What are the causes of retrograde ejaculation?

From the Guidelines

Retrograde ejaculation is primarily caused by factors that interfere with the normal closure of the bladder neck during ejaculation, including surgical procedures, neurological conditions, and certain medications. The condition occurs when semen flows backward into the bladder instead of out through the penis during orgasm. Some of the main causes include:

• Surgical procedures such as prostate surgery, bladder neck surgery, or retroperitoneal lymph node dissection
• Neurological conditions like multiple sclerosis, spinal cord injuries, or diabetic neuropathy 1
• Medications that affect bladder neck muscle function, including alpha-blockers (tamsulosin, alfuzosin, doxazosin) used for prostate problems, certain antipsychotics (thioridazine, chlorpromazine), some antidepressants (particularly tricyclics like imipramine), and medications for high blood pressure These factors interfere with the normal closure of the bladder neck during ejaculation, which typically prevents semen from entering the bladder. Treatment depends on the cause and may include medication adjustments, switching to alternative drugs, or procedures to improve bladder neck function. Men experiencing retrograde ejaculation may notice cloudy urine after orgasm and little to no semen coming out during ejaculation, though the sensation of orgasm typically remains intact. It's worth noting that diabetic autonomic neuropathy can also cause genitourinary disturbances, including sexual dysfunction and bladder dysfunction, leading to retrograde ejaculation 1. However, the most recent and highest quality study on the topic is from 2024, which defines retrograde ejaculation as a condition where semen flows backward into the bladder instead of exiting through the urethra during ejaculation, leading to reduced fertility 1.

From the FDA Drug Label

Abnormal ejaculation includes ejaculation failure, ejaculation disorder, retrograde ejaculation, and ejaculation decrease. As shown in Table 1, abnormal ejaculation was associated with Tamsulosin Hydrochloride Capsules administration and was dose-related in the U. S. studies.

The cause of retrograde ejaculation is associated with Tamsulosin Hydrochloride Capsules administration, and it is dose-related.

• Key points:
  • Abnormal ejaculation includes ejaculation failure, ejaculation disorder, retrograde ejaculation, and ejaculation decrease.
  • Tamsulosin Hydrochloride Capsules administration is associated with abnormal ejaculation.
  • The relationship between Tamsulosin Hydrochloride Capsules and retrograde ejaculation is dose-related 2.
• Finasteride is also associated with ejaculation disorders, including reduced ejaculate volume 3.

From the Research

Causes of Retrograde Ejaculation

The causes of retrograde ejaculation can be attributed to various factors, including:

• Diabetes mellitus, as seen in patients with retrograde ejaculation who were treated with different drug regimens 4
• Surgical operations, such as retroperitoneal lymphadenectomy, which can cause ejaculation disorders 5, 6
• Traumatic injury of the posterior urethra, either due to the trauma itself or the subsequent therapy 6
• Certain medications that block alpha-adrenoreceptors or act at the central level, which can produce ejaculation disorders as a side effect 6
• Iatrogenic causes, such as surgical procedures for testis cancer, benign prostatic hyperplasia, or other retroperitoneal operations 6
• Idiopathic causes, where the origin of the retrograde ejaculation is unknown 7

Medical Conditions Associated with Retrograde Ejaculation

Certain medical conditions have been linked to retrograde ejaculation, including:

• Diabetes mellitus, which can cause retrograde ejaculation due to nerve damage or other complications 4, 5
• Testis cancer, which can lead to retrograde ejaculation after surgical treatment, such as retroperitoneal lymphadenectomy 6, 7
• Benign prostatic hyperplasia, which can cause retrograde ejaculation after surgical treatment, such as transurethral prostatic resection 6

Surgical Procedures Associated with Retrograde Ejaculation

Several surgical procedures have been linked to retrograde ejaculation, including:

• Retroperitoneal lymphadenectomy, which can cause ejaculation disorders due to damage to the nerves responsible for ejaculation 5, 6
• Transurethral prostatic resection, which can cause retrograde ejaculation due to damage to the bladder neck 6
• Other retroperitoneal operations, such as wide lymphadenectomy for renal cell carcinoma or tumors of the upper urinary tract, which can produce ejaculation disorders 6