From the Guidelines
Retrograde ejaculation is primarily caused by damage to the nerves or muscles that control the bladder neck, which normally closes during ejaculation to prevent semen from entering the bladder. Common causes include diabetes (which can damage nerves controlling the bladder), prostate or bladder surgery (such as TURP or radical prostatectomy), spinal cord injuries, multiple sclerosis, and certain medications. Medications that frequently cause retrograde ejaculation include alpha-blockers used for prostate enlargement (like tamsulosin or alfuzosin), certain antipsychotics, and some antidepressants. Medical conditions that affect the sympathetic nervous system can also lead to this condition. Treatment depends on the underlying cause and may include medication adjustments, alpha-adrenergic agonists like pseudoephedrine (30-60mg taken 2-4 hours before intercourse), or imipramine (25-50mg daily) 1. These medications help tighten the bladder neck, potentially restoring normal ejaculation. For medication-induced cases, stopping or changing the causative drug may resolve the condition. Retrograde ejaculation itself is not harmful but can cause infertility, as sperm are directed into the bladder rather than out through the penis during orgasm. Some key points to consider in the management of retrograde ejaculation include:
- Evaluation of bladder function should be performed for individuals with diabetes who have recurrent urinary tract infections, pyelonephritis, incontinence, or a palpable bladder 1.
- Diabetic autonomic neuropathy may also cause genitourinary disturbances, including sexual dysfunction and bladder dysfunction 1.
- Lower urinary tract symptoms manifest as urinary incontinence and bladder dysfunction (nocturia, frequent urination, urination urgency, and weak urinary stream) 1. It is essential to prioritize the patient's quality of life and address any underlying conditions that may be contributing to the retrograde ejaculation. In some cases, treatment may involve a multidisciplinary approach, including urology, endocrinology, and physical therapy. Ultimately, the goal of treatment is to restore normal ejaculation and improve fertility, while also addressing any underlying medical conditions that may be contributing to the retrograde ejaculation.
From the Research
Causes of Retrograde Ejaculation
- Diabetes mellitus is a known cause of retrograde ejaculation, with studies suggesting that it can occur in 5-18% of cases with diabetic neuropathy 2, 3, 4.
- Autonomic neuropathy associated with diabetes mellitus can lead to retrograde ejaculation, making it a late feature of the disease 2, 4.
- Other potential causes of retrograde ejaculation include:
- Retroperitoneal lymphadenectomy, with conservative treatment offering improvement or conversion to anterograde ejaculation in some cases 5.
- Certain medications or medical conditions that affect the autonomic nervous system.
- The exact mechanisms of retrograde ejaculation are not fully understood, but it is thought to be related to the disruption of normal ejaculatory function, including the sympathetic and parasympathetic nervous systems 6, 5.
Association with Diabetes
- Studies have shown that men with diabetes mellitus are more likely to experience retrograde ejaculation, with a higher prevalence of erectile dysfunction in this group 3.
- The duration of diabetes mellitus may be a factor in the development of retrograde ejaculation, with longer duration potentially increasing the risk 3.
- However, other factors such as BMI, waist circumference, blood pressure, and lipid profiles do not appear to be directly associated with retrograde ejaculation in diabetic patients 3.
Clinical Presentation
- Retrograde ejaculation can present as a decrease or absence of ejaculate volume, with spermatozoa present in the post-ejaculatory urine specimen 4.
- It is essential to analyze post-ejaculatory urine in patients with low ejaculate volumes or suspected retrograde ejaculation, particularly in those with diabetes mellitus 3, 4.