From the Guidelines
Retrograde ejaculation management should prioritize medical management with SSRIs, such as paroxetine, sertraline, citalopram, or fluoxetine, dosed daily, as the first line of treatment. This approach is supported by the most recent guidelines, including the NCCN Guidelines Insights: Survivorship, Version 2.2024 1. The management of retrograde ejaculation depends on the underlying cause and the patient's fertility goals.
Medical Management
- SSRIs (ie, paroxetine, sertraline, citalopram, fluoxetine) dosed daily are recommended as the first line of treatment for retrograde ejaculation, as they can help improve ejaculation function 1.
- Clomipramine dosed on demand may also be considered as an alternative option for patients who do not respond to SSRIs or have contraindications to their use 1.
- Pelvic physical therapy can be used in conjunction with medical management to improve pelvic floor muscle function and overall ejaculation function 1.
Additional Considerations
- For patients with climacturia, emptying the bladder prior to sex, pelvic physical therapy, or using condoms to catch urine can help manage symptoms 1.
- Testosterone therapy may be indicated in some cases, particularly if low testosterone levels are contributing to the retrograde ejaculation 1.
- Addressing underlying conditions, such as diabetes or multiple sclerosis, and managing medication side effects that may be contributing to the retrograde ejaculation is also crucial in improving symptoms and overall quality of life.
From the Research
Causes of Retrograde Ejaculation
- Diabetes mellitus is a known cause of retrograde ejaculation (RE) 2
- Retroperitoneal lymphadenectomy is also a cause of RE 3
Management of Retrograde Ejaculation
- Medical treatment is a promising method for managing RE in diabetic patients 4
- Different drug regimens can be used, including imipramine, pseudoephedrine, and combination of the two drugs 4, 3
- Imipramine and pseudoephedrine have been shown to be effective in producing antegrade ejaculate in patients with complete RE 4, 3
- Medical treatment can also improve semen quality in patients with partial RE 4, 5
- Surgical techniques and electroejaculation are also options for managing RE, but numbers are small and more research is needed 6
Treatment Options
- Urinary sperm retrieval and medical management with anticholinergics and sympathomimetics are treatment options for RE 6
- Alpha agonistic drugs, such as milodrin, can be used to treat anejaculation (AE) 5
- Parasympathetic drugs can also be used to treat AE, but medical treatment is not generally recommended as first-line treatment for AE 5
Success Rates
- Imipramine was successful in producing antegrade ejaculate in 38.5% of patients with complete RE 4
- Pseudoephedrine was successful in 47.8% of patients with complete RE 4
- Combination of imipramine and pseudoephedrine was successful in 61.5% of patients with complete RE 4
- Positive results were obtained in 29.3% of patients with diabetes and RE treated with ephedrine or imipramine 3