Retrograde Ejaculation

Retrograde ejaculation is a condition in which semen is ejaculated backward into the bladder rather than out through the penis.

In retrograde ejaculation, the part of the bladder that normally closes during ejaculation (the bladder neck) remains open, causing the ejaculatory fluid to travel backward into the bladder. Common causes of retrograde ejaculation include diabetes, spinal cord injuries, certain drugs, and some surgical operations (including major abdominal or pelvic surgery--one of the most common causes is transurethral resection of the prostate).

Men with retrograde ejaculation can still have orgasms. However, retrograde ejaculation decreases the amount of fluid ejaculated out of the penis; sometimes, no fluid comes out. The condition can cause infertility but is otherwise not harmful.

A doctor makes the diagnosis of retrograde ejaculation by finding a large amount of sperm in a urine sample. Most men need no treatment. About one third of men with retrograde ejaculation improve after treatment with drugs that close the bladder neck (such as pseudoephedrine, phenylephrine, chlorpheniramine, brompheniramine, or imipramine). However, most of these drugs can increase heart rate and blood pressure, which can be dangerous in men with high blood pressure or heart disease.

If infertility requires treatment and drugs do not help, doctors can sometimes collect a man's sperm for insemination (see Section 22, Chapter 254).