Condition

Retrograde Ejaculation

Reviewed by Dr Abhishek Kumar on

Retrograde ejaculation happens when semen travels backward into the bladder at the moment of orgasm instead of leaving through the tip of the penis, because the valve-like muscle at the bladder neck does not close properly. The orgasm itself usually still feels normal, but the man notices little or no fluid coming out, and cloudy, sperm-containing urine afterwards; it is not painful and does not affect erections directly, though it can affect fertility.

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The bladder neck closes reflexively during ejaculation under sympathetic nerve control, and anything that weakens that reflex or damages the muscle itself can send semen the wrong way[1]. The most familiar causes are longstanding diabetes affecting the nerves supplying the bladder neck, certain medicines — particularly alpha-blockers such as tamsulosin, prescribed for prostate symptoms, and some antidepressants — and previous surgery on the prostate or bladder neck, which can leave the valve unable to close at all[1][2]. Alpha-blockers illustrate how much this depends on the specific drug: abnormal ejaculation is reported far more often with tamsulosin than with other alpha-blockers used for the same prostate symptoms, which is one reason the choice of medicine matters when this is a concern[2].

Some symptoms need prompt care: when to seek emergency or specialist care.

How each system of medicine approaches Retrograde Ejaculation

SystemApproachTypical review period
Modern medicineDiagnosis is usually supported by finding sperm in a urine sample collected soon after orgasm, together with a review of diabetes, current medicines, neurological conditions, and any previous prostate or bladder-neck surgery.A medicine trial is usually judged over a handful of attempts rather than a single dose, and most of the published support for it comes from small case series rather than large randomised trials[1]. Limited or mixed evidence

The available evidence is mainly from clinical reviews and observational or small studies rather than dedicated randomised trials or a specific clinical guideline, so treatment recommendations are necessarily limited.

Modern medicine for Retrograde Ejaculation

Oral sympathomimetic or tricyclic medicines are sometimes tried to help the bladder-neck muscle close more firmly before intercourse; when the valve itself has been removed or divided by earlier prostate surgery, no medicine can recreate it, and attention turns to fertility options instead[1].

  • Diabetes is one possible cause: long-standing diabetes can affect the nerves and muscles involved in ejaculation and may also contribute to erectile or urinary symptoms.
  • Some medicines can contribute: alpha-blockers used for urinary symptoms, including tamsulosin, can cause reduced or absent ejaculation in some men. Reviewing the medicine with the prescriber can help determine whether it is contributing and whether an alternative is appropriate[2].
  • Fertility may still be possible: sperm can sometimes be recovered from urine collected after orgasm and used for assisted reproduction. The urine may be prepared to improve sperm recovery, depending on the clinical approach.

Doctors of this system: Sexologist in India

What is known and what remains uncertain

  • Known: alpha-blocker medicines, particularly tamsulosin, are a recognised cause of reduced or absent ejaculate that sometimes reverses with a change of medicine.
  • Known: sperm collected from urine passed right after orgasm can be used for assisted conception, a technique described in the fertility literature for decades.
  • Known: retrograde ejaculation is not painful and does not directly affect the ability to have an erection.
  • Uncertain: how well oral medicines work to close the bladder neck, since most of the published support comes from small case series rather than large randomised trials.
  • Uncertain: whether switching from tamsulosin to a different alpha-blocker will restore normal ejaculation in a given individual.

Questions to ask your doctor

  • Could any of my current medicines be causing this, and is there an alternative?
  • Is my diabetes control or a previous prostate or bladder-neck operation likely to be the cause?
  • What tests will confirm this, and what do they involve?
  • If I want to have children, what are my options?
  • Is a medicine likely to help in my case, or has the valve been permanently affected?

Doctors who consult for Retrograde Ejaculation

  • Dr Abhishek Kumar

    Qualification
    M.B.B.S
    System of medicine
    Modern medicine
    Registration
    Reg. No. 73512, West Bengal Medical Council

Frequently Asked Questions

Is retrograde ejaculation harmful?

No, it is not painful or dangerous by itself, and it does not affect the ability to have or keep an erection; the main practical effects are a dry or reduced orgasm and, for some men, reduced fertility.

Could a medicine I am already taking be causing it?

It is possible, particularly alpha-blockers such as tamsulosin taken for prostate symptoms, and some antidepressants; abnormal ejaculation is reported more often with tamsulosin than with other drugs in the same class[2]. Your doctor reviews your current medicines before looking for another cause.

Can it be reversed after prostate surgery?

That depends on the operation. If the bladder-neck muscle has been physically divided or removed, no medicine restores it; if the nerve supply is only weakened, a medicine is sometimes tried first[1].

Does it affect my chances of having a child?

It can, because most of the sperm ends up in the bladder rather than outside the body. Sperm collected from urine passed right after orgasm can still be used for assisted conception, a technique used for this purpose for decades[3].

Which system of medicine treats this?

This page covers modern medicine only, because identifying and, where possible, reversing the cause — a medicine, diabetes, or a previous operation — is a medical process; a consultation in any system leads to the same assessment and referral.

References

  1. Otani T. Clinical review of ejaculatory dysfunction. Reprod Med Biol. 2019;18(4):331-343. https://doi.org/10.1002/rmb2.12289
  2. van Dijk MM, de la Rosette JJ, Michel MC. Effects of alpha1-adrenoceptor antagonists on male sexual function. Drugs. 2006;66(3):287-301. https://doi.org/10.2165/00003495-200666030-00002
  3. Cameron MC, Gillett WR. The recovery of sperm, insemination, and pregnancy in the treatment of infertility because of retrograde ejaculation. Fertil Steril. 1985;44(6):844-845. https://doi.org/10.1016/s0015-0282(16)49051-5

This information is general and educational. It is not a diagnosis; please discuss your situation with the doctor during your consultation.

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