Retrograde ejaculation occurs when

semen Semen, also known as seminal fluid, is a bodily fluid that contains spermatozoon, spermatozoa which is secreted by the male gonads (sexual glands) and other sexual organs of male or hermaphrodite, hermaphroditic animals. In humans and placen ...

which would be ejaculated via the

urethra The urethra (: urethras or urethrae) is the tube that connects the urinary bladder to the urinary meatus, through which Placentalia, placental mammals Urination, urinate and Ejaculation, ejaculate. The external urethral sphincter is a striated ...

is redirected to the

urinary bladder The bladder () is a hollow organ in humans and other vertebrates that stores urine from the Kidney (vertebrates), kidneys. In placental mammals, urine enters the bladder via the ureters and exits via the urethra during urination. In humans, the ...

. Normally, the sphincter of the bladder contracts before ejaculation, inhibiting urination and preventing a reflux of semen into the bladder. The semen is forced to exit via the urethra, the path of least resistance. When the bladder sphincter does not function properly, retrograde ejaculation may occur. It can also be induced deliberately as a primitive form of male birth control (known as ''coitus saxonicus'') or as part of certain

alternative medicine Alternative medicine refers to practices that aim to achieve the healing effects of conventional medicine, but that typically lack biological plausibility, testability, repeatability, or supporting evidence of effectiveness. Such practices are ...

practices. The retrograde-ejaculated semen is excreted from the bladder during the next

urination Urination is the release of urine from the bladder through the urethra in Placentalia, placental mammals, or through the cloaca in other vertebrates. It is the urinary system's form of excretion. It is also known medically as micturition, v ...

Signs and symptoms

Retrograde ejaculation is sometimes referred to as a "

dry orgasm Dry or dryness most often refers to: * Lack of rainfall, which may refer to **Arid regions **Drought * Dry or dry area, relating to legal prohibition of selling, serving, or imbibing alcoholic beverages * Dry humor, deadpan * Dryness (medical) ...

." A man may notice that no

is produced during masturbation despite the occurrence of orgasm. Another underlying cause for this phenomenon may be

ejaculatory duct obstruction Ejaculatory duct obstruction (EDO) is a pathological condition which is characterized by the obstruction of one or both ejaculatory ducts. Thus, the efflux of (most constituents of) semen is not possible. It can be congenital or acquired. It is a ...

. During a male orgasm,

sperm Sperm (: sperm or sperms) is the male reproductive Cell (biology), cell, or gamete, in anisogamous forms of sexual reproduction (forms in which there is a larger, female reproductive cell and a smaller, male one). Animals produce motile sperm ...

are released from the

epididymides The epididymis (; : epididymides or ) is an elongated tubular genital organ attached to the posterior side of each one of the two male reproductive glands, the testicles. It is a single, narrow, tightly coiled tube in adult humans, in length; ...

and travel via small tubes called the

vasa deferentia The vas deferens (: vasa deferentia), ductus deferens (: ductūs deferentes), or sperm duct is part of the male reproductive system of many vertebrates. In mammals, spermatozoa are produced in the seminiferous tubules and flow into the epididyma ...

. The sperm mix with seminal fluid in the seminal vesicles, prostate fluid from the

prostate The prostate is an male accessory gland, accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found in all male mammals. It differs between species anatomically, chemica ...

gland, and lubricants from the

bulbourethral gland The bulbourethral glands or Cowper's glands (named for English anatomist William Cowper) are two small exocrine and accessory glands in the reproductive system of many male mammals. They are homologous to Bartholin's glands in females. The bul ...

. During climax, muscles at the end of the

bladder neck The bladder () is a hollow organ in humans and other vertebrates that stores urine from the kidneys. In placental mammals, urine enters the bladder via the ureters and exits via the urethra during urination. In humans, the bladder is a distensi ...

tighten to prevent retrograde flow of semen. In retrograde ejaculation, these bladder neck muscles are either very weak or the nerves controlling the muscles have been damaged.The condition known as retrograde ejaculation
Merck, Sharpe & Dohme. Retrieved on 2010-03-02

Causes

A malfunctioning bladder sphincter, leading to retrograde ejaculation, may be a result either of: *

Autonomic nervous system The autonomic nervous system (ANS), sometimes called the visceral nervous system and formerly the vegetative nervous system, is a division of the nervous system that operates viscera, internal organs, smooth muscle and glands. The autonomic nervo ...

dysfunction. (

Dysautonomia Dysautonomia, autonomic failure, or autonomic dysfunction is a condition in which the autonomic nervous system (ANS) does not work properly. This condition may affect the functioning of the heart, bladder, intestines, sweat glands, pupils, and ...

) * Operation on the

. It is a common complication of

transurethral resection of the prostate Transurethral resection of the prostate (commonly known as a TURP, plural TURPs, and rarely as a transurethral prostatic resection, TUPR) is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, ...

, a procedure in which prostate tissue is removed, slice by slice, through a resectoscope passed along the urethra. It can also be caused by a

retroperitoneal lymph node dissection Retroperitoneal lymph node dissection (RPLND) is a surgical procedure to remove abdominal lymph nodes. It is used to treat testicular cancer, as well as to help establish the exact stage and type of the cancer. Indications Testicular cancer m ...

for

testicular cancer Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system. Symptoms may include a lump in the testicle or swelling or pain in the scrotum. Treatment may result in infertility. Risk factors include an c ...

if nerve pathways to the bladder sphincter are damaged, with the resulting retrograde ejaculation being either temporary or permanent. Modern nerve-sparing techniques seek to reduce this risk; however, it may also occur as the result of Green Light Laser prostate surgery. Surgery on the bladder neck accounted for about ten percent of the cases of retrograde ejaculation or anejaculation reported in a literature review. Retrograde ejaculation is a common side effect of medications, such as

tamsulosin Tamsulosin, sold under the brand name Flomax among others, is a medication used to treat symptomatic benign prostatic hyperplasia and chronic prostatitis in men. It is also used to help with the passage of kidney stones. The evidence for be ...

, that are used to relax the muscles of the urinary tract, treating conditions such as

benign prostatic hyperplasia Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, urinary retention, inability t ...

. By relaxing the bladder sphincter muscle, the likelihood of retrograde ejaculation is increased. The medications that mostly cause it are

antidepressant Antidepressants are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction. Common side effects of antidepressants include Xerostomia, dry mouth, weight gain, dizziness, headaches, akathi ...

and

antipsychotic Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of Psychiatric medication, psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), p ...

medication, as well as NRIs such as

atomoxetine Atomoxetine, formerly sold under the brand name Strattera, is a selective norepinephrine reuptake inhibitor (sNRI) medication used to treat attention deficit hyperactivity disorder (ADHD) and, to a lesser extent, cognitive disengagement syndr ...

; patients experiencing this phenomenon tend to quit the medications. Retrograde ejaculation can also be a complication of

diabetes Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...

, especially in cases of diabetics with long term poor blood sugar control. This is due to

neuropathy Peripheral neuropathy, often shortened to neuropathy, refers to damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerve fibers are affected. Neuropa ...

of the bladder sphincter. Post-pubertal males (aged 17 to 20 years) who experience repeated episodes of retrograde ejaculation are often diagnosed with

urethral stricture A urethral stricture is a narrowing of the urethra, the tube connected to the Urinary bladder, bladder that allows urination. The narrowing reduces the flow of urine and makes it more difficult or even painful to empty the bladder. Urethral stric ...

disease shortly after the initial complaint arises. It is currently not known whether a congenital malformation of the bulbous urethra is responsible, or if pressure applied to the base of the penis or perineum immediately preceding ejaculatory inevitability may have inadvertently damaged the urethra. This damage is most often seen within 0.5 cm of the

ejaculatory duct The ejaculatory ducts (''ductus ejaculatorii'') are paired structures in the male reproductive system. Each ejaculatory duct is formed by the union of the vas deferens with the Excretory duct of seminal gland, duct of the seminal vesicle. They pa ...

(usually distal to the duct).

Conditions which can affect bladder neck muscle

Medications to treat

high blood pressure Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms itself. It is, however, a major ri ...

benign prostate hyperplasia Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, urinary retention, inability t ...

mood disorders A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood. The classification is in the ''Diagnostic ...

, surgery on the prostate and

nerve injury Nerve injury is an injury to a nerve. There is no single classification system that can describe all the many variations of nerve injuries. In 1941, Herbert Seddon introduced a classification of nerve injuries based on three main types of nerve ...

(which may occur in multiple sclerosis, spinal cord injury or

Diagnosis

Diagnosis is usually determined after a medical professional performs a

urinalysis Urinalysis, a portmanteau of the words ''urine'' and ''analysis'', is a Test panel, panel of medical tests that includes physical (macroscopic) examination of the urine, chemical evaluation using urine test strips, and #Microscopic examination, m ...

on a urine specimen that is obtained shortly after ejaculation. In cases of retrograde ejaculation, the specimen will contain an abnormal level of

. Especially in case of ''orgasmic anejaculation'',

anejaculation Anejaculation is the pathological inability to ejaculate despite an erection in males, with (''orgasmic'') or without ( ''anorgasmic'') orgasm. Causes It can depend on one or more of several causes, including: * Sexual inhibition * Pharmacolo ...

can often be confused with retrograde ejaculation, and they share some fundamental aspects of the cause. Urinalysis is used to distinguish between them.

Tests

The genitals are physically examined to ensure that there are no anatomical problems. The urine will be tested for the presence of semen. If there are no sperm in the urine, it may be due to damage to the prostate as a result of surgery or prior

radiation therapy Radiation therapy or radiotherapy (RT, RTx, or XRT) is a therapy, treatment using ionizing radiation, generally provided as part of treatment of cancer, cancer therapy to either kill or control the growth of malignancy, malignant cell (biology), ...

Treatments

The treatment depends on the cause. Medications may work for retrograde ejaculation but only in a few cases. Surgery rarely is the first option for retrograde ejaculation and the results have proven to be inconsistent. Medications do not help retrograde ejaculation if there has been permanent damage to the prostate or the testes from radiation. Medications also do not help if prostate surgery has resulted in damage to the muscles or

nerve A nerve is an enclosed, cable-like bundle of nerve fibers (called axons). Nerves have historically been considered the basic units of the peripheral nervous system. A nerve provides a common pathway for the Electrochemistry, electrochemical nerv ...

s. Medications only work if there has been mild nerve damage caused by diabetes,

multiple sclerosis Multiple sclerosis (MS) is an autoimmune disease resulting in damage to myelinthe insulating covers of nerve cellsin the brain and spinal cord. As a demyelinating disease, MS disrupts the nervous system's ability to Action potential, transmit ...

, or mild

spinal cord injury A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. It is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions. Symptoms of ...

Medications

Tricyclic antidepressant Tricyclic antidepressants (TCAs) are a class of medications that are used primarily as antidepressants. TCAs were discovered in the early 1950s and were marketed later in the decade. They are named after their chemical structure, which contains ...

s like

imipramine Imipramine, sold under the brand name Tofranil, among others, is a tricyclic antidepressant (TCA) mainly used in the treatment of depression. It is also effective in treating anxiety and panic disorder. Imipramine is taken by mouth. Common s ...

. * Antihistamines like

chlorphenamine Chlorphenamine (CP, CPM), also known as chlorpheniramine, is an antihistamine used to treat the symptoms of allergic conditions such as allergic rhinitis (hay fever). It is taken orally (by mouth). The medication takes effect within two hours ...

. * Decongestants like

ephedrine Ephedrine is a central nervous system (CNS) stimulant and sympathomimetic agent that is often used to prevent hypotension, low blood pressure during anesthesia. It has also been used for asthma, narcolepsy, and obesity but is not the preferred ...

and

phenylephrine Phenylephrine, sold under the brand names Neosynephrine and Sudafed PE among others, is a medication used as a decongestant for uncomplicated nasal congestion in the form of a nasal spray or oral tablet, to dilate the pupil, to increase bloo ...

. These medications tighten the bladder neck muscles and prevent semen from going backwards into the bladder. However, the medications do have many side effects and they have to be taken at least 1–2 hours prior to sexual intercourse. In many cases, the medications fail to work at the right time because most men are not able to predict when they will have an orgasm.

Infertility treatments

If a couple is experiencing

infertility In biology, infertility is the inability of a male and female organism to Sexual reproduction, reproduce. It is usually not the natural state of a healthy organism that has reached sexual maturity, so children who have not undergone puberty, whi ...

as a result of retrograde ejaculation and medications are not helping, the collection of the semen collection may undergo a special procedure. First, the patient alkalinizes his urine by intake of sodium bicarbonate (3g dissolved in water in the evening before bed, and then another dose after complete bladder emptying right before going to the laboratory). Before semen collection the patient must empty his bladder. The patient then has to masturbate in one container and immediately after has to urinate in another container. The male's ejaculate may be

centrifuge A centrifuge is a device that uses centrifugal force to subject a specimen to a specified constant force - for example, to separate various components of a fluid. This is achieved by spinning the fluid at high speed within a container, thereby ...

d from urine voided, and the isolated sperm injected directly into the woman through the use of

intrauterine insemination Artificial insemination is the deliberate introduction of sperm into a female's cervix or uterine cavity for the purpose of achieving a pregnancy through in vivo fertilization by means other than sexual intercourse. It is a fertility treatment ...

. In more severe cases,

in-vitro fertilization In vitro fertilisation (IVF) is a process of fertilisation in which an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating the ovulatory process, then removing an ovum or ova (egg or eggs) from t ...

with

intracytoplasmic sperm injection Intracytoplasmic sperm injection (ICSI ) is an in vitro fertilization (IVF) procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. This technique is used in order to prepare the gametes for the obtention of embr ...

may be used.Retrograde ejaculation treatments
Infertility factors portal. Retrieved on 2010-03-02

Intentional induction

Retrograde ejaculation can be deliberately induced by squeezing the urethra at the base or applying pressure to the

perineum The perineum (: perineums or perinea) in placentalia, placental mammals is the space between the anus and the genitals. The human perineum is between the anus and scrotum in the male or between the anus and vulva in the female. The perineum is ...

during orgasm. The retrograde-ejaculated sperm goes into the bladder and is excreted with the next urination.

Contraception

In certain cultures, such as in the

Oneida Community The Oneida Community ( ) was a Christian perfection, perfectionist religious communal society founded by John Humphrey Noyes and his followers in 1848 near Oneida, New York. The community believed that Jesus had Hyper-preterism, already return ...

, retrograde ejaculation is performed as a form of primitive male birth control (''coitus saxonicus''). However, the practice is not considered a reliable method compared to most modern types of birth control. Besides the lack of protection from

STDs A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, oral s ...

, the technique itself can be hard to execute correctly during the act of coitus, especially if the male does not fully understand the anatomy involved. Many doctors also do not recommend ''coitus saxonicus'' due to the risk of putting pressure on the

pudendal nerve The pudendal nerve is the main nerve of the perineum. It is a Mixed nerve, mixed (motor and sensory) nerve and also conveys Sympathetic nervous system, sympathetic Autonomic nervous system, autonomic fibers. It carries sensation from the exter ...

, which can cause numbness in the

penis A penis (; : penises or penes) is a sex organ through which male and hermaphrodite animals expel semen during copulation (zoology), copulation, and through which male placental mammals and marsupials also Urination, urinate. The term ''pen ...

Taoism

Taoists Taoism or Daoism (, ) is a diverse philosophical and religious tradition indigenous to China, emphasizing harmony with the Tao ( zh, p=dào, w=tao4). With a range of meaning in Chinese philosophy, translations of Tao include 'way', 'road', ' ...

and some fields of

recommend and teach deliberate retrograde ejaculation as a way of "conserving the body's energy". It was believed that retrograde ejaculation caused the sperm to travel into the head and nourish the brain, or that energy is conserved physically by keeping the sperm (and thereby, the "intelligence" that created it) in the body. However, there are other Taoist perspectives on the general subject of ejaculation and techniques that do not involve retrograde ejaculation (see

Taoist sexual practices Taoist sexual practices ( zh, s=房中术, t=房中術, p=fángzhōngshù, l=arts of the bedchamber, first=t) are the ways Taoists may practice sexual activity. These practices are also known as "joining energy" or "the joining of the essences". ...

Notes

External links

{{Male diseases of the pelvis and genitals Male genital disorders Human penis Ejaculation