From the Guidelines
Retrograde ejaculation is a condition where semen flows backward into the bladder instead of out through the penis during orgasm, and it can be diagnosed based on the absence of semen in the ejaculate, with treatment depending on the underlying cause, such as medication-induced cases, diabetes, or surgical damage. The diagnosis of retrograde ejaculation is typically made based on the patient's symptoms, including dry or minimal ejaculate, and can be confirmed by analyzing the post-ejaculation urine sample for the presence of sperm [ 1 ].
Causes of Retrograde Ejaculation
The causes of retrograde ejaculation can be varied, including:
- Damage to the nerves or muscles that control ejaculation, often resulting from diabetes, multiple sclerosis, or certain surgeries (prostate, bladder neck) [ 1, 1 ]
- Medications like alpha-blockers, antidepressants, and antipsychotics [ 1 ]
- Surgical damage to the bladder neck or prostate
Treatment of Retrograde Ejaculation
Treatment of retrograde ejaculation depends on the underlying cause, and may include stopping the offending medication, or using medications such as pseudoephedrine (30-60mg taken 2-2.5 hours before intercourse), imipramine (25-50mg twice daily), or chlorpheniramine (4mg twice daily) to strengthen the bladder neck closure [ 1 ]. For fertility concerns, sperm can be retrieved from post-ejaculation urine samples for assisted reproductive techniques. Lifestyle adjustments like emptying the bladder before sex and maintaining good blood sugar control for diabetics may also help [ 1, 1 ].
Impact on Quality of Life
While retrograde ejaculation typically causes dry or minimal ejaculate, it does not affect sexual pleasure or ability to reach orgasm [ 1 ]. However, it can cause infertility, which can have a significant impact on a person's quality of life. Therefore, it is essential to address the underlying cause of retrograde ejaculation and provide appropriate treatment to improve fertility outcomes and overall quality of life.
From the Research
Diagnosis of Retrograde Ejaculation
- Retrograde ejaculation is a condition where semen enters the urinary bladder instead of emerging through the penis after orgasm 2
- It can be partial or complete, resulting in either low seminal volume or complete absence of the ejaculate (dry ejaculate) 3
- The diagnosis of retrograde ejaculation involves identifying the underlying cause, which can be anatomic, neurological, or pharmacological 3
Treatment of Retrograde Ejaculation
- Medical treatment for retrograde ejaculation in diabetic patients is a promising method and should be the first line of treatment in these cases 4
- Different drug regimens can be used, including imipramine and pseudoephedrine, which have been shown to be effective in producing antegrade ejaculate in patients with complete retrograde ejaculation 4, 5
- 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
- Assisted reproductive techniques, such as intracytoplasmic sperm injection (ICSI), can be used to achieve fertilization in cases of male subfertility due to retrograde ejaculation 2, 6
- Surgical sperm retrieval can be attempted if other measures fail 6
Management of Retrograde Ejaculation
- Retrograde ejaculation can be managed by medications to reverse the condition in mild cases and in bladder harvest of semen after ejaculation in more severe cases 6
- Anejaculation might also be managed by medication in mild cases while assisted ejaculatory techniques, including penile vibratory stimulation and electroejaculation, are used in more severe cases 6
- The method of choice depends largely on the number of motile sperm in the ejaculate 6