retrograde ejaculation vary depending on the individual's medical history and current physical state. Some common factors that can lead to the condition include:
Medication Side Effects - Certain drugs used for treating depression or psychosis may cause the internal urethral sphincter to weaken, resulting in semen leaking into the bladder instead of being released through the penis. These drugs include tricyclic antidepressants (such as amitriptyline), selective serotonin reuptake inhibitors (SSRIs) such as Prozac or Zoloft, dopaminergic agents (like pramipexole), and antihypertensives like tamsulosin and terazosin.
Prostate Surgery - A man who has undergone a procedure involving his prostate gland is at risk of developing retrograde ejaculation since it could have damaged the neurological pathways responsible for controlling ejaculation.
Spinal Cord Injuries - Damage to the central nervous system caused by an accident or illness can disrupt communication between the brain and the body, leading to problems with muscle control and causing retrograde ejaculation.
Diabetes - Diabetes affects the nerves throughout the body, including those involved in sexual arousal and orgasm, increasing the likelihood of retrograde ejaculation.
High Blood Pressure - Elevated blood pressure can put additional strain on the internal urethral sphincter, making it more likely to relax when it shouldn't during orgasm.
Pelvic Floor Weakness - Men who suffer from urinary incontinence or other pelvic floor issues may be susceptible to retrograde ejaculation due to weakened muscles in that area.
What Are The Symptoms Of Retrograde Ejaculation?
Men experiencing retrograde ejaculation may notice several symptoms, including:
Little To No Pleasure During Sex - Because semen does not exit the body as intended, men with retrograde ejaculation often report feeling little to no pleasure during orgasm. This can lead to decreased interest in sex and erectile dysfunction over time.
Cloudy Urine After Sex - Since semen mixes with urine in the bladder, a man's urine may appear cloudy immediately following orgasm. He may also notice a bitter taste after ejaculating.
Rarely, men may experience urinary tract infections (UTIs) or kidney stones if semen is left in their bladders for extended periods. In addition, they may become pregnant if they are trying to conceive naturally since sperm will remain within the bladder instead of being expelled outside the body.
Diagnosing Retrograde Ejaculation
If you suspect you have retrograde ejaculation, your healthcare provider will perform a physical examination and order tests to rule out other conditions. These tests may include blood work to check hormone levels, sperm count, prostate function, and neurological response. They may also recommend an ultrasound scan to view the prostate gland or urethra, imaging studies like CT or MRI scans to visualize the pelvic floor muscles, or electromyography to measure nerve impulses associated with sexual arousal.