Normally, as ejaculation begins, nerve signals close the neck of the bladder so semen can only go one way: out. If that muscle does not contract properly, semen takes the easier route backwards into the bladder1. It then leaves the body the next time you urinate.
Unlike many ejaculation problems, retrograde ejaculation is almost always physical rather than psychological. It is a common type of ejaculatory dysfunction but accounts for only 0.3 to 2% of infertility1.
It is not harmful in itself, and you can still have an orgasm. The main concerns are the underlying cause, which is worth identifying, and fertility, if you are trying for a baby.
What are the signs of retrograde ejaculation?
Little or no semen at orgasm, and cloudy urine the first time you pee afterwards. Some men only find out when they have trouble conceiving.
The cloudiness is simply semen mixed with urine in the bladder1. Partial retrograde ejaculation, where some semen comes out and some goes backwards, shows up as a noticeably reduced volume (see hypospermia).
If you notice it after starting a new medicine or after prostate surgery, tell the prescriber or surgeon. It is a known effect, and they will not be surprised by the question.
What causes retrograde ejaculation?
Anything that stops the bladder neck closing: certain medicines, nerve damage, or surgery on the prostate or bladder neck. Diabetes is a notable cause.
Recognised causes include1:
- Medicines: alpha-blockers (often prescribed for urinary symptoms from an enlarged prostate) and some psychiatric medicines.
- Nerve damage: diabetes, spinal cord injury, multiple sclerosis, stroke and some major abdominal or pelvic operations.
- Surgery: transurethral resection of the prostate (TURP) and bladder-neck incision.
- Diabetes in particular: in one controlled study, 9 of 26 men with diabetes had retrograde ejaculation, compared with none of 16 controls, and those men also more often had erectile dysfunction3.
How is retrograde ejaculation diagnosed?
With a urine sample passed straight after orgasm. Finding sperm in it confirms that semen is going into the bladder.
The urine test separates retrograde ejaculation from anejaculation, where no semen is released at all; both can cause a dry orgasm1,4. Fructose, a sugar made by the seminal vesicles, can also turn up in that urine sample1. Your doctor will also look for the underlying cause, for example by reviewing medicines and checking for diabetes.
How is retrograde ejaculation treated?
If you are not trying for a baby, treatment is optional once the cause is understood. If you are, there are medicines to help close the bladder neck and ways to recover sperm for assisted conception.
Sympathomimetic medicines, a group that includes some decongestants, can help the bladder neck close. In a systematic review they restored normal ejaculation in about 28% of cases, their effect can wear off over time, and side effects include a dry mouth and raised blood pressure1. Combining them with antimuscarinic medicines may work better, but the studies are small. Only use any of these under medical supervision. Surgery to reconstruct the bladder neck has also been described, though only in a handful of men1.
For conception, sperm can be recovered from urine after orgasm and used in assisted reproduction. Reviews of the evidence find that most studies are small and observational, so treatment is tailored to the individual2,4.
Common questions
Is retrograde ejaculation dangerous?
No. The semen simply leaves in your urine. It is still worth seeing a doctor, because the cause, such as diabetes or a medicine side effect, may need attention.
Can you get someone pregnant with retrograde ejaculation?
Sometimes, if part of the semen still comes out. If not, sperm can be recovered from urine after orgasm and used in assisted reproduction.
Does tamsulosin cause retrograde ejaculation?
Alpha-blockers, the group of medicines tamsulosin belongs to, are a recognised cause. Do not stop a prescribed medicine on your own; ask your prescriber whether there is an alternative.
Read more on this
Sources
- Parnham A, Serefoglu EC. Retrograde ejaculation, painful ejaculation and hematospermia. Transl Androl Urol. 2016;5(4):592-601. PubMed
- Jefferys A, Siassakos D, Wardle P. The management of retrograde ejaculation: a systematic review and update. Fertil Steril. 2012;97(2):306-312. PubMed
- Fedder J, Kaspersen MD, Brandslund I, Højgaard A. Retrograde ejaculation and sexual dysfunction in men with diabetes mellitus: a prospective, controlled study. Andrology. 2013;1(4):602-606. PubMed
- Mehta A, Sigman M. Management of the dry ejaculate: a systematic review of aspermia and retrograde ejaculation. Fertil Steril. 2015;104(5):1074-1081. PubMed
Not medical advice. Written by Eric Stephens from the research cited above; not reviewed by a doctor. If something worries you, see a GP.