From the Guidelines
Retrograde ejaculation is best managed with a combination of medication, such as SSRIs (e.g., paroxetine, sertraline, citalopram, fluoxetine) dosed daily, and pelvic physical therapy, as recommended by the most recent guidelines 1. The management of retrograde ejaculation depends on the underlying cause and the patient's fertility goals.
- For men who wish to father children, medication such as SSRIs (e.g., paroxetine, sertraline, citalopram, fluoxetine) dosed daily, or clomipramine dosed on demand, may be effective in treating the condition 1.
- Pelvic physical therapy is also a recommended treatment option for retrograde ejaculation, as it can help improve bladder neck closure and prevent semen from entering the bladder 1.
- Additionally, testosterone therapy may be indicated in some cases, particularly if the patient has low testosterone levels 1.
- For men with retrograde ejaculation due to anatomical causes, such as transurethral resection of the prostate or diabetes-related autonomic neuropathy, medication may be less effective, and fertility interventions may be necessary sooner.
- If fertility is not a concern, no treatment may be needed, as the condition is not harmful to health, although some men may pursue treatment for psychological satisfaction. It's worth noting that the guidelines from the National Comprehensive Cancer Network (NCCN) provide the most up-to-date and evidence-based recommendations for the management of retrograde ejaculation, and should be consulted for the most current treatment options 1.
From the Research
Management and Treatment of Retrograde Ejaculation
Retrograde ejaculation is a condition where semen flows backward into the bladder instead of out of the body through the urethra during ejaculation. The management and treatment of this condition depend on the underlying cause.
- Medical treatment is a promising method for managing retrograde ejaculation in diabetic patients, with drugs such as imipramine and pseudoephedrine showing success in producing antegrade ejaculate 2.
- Alkalinizing urinary pH with oral medications or by adding sperm wash media into the bladder prior to ejaculation may preserve the viability of the sperm 3.
- Imipramine has been used to successfully treat retrograde ejaculation caused by retroperitoneal surgery, with a daily oral dose increasing from 25 to 50 mg for 7 days prior to the planned ejaculation or the expected ovulation of the female partner 4.
- Medication is the mainstay of treatment for retrograde ejaculation, although only a minority responds and develops antegrade ejaculation. For non-responders, sperm retrieval techniques can assist reproductive abilities 5.
- A noninvasive method involving the collection of postcoital voided bladder contents and resuspension in a buffer solution has been used to recover and reconstitute sperm for artificial insemination 6.
Treatment Approaches
The treatment approaches for retrograde ejaculation are determined by the cause, which can be anatomic, neurological, or pharmacological.
- Medical treatment: imipramine, pseudoephedrine, and other drugs can be used to manage retrograde ejaculation 2, 4.
- Sperm retrieval techniques: these can be used to assist reproductive abilities in men who do not respond to medical therapy 5.
- Artificial insemination: this can be used with recovered and reconstituted sperm from postcoital voided bladder contents 6.