Retrograde Ejaculation

Though many men don’t like to talk about it, ejaculation problems are very common. Some of the most common issues include premature, delayed, or retrograde ejaculation.

Retrograde ejaculation is a medical condition characterized by the backflow of semen into the bladder after ejaculating — instead of coming out the tip of the penis. It’s usually not harmful but could impact fertility if you’re trying to have children or are planning to in the future.

Retrograde ejaculation itself is unlikely to cause complications, but it can sometimes be a sign of an underlying medical condition that may require treatment, like diabetes. In other cases, it may develop simply due to a man’s individual anatomy.

Stay with us as we explain everything you need to know about retrograde ejaculation, including the potential causes, symptoms, and treatment options.

What Is Retrograde Ejaculation?

Retrograde ejaculation happens when semen travels into the bladder instead of out the tip of your penis. It can result in either a weak ejaculation or no semen at all during ejaculation. Another name for when you don’t emit semen is a dry orgasm.

Semen is a combination of sperm produced in the testicles and fluid produced by other parts of the reproductive tract — such as the seminal vesicles and prostate gland. This fluid helps transport and nourish sperm.

Normally during a male orgasm, semen travels out of the body through the urethra with the help of contracting muscles in the pelvis and around the penis. The urethra is the tube that exits the tip of the penis. It also serves as a passage for urine. 

As semen travels through the urethra, a muscle at the bottom of the bladder closes to prevent semen from traveling backwards into the bladder. In men with retrograde ejaculation, the bladder neck muscle doesn’t fully close off the bladder, which allows some or all of the semen to flow into the opening of the bladder instead of out the tip of the penis.

How Common Is Retrograde Ejaculation?

It’s not exactly clear how common retrograde ejaculation is. But in studies looking at its frequency among males visiting fertility clinics, the condition affects up to two percent of men in this demographic.

What about retrograde ejaculation symptoms?

Retrograde ejaculation doesn’t typically cause any symptoms other than little or no semen released during an orgasm — and possibly low semen volume or weak ejaculation .

Symptoms of Retrograde Ejaculation

Retrograde ejaculation isn’t painful and usually doesn’t feel different from any other orgasm. It also doesn’t interfere with erectile function.

Most men produce around one-quarter to one teaspoon of semen when they orgasm. Those with retrograde ejaculation may see less semen coming out of their penis since some or all of it enters their bladder.

With semen in the bladder, retrograde ejaculation can cause cloudy urine the next time you pee after an orgasm.

If your retrograde ejaculation is mild, you might not notice these signs. But some men may have stress or anxiety about noticing changes in their ejaculation.

Retrograde ejaculation happens when semen flows backward from the urethra to the bladder due to problems with the bladder neck muscle.

The bladder neck muscle is also sometimes called the bladder neck sphincter. A sphincter is a ring-shaped muscle in the body that opens and closes a passage.

What Causes Retrograde Ejaculation?

There are many possible retrograde ejaculation causes. 

Any condition that can change the function of the bladder neck muscle can potentially lead to retrograde ejaculation. But most often, it happens because of:

• Medication side effects

• Surgical complications

• Medical conditions or anatomical abnormalities

Keep scrolling for details.

Medications That Cause Retrograde Ejaculation

Some types of medication can potentially cause retrograde ejaculation, including those used to treat benign prostatic hyperplasia (BPH or enlarged prostate) and high blood pressure (hypertension).

Some medications linked to retrograde ejaculation include:

• Alpha-blockers. Alpha-blockers are used to treat high blood pressure and benign prostatic hyperplasia. Most medications in this class, such as tamsulosin, and silodosin (Rapaflo®, Urorec®), have been linked to an increased risk of retrograde ejaculation because they relax muscles around the bladder.

• Antidepressants. Research suggests some antidepressants may cause retrograde ejaculation in very rare instances.. For example, a 2023 study reported a case thought to be caused by the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor®).

• Antipsychotic medications. Some medications used to treat psychotic disorders might also rarely cause ejaculation problems, including retrograde ejaculation. This includes thioridazine (Mellaril® or Melleril®), iloperidone (Fanapt®), clozapine (Clozaril®), and risperidone (Risperdal®).

Surgical Procedures That May Cause Retrograde Ejaculation

Some surgical procedures can damage the muscles and nerves around the bladder and lead to retrograde ejaculation.

Surgical procedures that may cause retrograde ejaculation include:

• Surgeries for enlarged prostate. Ejaculatory complications are common among people who have prostate surgeries for an enlarged prostate, such as transurethral resection of the prostate (TURP). TURP is the gold standard treatment for BPH, but it can lead to retrograde ejaculation in up to 70 percent of cases. Retrograde ejaculation is also reported in up to 75 percent of those who get a procedure called holmium laser enucleation of the prostate (HoLEP). Newer prostate surgeries such as the Urolift procedure have a much lower risk of causing ejaculation problems, but may not be as effective long term for the management of an enlarged prostate. 

• Bladder surgery. Some types of bladder surgery, like transurethral bladder neck incisions, may contribute to retrograde ejaculation if the bladder neck muscle is damaged.

• Cancer surgery. Some surgical procedures to stage or treat pelvic cancers involve removal of abdominal and pelvic lymph nodes that are very close to the nerves that control ejaculation. Surgical damage to these nerves may cause retrograde ejaculation.

• Other surgeries. Other surgeries that have been linked to retrograde ejaculation include those used to treat rectal or testicular cancer, lower spine injuries, and aortic aneurysms. These surgeries can also damage the nerves in the pelvis that control ejaculation.

Medical Conditions That Cause Retrograde Ejaculation

Certain medical conditions can lead to dysfunction in the muscles or nerves around the bladder and cause retrograde ejaculation. These conditions include:

• Diabetes complications

• Multiple sclerosis

• Nerve damage

• Lower spinal cord injury

• Stroke

• Congenital abnormalities (birth defects)

If you have any of these conditions and are also experiencing retrograde ejaculation, let your healthcare provider know.

Although it’s not entirely clear how common retrograde ejaculation is, some groups may be at a higher risk than others. These people include males with diabetes and males who’ve had bladder or prostate surgery.

Risk Factors for Retrograde Ejaculation

In recent years, the number of retrograde ejaculation cases caused by diabetes seems to be increasing.

Diabetes can cause chronically elevated blood sugar levels. High blood sugar can damage nerves throughout your body. This nerve damage is called diabetic neuropathy.

Retrograde ejaculation can develop if the nerves controlling ejaculation are damaged.

Men who undergo prostate surgery or have surgery in their pelvic area are at a very high risk of developing ejaculatory complications.

As many as 70 to 90 percent of men who get TURP surgery develop retrograde ejaculation.

To diagnose retrograde ejaculation, your healthcare provider will ask you questions about your symptoms and likely perform a physical examination.

They’ll also review your personal and family medical history to rule out other possible causes and may perform specialized tests..

Diagnosing Retrograde Ejaculation

To diagnose retrograde ejaculation, your healthcare provider or a urology specialist will collect a urine sample after you have an orgasm.. This test is called post-ejaculate urinalysis. They’ll look to see if sperm is in the urine sample.

A retrograde ejaculation diagnosis can be made if there are five sperm per high-power field in your urine sample. A high-power field is the area seen under a microscope at maximum magnification, typically 400 times magnification.

The best treatment for retrograde ejaculation depends on the underlying cause. It often doesn’t require surgery unless it’s affecting fertility.

Retrograde Ejaculation Treatment

Your healthcare provider may recommend changing medications, taking a new medication, lifestyle adjustments, or fertility treatment.

Changing Medications

If your symptoms are linked to a medication you currently use, such as an alpha-blocker or antidepressant, your healthcare provider may recommend adjusting your dosage or switching to a different prescription.

You might get back to normal ejaculation after the medication is stopped.

Medications to Treat Retrograde Ejaculation

There are no specific medications that are FDA-approved for retrograde ejaculation treatment. But some prescription drugs might help reduce symptoms depending on the cause. 

Medications you might be prescribed:

• Imipramine

• Pseudoephedrine

• Antihistamines

• Chlorpheniramine

• Phenylephrine

All medications can cause side effects. Your healthcare provider can go over these with you and tell you about the potential risks.

Other Treatments That Might Help With Retrograde Ejaculation

If retrograde ejaculation is caused by a medical condition like diabetes, a healthcare provider might recommend medications or lifestyle changes to lower blood sugar levels.

Folks with diabetes sometimes need to take insulin to keep their blood sugar levels at a healthy range. Medical providers also sometimes suggest medications like metformin or semaglutide (Ozempic® and Rybelsus®).

If you’re okay with not ejaculating when you orgasm, your healthcare provider may not suggest any specific treatment. You might be wondering if there are benefits to not ejaculating.

The practice of semen retention has become trendy — whether through abstaining from masturbation or sexual intercourse with a partner. But there isn’t much evidence to support a benefit from refraining from orgasming. 

In rare cases, surgery to bulk up or improve the function of the bladder neck muscle and sphincter may be performed. The effectiveness and safety of these procedures, though, is not well established.

Fertility Treatments

If you have retrograde ejaculation and would like to have children in the future, it’s best to talk to a fertility specialist.

Several fertility procedures may be available, including:

• Intrauterine insemination (IUI) or in-vitro fertilization (IVF) using ejaculated sperm

• Intrauterine insemination (IUI) or in-vitro fertilization (IVF) using sperm collected from urine

• In-vitro fertilization (IVF) using sperm surgically retrieved from the testicles
  

Consult a fertility specialist or reproductive urologist if you’re interested in exploring these options.

You may or may not be able to prevent retrograde ejaculation, depending on the underlying cause.

Retrograde Ejaculation Prevention Tips

If retrograde ejaculation is caused by type 2 diabetes, you might be able to prevent it by:

• Maintaining a healthy weight

• Staying or becoming physically active

• Minimizing your intake of foods with added sugar

• Eating mostly whole foods instead of ultra-processed foods

• Eating plenty of fruits and vegetables

Researchers are continuing to develop new surgical techniques to treat prostate disorders. Ejaculation-sparing techniques come with better outcomes than traditional surgery when preserving sexual function is a priority.

In a 2021 study, researchers found that ejaculation-sparing TURP surgery provided better results than ejaculation-sparing HoLEP in 119 men with BPH.

Your provider can let you know if you’re a candidate for a less invasive surgical technique that comes with a lower risk of retrograde ejaculation.