Retrograde ejaculation - Causes, diagnosis and treatment

Ejaculation is the ejection or discharge of semen ( which carries sperm) from the erect penis, and is usually accompanied by orgasm. During climax, the muscles at the end of the bladder neck tighten to prevent retrograde flow of semen, thus ensuring that the semen emerges forward through the erect penis during intercourse, and does not go backward into the bladder. This is called antegrade ( forward) ejaculation.

What isRetrograde Ejaculation?

Retrograde (backward) ejaculation occurs when semen enters the bladder instead of emerging through the penis during orgasm. The main reason for retrograde ejaculation is that the bladder neck does not close automatically ( as it is supposed to ) at the time of ejaculation.

If you suffer from retrograde ejaculation, although you still reach a pleasurable sexual climax, you may ejaculate very little or no semen. This is called a dry orgasm. Retrograde ejaculation isn't harmful, but it can cause male infertility.

Read more-Doctor, why can't I ejaculate ?

The Causes

  • Surgeries that affect the nerves or muscles that control the bladder neck, as a result of which it does not function properly.
  • Diabetes, due to neuropathy of the bladder sphincter
  • Some medications, including drugs used to treat high blood pressure (hypertension) and some mood-altering drugs


Retrograde ejaculation doesn't affect your ability to get an erection or have an orgasm - but when you climax, semen goes into your bladder instead of coming out of your penis. Retrograde ejaculation symptoms include:

  • Dry orgasms, orgasms in which you ejaculate very little or no semen out of your penis. The medical word for this is aspermia, or no semen. Thus, when you go the lab to get your semen tested, you find that you are not able to collect any semen at all, even though you get a orgasm.
This can be very frustrating for you - and your partner. The lab is unable to give a report; and your doctor may also not be able to understand why you are not able to do such a simple basic test , because this is not a common problem.

However, about 15% of men with aspermia will have retrograde ejaculation. Please note that aspermia ( no semen) is completely different from the much commoner condition called azoospermia ( where no sperm are found in the semen when this is examined in the lab).
  • You may notice that your urine is cloudy after orgasm because it contains semen

Tests and diagnosis

When you see the doctor, he or she will examine your urine for the presence of semen after you have an orgasm

  • This procedure is usually done at the doctor's office
  • Your doctor will ask you to empty your bladder, masturbate to climax, and then provide a urine sample for laboratory analysis
  • If sperm are found in your urine, the diagnosis of retrograde ejaculation is confirmed
  • If you have dry orgasms, but your doctor doesn't find semen in your bladder, you may have a problem with production of the seminal fluid by the seminal vesicles. This can be caused by damage as a result of surgery or radiation treatment for cancer in the pelvic area. This is rare and will require referral to a specialist for further evaluation.

What is​Anejaculation

Anejaculation can often be confused with retrograde ejaculation. Your doctor can use intense vibratory stimulation to help differentiate between the two. Also, ejaculatory duct obstruction and an absent vas deferens result in a very low volume ejaculate. It's important to go to a specialist, to ensure that the right diagnosis is made !

Treatments and Drugs

Retrograde ejaculation typically doesn't require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause. Drugs may work for retrograde ejaculation caused by certain conditions.

  • Drugs generally won't help if retrograde ejaculation is due to surgery that causes permanent physical changes of your anatomy. Examples include bladder neck surgery and transurethral resection of the prostate.
  • Drugs may work if retrograde ejaculation is due to nerve damage. This can be caused by diabetes, multiple sclerosis, certain surgeries, and other conditions and treatments.

The Medications

If your doctor thinks drugs you are taking may be affecting your ability to ejaculate normally, he or she may have you stop taking them for a period of time. Drugs that can cause retrograde ejaculation include certain medications for mood disorders and alpha blockers - drugs used to treat high blood pressure and some prostate conditions.Drugs to treat retrograde ejaculation include:

  • Imipramine (Tofranil), a tricyclic antidepressant
  • Chlorpheniramine and brompheniramine, antihistamines sometimes used to treat cold symptoms
  • Ephedrine, pseudoephedrine and phenylephrine, used in decongestant medications such as Silfedrine, Sudafed and others

Their Effect

These medications help keep the bladder neck muscle closed during ejaculation. While they're often an effective treatment for retrograde ejaculation, all of these medications can cause side effects.InfertilityIt is also true that one drug may work where another has failed, so it might make good sense to try a second medication if the first one fails.

If you have retrograde ejaculation, you'll likely need treatment to get your partner pregnant.When fertility is desired and oral therapy fails to correct retrograde ejaculation, sperm can be harvested from the bladder or bladder urine and be used with IUI and IVF. In the simplest case, the patient can take medications to raise the urine pH ( to make it alkaline) and then ejaculate and urinate.

The Further Process

  • The post-ejaculate urine can be processed and the sperm removed and concentrated
  • The sperm can then be inseminated into the partner's uterus in a procedure called intrauterine insemination (IUI) , provided the sperm count and motility are normal
  • If sperm numbers and motility are too low for IUI, then in vitro fertilization (IVF/ICSI ) can also be used
  • Sometimes, exposure to the bladder urine causes all of the sperm to die despite regulating the urine pH
  • In this situation, a "bladder sperm harvest" can be performed. With this technique, a small, lubricated catheter is placed in the patient's bladder through the penis and the urine removed
  • After carefully washing the bladder, it is partially filled with culture medium, a fluid that supports sperm motility. After the catheter is removed, the patient then ejaculates and voids
  • The voided urine is now enriched with culture medium and the sperm within it is more likely to be motile and therefore usable for assisted reproduction
It's a good idea to do a dummy run of this treatment prior to the actual IVF cycle. This allows us to decide what protocol to use for you. If needed, the sperm collected in the lab can be frozen and used later as needed for further cycles.

Read more-Ejaculatory Dysfunction – Psychological or Physical Causes

Retrograde ( backward) ejaculation occurs when semen enters the bladder instead of emerging through the penis during orgasm. The main reason for retrograde ejaculation is that the bladder neck does not close automatically ( as it is supposed to ) at the time of ejaculation.
Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.