Retrograde ejaculation
Encyclopedia
In the human male reproductive system, retrograde ejaculation occurs when semen
, which would normally be ejaculated
via the urethra
, is redirected to the urinary bladder
. Normally, the sphincter
of the bladder contracts before ejaculation forcing the semen to exit via the urethra, the path of least pressure. When the bladder sphincter does not function properly, retrograde ejaculation may occur.
Even though retrograde ejaculation is a disorder that does not harm the body, it does have a few complications. Some men may become infertile
, and others may complain that their orgasms
are not as pleasurable.
. Men often notice during masturbation that they do have an orgasm but there is no semen release. Another underlying cause for this phenomenon may be ejaculatory duct obstruction
.
During a male orgasm, sperm
are released from the epididymis
and travel via small tubes called the vas deferens
. Sperm mix with secretions from the prostate
. During climax, muscles at the end of the bladder neck
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 become damaged.
, benign prostate hypertrophy
, mood disorders, surgery on the prostate and nerve injury
(which may occur in multiple sclerosis, spinal cord injury or diabetes
).
or the operation of the prostate
. It is a common complication of transurethral resection of the prostate
, 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
for testicular cancer
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.
Retrograde ejaculation is a common side effect of medications, such as tamsulosin
, that are used to relax the muscles of the urinary tract, treating conditions such as benign prostatic hyperplasia
. By relaxing the bladder sphincter muscle, the likelihood of retrograde ejaculation is increased.
The medications that mostly cause it are antidepressant
and antipsychotic
medication; patients experiencing this phenomenon tend to quit the medications.
Retrograde ejaculation can also be a complication of diabetes, especially in cases of diabetics with long term poor blood sugar control. This is due to neuropathy 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
disease shortly after the initial complaint arises. It is currently not known whether a congenital malformation of the Bulbar 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
(usually distal to the duct).
Retrograde ejaculation can also be a result of young men pinching off the opening at the top of the penis, to avoid creating a mess upon ejaculation.
performed on a urine specimen that is obtained shortly after ejaculation. In cases of retrograde ejaculation, the specimen will contain an abnormal level of sperm
.
Especially in case of orgasmic anejaculation, anejaculation
can often be confused with retrograde ejaculation, and they share some fundamental aspects of the etiology
. Urinalysis is used to distinguish between them.
.
s. Medications only work if there has been mild nerve damage caused by diabetes, multiple sclerosis
or mild spinal cord injury
.
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.
as a result of retrograde ejaculation and medications are not helping, the male's ejaculate may be centrifuge
d and the isolated sperm injected directly into the woman through the use of intrauterine insemination. In more severe cases, in-vitro fertilization with intracytoplasmic sperm injection
may be used.
recommend and teach deliberate retrograde ejaculation as a way of "conserving the body's energy". One manner of achieving this is by applying pressure to the perineum
during orgasm. It was believed that doing this 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. This approach has since been discredited by modern medicine, as the retrograde-ejaculated sperm actually go into the bladder and are simply lost at the next urination. However, there are other Taoist perspectives on the general subject of ejaculation and techniques that do not involve retrograde ejaculation (see Taoist sexual practices
).
Due to its aforementioned effects on fertility, there is a potential misconception that inducing this condition can be used as a method of contraception
. However, it is neither reliable nor effective, due to some sperm still potentially emerging. Many doctors also do not recommend inducing retrograde ejaculation due to the risk of putting pressure on the pudendal nerve
. Such pressure can cause numbness in the penis
.
Semen
Semen is an organic fluid, also known as seminal fluid, that may contain spermatozoa. It is secreted by the gonads and other sexual organs of male or hermaphroditic animals and can fertilize female ova...
, which would normally be ejaculated
Ejaculation
Ejaculation is the ejecting of semen from the male reproductory tract, and is usually accompanied by orgasm. It is usually the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. In rare cases ejaculation occurs because of prostatic disease...
via the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
, is redirected to the urinary bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
. Normally, the sphincter
Sphincter
A sphincter is an anatomical structure, or a circular muscle, that normally maintains constriction of a natural body passage or orifice and which relaxes as required by normal physiological functioning...
of the bladder contracts before ejaculation forcing the semen to exit via the urethra, the path of least pressure. When the bladder sphincter does not function properly, retrograde ejaculation may occur.
Even though retrograde ejaculation is a disorder that does not harm the body, it does have a few complications. Some men may become infertile
Infertility
Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term...
, and others may complain that their orgasms
Orgasm
Orgasm is the peak of the plateau phase of the sexual response cycle, characterized by an intense sensation of pleasure...
are not as pleasurable.
Retrograde ejaculation and infertility
Retrograde ejaculation is sometimes referred to as a "dry orgasm." Retrograde ejaculation is one cause of male infertilityMale infertility
Male infertility refers to the inability of a male to achieve a pregnancy in a fertile female. In humans it accounts for 40-50% of infertility. Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.-Pre-testicular...
. Men often notice during masturbation that they do have an orgasm but there is no semen release. Another underlying cause for this phenomenon may be ejaculatory duct obstruction
Ejaculatory duct obstruction
Ejaculatory duct obstruction is a congenital or acquired pathological condition which is characterized by the obstruction of one or both ejaculatory ducts. Thus, the efflux of semen is not possible....
.
During a male orgasm, sperm
Sperm
The term sperm is derived from the Greek word sperma and refers to the male reproductive cells. In the types of sexual reproduction known as anisogamy and oogamy, there is a marked difference in the size of the gametes with the smaller one being termed the "male" or sperm cell...
are released from the epididymis
Epididymis
The epididymis is part of the male reproductive system and is present in all male amniotes. It is a narrow, tightly-coiled tube connecting the efferent ducts from the rear of each testicle to its vas deferens. A similar, but probably non-homologous, structure is found in cartilaginous...
and travel via small tubes called the vas deferens
Vas deferens
The vas deferens , also called ductus deferens, , is part of the male anatomy of many vertebrates; they transport sperm from the epididymis in anticipation of ejaculation....
. Sperm mix with secretions from the prostate
Prostate
The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
. During climax, muscles at the end of the bladder neck
Neck of urinary bladder
The neck of the urinary bladder is the portion of the urinary bladder adjacent to the prostate gland in men....
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 become damaged.
Conditions which can affect bladder neck muscle
Medications to treat high blood pressureHypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, benign prostate hypertrophy
Benign prostatic hyperplasia
Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
, mood disorders, surgery on the prostate and nerve injury
Nerve injury
Nerve injury is injury to nervous tissue. There is no single classification system that can describe all the many variations of nerve injury. Most systems attempt to correlate the degree of injury with symptoms, pathology and prognosis...
(which may occur in multiple sclerosis, spinal cord injury or diabetes
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
).
Causes
A malfunctioning bladder sphincter, leading to retrograde ejaculation, may be a result of the autonomic nervous systemAutonomic nervous system
The autonomic nervous system is the part of the peripheral nervous system that acts as a control system functioning largely below the level of consciousness, and controls visceral functions. The ANS affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of the pupils,...
or the operation of the prostate
Prostate
The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
. It is a common complication of transurethral resection of the prostate
Transurethral resection of the prostate
Transurethral resection of the prostate is a urological operation. It is used to treat benign prostatic hyperplasia . As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection...
, 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
Retroperitoneal lymph node dissection, commonly referred to as RPLND, is a procedure to remove abdominal lymph nodes to treat testicular cancer, as well as help establish its exact stage and type. It is usually performed using an incision that extends from the sternum to several inches below the...
for testicular cancer
Testicular cancer
Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system.In the United States, between 7,500 and 8,000 diagnoses of testicular cancer are made each year. In the UK, approximately 2,000 men are diagnosed each year. Over his lifetime, a man's risk of...
if nerve pathways
Sympathetic nervous system
The sympathetic nervous system is one of the three parts of the autonomic nervous system, along with the enteric and parasympathetic systems. Its general action is to mobilize the body's nervous system fight-or-flight response...
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.
Retrograde ejaculation is a common side effect of medications, such as tamsulosin
Tamsulosin
Tamsulosin is an α1a-selective alpha blocker used in the symptomatic treatment of benign prostatic hyperplasia . Tamsulosin was developed by Yamanouchi Pharmaceuticals and is marketed by various companies under licence, including Boehringer-Ingelheim and CSL...
, that are used to relax the muscles of the urinary tract, treating conditions such as benign prostatic hyperplasia
Benign prostatic hyperplasia
Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
. By relaxing the bladder sphincter muscle, the likelihood of retrograde ejaculation is increased.
The medications that mostly cause it are antidepressant
Antidepressant
An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...
and antipsychotic
Antipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
medication; patients experiencing this phenomenon tend to quit the medications.
Retrograde ejaculation can also be a complication of diabetes, especially in cases of diabetics with long term poor blood sugar control. This is due to neuropathy 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
Urethral stricture
A urethral stricture is a narrowing of the urethra caused by injury or disease such as urinary tract infections or other forms of urethritis.-Signs and symptoms:...
disease shortly after the initial complaint arises. It is currently not known whether a congenital malformation of the Bulbar 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
Ejaculatory duct
-Anatomy:The ejaculatory ducts are paired structures in male anatomy. Each ejaculatory duct is formed by the union of the vas deferens with the duct of the seminal vesicle. They pass through the prostate, and open into the urethra at the Colliculus seminalis...
(usually distal to the duct).
Retrograde ejaculation can also be a result of young men pinching off the opening at the top of the penis, to avoid creating a mess upon ejaculation.
Diagnosis
Diagnosis is usually by way of a urinalysisUrinalysis
A urinalysis , also known as Routine and Microscopy , is an array of tests performed on urine, and one of the most common methods of medical diagnosis...
performed on a urine specimen that is obtained shortly after ejaculation. In cases of retrograde ejaculation, the specimen will contain an abnormal level of sperm
Spermatozoon
A spermatozoon is a motile sperm cell, or moving form of the haploid cell that is the male gamete. A spermatozoon joins an ovum to form a zygote...
.
Especially in case of orgasmic anejaculation, anejaculation
Anejaculation
Anejaculation is the pathological inability to ejaculate in males, with or without orgasm.It can depend on one or more of several causes, including ':*Sexual inhibition*Pharmacological inhibition...
can often be confused with retrograde ejaculation, and they share some fundamental aspects of the etiology
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
. Urinalysis is used to distinguish between them.
Tests
A physical exam of the genitals is applied to ensure that there are no anatomical problems. The urine will be examined 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 therapyRadiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
.
Potential 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 non-consistent. 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 nerveNerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...
s. Medications only work if there has been mild nerve damage caused by diabetes, multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
or mild spinal cord injury
Spinal cord injury
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
.
Medications used to treat retrograde ejaculation
- Tricyclic antidepressantTricyclic antidepressantTricyclic antidepressants are heterocyclic chemical compounds used primarily as antidepressants. The TCAs were first discovered in the early 1950s and were subsequently introduced later in the decade; they are named after their chemical structure, which contains three rings of atoms...
s like imipramineImipramineImipramine , also known as melipramine, is an antidepressant medication, a tricyclic antidepressant of the dibenzazepine group...
. - Antihistamines like chlorphenamineChlorphenamineChlorphenamine or chlorpheniramine , commonly marketed in the form of chlorpheniramine maleate , is a first-generation alkylamine antihistamine used in the prevention of the symptoms of allergic conditions such as rhinitis and urticaria. Its sedative effects are relatively weak compared to other...
. - Decongestants like ephedrineEphedrineEphedrine is a sympathomimetic amine commonly used as a stimulant, appetite suppressant, concentration aid, decongestant, and to treat hypotension associated with anaesthesia....
and phenylephrinePhenylephrinePhenylephrine is a selective α1-adrenergic receptor agonist used primarily as a decongestant, as an agent to dilate the pupil, and to increase blood pressure...
.
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 infertilityInfertility
Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term...
as a result of retrograde ejaculation and medications are not helping, the male's ejaculate may be centrifuge
Centrifuge
A centrifuge is a piece of equipment, generally driven by an electric motor , that puts an object in rotation around a fixed axis, applying a force perpendicular to the axis...
d and the isolated sperm injected directly into the woman through the use of intrauterine insemination. In more severe cases, in-vitro fertilization with intracytoplasmic sperm injection
Intracytoplasmic sperm injection
Intracytoplasmic sperm injection is an in vitro fertilization procedure in which a single sperm is injected directly into an egg.-Indications:...
may be used.
Alternative medicine
Taoists and some fields of alternative medicineAlternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....
recommend and teach deliberate retrograde ejaculation as a way of "conserving the body's energy". One manner of achieving this is by applying pressure to the perineum
Perineum
In human anatomy, the perineum is a region of the body including the perineal body and surrounding structures...
during orgasm. It was believed that doing this 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. This approach has since been discredited by modern medicine, as the retrograde-ejaculated sperm actually go into the bladder and are simply lost at the next urination. 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
Taoist sexual practices , literally "the bedroom arts", are the way some Taoists practiced sex. These practices were also known as "Joining Energy" or "The Joining of the Essences"...
).
Due to its aforementioned effects on fertility, there is a potential misconception that inducing this condition can be used as a method of contraception
Contraception
Contraception is the prevention of the fusion of gametes during or after sexual activity. The term contraception is a contraction of contra, which means against, and the word conception, meaning fertilization...
. However, it is neither reliable nor effective, due to some sperm still potentially emerging. Many doctors also do not recommend inducing retrograde ejaculation due to the risk of putting pressure on the pudendal nerve
Pudendal nerve
The pudendal nerve is a sensory and somatic nerve in the pelvic region which is a large branch of the sacral plexus that innervates the external genitalia of both sexes, as well as sphincters for the bladder and the rectum...
. Such pressure can cause numbness in the penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
.
External links
- http://www2.rz.hu-berlin.de/sexology/ECE1/retrograde.html
- Sexual Medicine Society of North America's website: SexHealthMatters.org