From the Guidelines
The presence of sperm in urinalysis without ejaculation can be considered normal in certain circumstances, as it may occur after sexual arousal, incomplete ejaculation, or nocturnal emissions. According to the updates to male infertility: AUA/ASRM guideline (2024) 1, this condition is often harmless and requires no treatment. The guideline defines various terms related to male infertility, including azoospermia, which is the absence of spermatozoa in the semen, but it does not specifically address the presence of sperm in urine without ejaculation. However, it can be inferred that spermaturia, or the presence of sperm in urine, can occur due to the connection between the reproductive and urinary systems in males.
Some possible explanations for finding sperm in urine without ejaculation include:
- Incomplete ejaculation, where sperm may remain in the urethra and get flushed out during urination
- Nocturnal emissions ("wet dreams")
- Sexual activity without ejaculation
- Retrograde ejaculation, where semen enters the bladder instead of exiting through the penis, although this condition is typically associated with other symptoms such as low-volume or absent ejaculation.
It is essential to note that if the presence of sperm in urine is accompanied by other symptoms like pain during urination, blood in urine, or pelvic discomfort, it is recommended to consult a healthcare provider to rule out other conditions such as urinary tract infection or prostate issues 1. However, in the absence of symptoms, the presence of sperm in urine without ejaculation is generally not a cause for concern.
From the Research
Presence of Sperm in Urinalysis
- The presence of sperm in urinalysis without ejaculation can be attributed to various factors, including retrograde ejaculation, which is a condition where semen enters the bladder instead of being ejected out of the body during orgasm 2, 3.
- A study published in 2012 found that the presence of sperm in postejaculate urinalysis is common in both fertile and infertile men, and it is not a definitive indicator of retrograde ejaculation 4.
- Another study published in 2005 suggested that the presence of sperm in urine does not necessarily imply retrograde ejaculation, and a retroejaculation index should be used to diagnose the condition 2.
- The use of alpha-blockers, such as silodosin, can cause ejaculatory dysfunction, including retrograde ejaculation, due to their effect on the muscles of the pelvic floor and the seminal vesicles 3, 5.
Diagnostic Considerations
- The diagnosis of retrograde ejaculation should be based on a combination of factors, including the presence of sperm in urine, semen volume, and the retroejaculation index 2.
- A study published in 2020 found that the presence of sperm in midstream urine can be used to differentiate between retrograde ejaculation and anejaculation in patients with lower urinary tract symptoms 6.
- The interpretation of postejaculate urinalysis results should be directed by whether the number of sperm in the urine could affect subsequent management, rather than relying on a specific threshold to define a positive test 4.