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Retrograde ejaculation

Definition

Retrograde ejaculation occurs when semen enters the bladder instead of going out through the urethra during ejaculation.

Alternative Names

Ejaculation retrograde

Causes, incidence, and risk factors

The main reason for retrograde ejaculation is that the bladder neck does not close. This causes semen to go backwards into the bladder rather than forward out of the penis.

Retrograde ejaculation may also be caused by:

  • Diabetes
  • Some medications, including drugs used to treat high blood pressure (hypertension) and some mood-altering drugs
  • Surgery to the prostate or urethra

The condition is uncommon.

Symptoms

  • Cloudy urine after orgasms
  • Little or no semen is released during ejaculation

Signs and tests

A urinalysis that is taken soon after ejaculation will show a large amount of sperm in the urine.

Treatment

Your health care provider may recommend that you stop taking a drug if it is causing your retrograde ejaculation. This can make the problem go away.

Retrograde ejaculation that is caused by diabetes or surgery may be treated with medications such as pseudoephedrine or imipramine.

Expectations (prognosis)

If retrograde ejaculation is caused by medications, stopping the drug will often bring back normal ejaculation. If retrograde ejaculation is caused by surgery or diabetes, it is often not correctable.

Complications

The condition may cause infertility. However, semen can often be removed from the bladder and used during assistive reproductive techniques to achieve a pregnancy.

Calling your health care provider

Call for an appointment with your health care provider if you are having trouble conceiving a child or you are worried about retrograde ejaculation.

Prevention

Maintaining good blood sugar control may help prevent this condition in men who have diabetes. Avoiding drugs that cause retrograde ejaculation will also prevent this condition.

References

Lipshultz LI, Thomas AJ, Khera M. Surgical management of male infertility. In: Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 20.

Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician. 2010;81:305-312.

Bhasin S, Basson R. Sexual dysfunction in men and woman. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 20.


Review Date: 9/16/2011
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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