What causes painful retrograde ejaculation?

From the Guidelines

Painful retrograde ejaculation is most commonly caused by surgical procedures, inflammation, or infection in the urinary tract, prostate, or ejaculatory ducts, with transurethral resection of the prostate (TURP) being a notable cause, although transurethral incision of the prostate (TUIP) has a significantly reduced risk of retrograde ejaculation compared to TURP 1. When considering the potential causes of painful retrograde ejaculation, it's essential to evaluate the patient's medical history, including any recent surgical procedures, infections, or inflammation in the urinary tract or prostate.

• Common causes of painful retrograde ejaculation include:
  • Prostatitis (inflammation of the prostate)
  • Urethritis (inflammation of the urethra)
  • Surgical procedures like TURP
  • Certain medications, such as alpha-blockers
  • Neurological conditions affecting pelvic nerves
  • Diabetes with neuropathy Given the potential causes, treatment options may vary, but the primary goal is to address the underlying cause of the condition.
• Treatment options may include:
  • Antibiotics for infections
  • Anti-inflammatory medications to reduce inflammation and pain
  • Adjusting or changing medications that may be contributing to the condition
  • Medications to strengthen bladder neck closure in cases related to anatomical changes from surgery It's crucial for patients experiencing painful retrograde ejaculation to seek medical evaluation promptly, as the condition can affect fertility and may indicate a more serious underlying problem requiring specific treatment.

From the FDA Drug Label

Abnormal ejaculation includes ejaculation failure, ejaculation disorder, retrograde ejaculation, and ejaculation decrease.

The following adverse reactions have been identified during post-approval use of Tamsulosin Hydrochloride Capsules...

• sexual dysfunction that continued after discontinuation of treatment, including erectile dysfunction, decreased libido and ejaculation disorders (e. g. reduced ejaculate volume).

Painful retrograde ejaculation can be caused by:

• Tamsulosin Hydrochloride Capsules administration, as it is associated with abnormal ejaculation, which includes retrograde ejaculation 2
• Finasteride tablets, as ejaculation disorders, including reduced ejaculate volume, have been reported in postmarketing experience 3

Note that the FDA drug label does not provide direct information on what causes painful retrograde ejaculation, only on the association between these medications and abnormal ejaculation or ejaculation disorders.

From the Research

Causes of Painful Retrograde Ejaculation

• Failure of the normal ejaculatory mechanism can lead to retrograde ejaculation, which may occur as a result of:
  • Transurethral prostatectomy 4
  • Retroperitoneal lymph-node dissection 4
  • Diabetic neuropathy 4
• The use of certain medications, such as:
  • Alpha-adrenergic receptor antagonists, like tamsulosin, which can induce ejaculatory disorder, including retrograde ejaculation 5
  • Antidepressants, like selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), which can cause painful ejaculation 6
• Abnormal increase of contraction in the vas deferens may also be a cause of ejaculatory disorder, including retrograde ejaculation 5

Treatment-Related Painful Retrograde Ejaculation

• Tamsulosin, an alpha1-adrenoceptor antagonist, has been reported to cause retrograde ejaculation, but it can also be used to treat painful ejaculation in some cases 6, 7
• Methoxamine, an alpha1-adrenergic agonist, has been used to treat retrograde ejaculation, with successful results in some patients 8
• Intermittent tamsulosin treatment has been shown to improve abnormal ejaculation, including retrograde ejaculation, in some patients 7