Retrograde ejaculation occurs when semen enters the bladder instead of emerging through the penis during orgasm. Although you still reach sexual climax, you might ejaculate very little or no semen. This is sometimes called a dry orgasm.
Retrograde ejaculation isn't harmful, but it can cause male infertility. Treatment for retrograde ejaculation is generally only needed to restore fertility.
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 signs and symptoms include:
Retrograde ejaculation isn't harmful and requires treatment only if you're attempting to father a child. However, if you have dry orgasms, see your doctor to be sure your condition isn't caused by an underlying problem that needs attention.
If you and your female partner have had regular, unprotected intercourse for a year or longer and have been unable to conceive, see your doctor. Retrograde ejaculation might be the cause of your problem if you ejaculate very little or no semen.
During a male orgasm, a tube called the vas deferens transports sperm to the prostate, where they mix with other fluids to produce liquid semen (ejaculate). The muscle at the opening of the bladder (bladder neck muscle) tightens to prevent ejaculate from entering the bladder as it passes from the prostate into the tube inside the penis (urethra). This is the same muscle that holds urine in your bladder until you urinate.
With retrograde ejaculation, the bladder neck muscle doesn't tighten properly. As a result, sperm can enter the bladder instead of being ejected out of your body through the penis.
Several conditions can cause problems with the muscle that closes the bladder during ejaculation. These include:
A dry orgasm is the primary sign of retrograde ejaculation. But dry orgasm — the ejaculation of little or no semen — can also be caused by other conditions, including:
You're at increased risk of retrograde ejaculation if:
Retrograde ejaculation isn't harmful. However, potential complications include:
If you take medications or have health problems that put you at risk of retrograde ejaculation, ask your doctor what you can do to lower your risk.
If you need to have surgery that might affect the bladder neck muscle, such as prostate or bladder surgery, ask about the risk of retrograde ejaculation. If you plan to have children in the future, talk with your doctor about options for preserving semen before the surgery.
Your doctor will:
If you have dry orgasms, but your doctor doesn't find semen in your bladder, you might have a problem with semen production. This can be caused by damage to the prostate or semen-producing glands as a result of surgery or radiation treatment for cancer in the pelvic area.
If your doctor suspects your dry orgasm is something other than retrograde ejaculation, you might need further tests or a referral to a specialist to find the cause.
Retrograde ejaculation typically doesn't require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause.
Medications might work for retrograde ejaculation caused by nerve damage. This type of damage can be caused by diabetes, multiple sclerosis, certain surgeries, and other conditions and treatments.
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.
If your doctor thinks drugs you are taking might be affecting your ability to ejaculate normally, he or she might have you stop taking them for a period of time. Drugs that can cause retrograde ejaculation include certain medications for depression and alpha blockers — drugs used to treat high blood pressure and some prostate conditions.
Drugs to treat retrograde ejaculation are drugs primarily used to treat other conditions, including:
These medications help keep the bladder neck muscle closed during ejaculation. While they're often an effective treatment for retrograde ejaculation, medications can cause side effects or adverse reactions with other medications. Certain medications used to treat retrograde ejaculation can increase your blood pressure and heart rate, which can be dangerous if you have high blood pressure or heart disease.
If you have retrograde ejaculation, you'll likely need treatment to get your female partner pregnant. In order to achieve a pregnancy, you need to ejaculate enough semen to carry your sperm into your partner's vagina and into her uterus.
If medication doesn't allow you to ejaculate semen, you will likely need infertility procedures known as assisted reproductive technology to get your partner pregnant. In some cases, sperm can be recovered from the bladder, processed in the laboratory and used to inseminate your partner (intrauterine insemination).
Sometimes, more-advanced assisted reproductive techniques are needed. Many men with retrograde ejaculation are able to get their partners pregnant once they seek treatment.
Alterations in orgasm are linked with lower emotional and physical satisfaction, which might lead to stress for you and your partner. Retrograde ejaculation can be especially challenging if you and your partner want to conceive a child.
While most men can get their female partners pregnant with infertility treatment, it can be costly and require stressful medical procedures for both you and your partner. Talking with a counselor might help.
Understanding all of your options and communicating with your doctor and partner can help.
You're likely to start by seeing your family doctor. Depending on the likely cause of your dry orgasms and whether you need evaluation and treatment to help you get your female partner pregnant, you might need to see a urinary and reproductive specialist (urologist).
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
Preparing a list of questions before your appointment can help you make the most of your time together.
When seeing your doctor for dry ejaculation — the primary sign of retrograde ejaculation — some basic questions to ask your doctor include:
If you're trying to get your female partner pregnant, you might also want to ask:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.
Your doctor will ask you questions about your health and symptoms. Your doctor might also do a physical exam that includes examining your penis, testicles and rectum. Your doctor will want to determine whether your dry orgasms are retrograde ejaculation or linked to another problem that may need further evaluation.
Being ready to answer your doctor's questions might save time to go over any points you want to spend more time on. Your doctor might ask:
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