Does phenoxybenzamine cause problems with retrograde ejaculation?

Phenoxybenzamine and Retrograde Ejaculation

Yes, phenoxybenzamine can cause retrograde ejaculation or complete absence of ejaculation as a side effect. 1

Mechanism and Evidence

• Phenoxybenzamine is an alpha-adrenergic blocker that can cause ejaculatory dysfunction by paralyzing the vas deferens, ampulla, and ejaculatory ducts 2
• Studies have shown that men treated with phenoxybenzamine experience ejaculatory failure during treatment, with normal ejaculation returning after discontinuation 1
• The primary ejaculatory issues associated with phenoxybenzamine include:
  • Complete absence of ejaculation (anejaculation) 3
  • Dry ejaculation 3, 2
  • Lack of seminal emission into the posterior urethra 1

Clinical Applications and Considerations

• Phenoxybenzamine has been studied for treating premature ejaculation due to its ejaculation-delaying properties 3
• In one study, 15 men treated with phenoxybenzamine for premature ejaculation showed subjective improvement in time from penetration to ejaculation, with dry ejaculation being the only reported side effect 3
• Some researchers have even explored phenoxybenzamine as a potential male contraceptive due to its reliable ability to block ejaculation 2

Alternative Treatments for Ejaculatory Disorders

• For premature ejaculation, current guidelines recommend:

  • Daily SSRIs (paroxetine, sertraline, citalopram, fluoxetine) 4
  • On-demand clomipramine 4
  • Topical penile anesthetics 4
  • Pelvic physical therapy 4

• For retrograde ejaculation, more effective and safer treatments include:

  • Imipramine (a tricyclic antidepressant) 5, 6
  • Pseudoephedrine (sympathomimetic) 6
  • Combination therapy with both medications has shown success rates of up to 61.5% in diabetic patients with retrograde ejaculation 6

Important Considerations

• The American Urological Association (AUA) guideline notes that while phenoxybenzamine has been studied for premature ejaculation, the evidence is insufficient to support its recommendation 4
• Adrenergic blockade for ejaculatory disorders has shown modest efficacy with medications like alfuzosin and terazosin, but phenoxybenzamine is not recommended due to limited evidence 4
• The ejaculatory effects of phenoxybenzamine are typically reversible upon discontinuation of the medication 2, 1

Conclusion

While phenoxybenzamine can effectively cause retrograde ejaculation or anejaculation, it is not recommended as a first-line treatment for ejaculatory disorders due to limited evidence supporting its use and the availability of more established alternatives with better safety profiles 4.