Retrograde ejaculation is a uncommon but treatable condition in which semen is directed into the bladder instead of being ejaculated. Normally, the bladder sphincter muscle contracts just before ejaculation, forcing semen into the urethra (the tube through which urine and ejaculate pass out of the body). But when the sphincter malfunctions—due to medication, surgery, or an underlying condition—it can remain open and allow semen to travel into the bladder, where it mixes with urine. The condition is not harmful or painful, but it can decrease fertility and prevent conception.
Treatment is not typically required for retrograde ejaculation unless it is impacting fertility. In these cases, a urologist's approach depends on the underlying cause.
Treatment for Retrograde Ejaculation
Treatment depends on the condition's underlying cause and ranges from medication to surgery. The most commonly used approaches are below.
Medication
Antidepressants, anti-anxiety medications, and medications for high blood pressure or prostate conditions (such as benign prostatic hyperplasia) can cause the bladder sphincter muscle to relax, reducing its ability to contract before ejaculation. This increases the likelihood of retrograde ejaculation. If medications are causing the condition, a physician can decrease dosage or even discontinue it to see if the problem resolves.
Even when medication is not the cause, prescription drugs may help. These include:
- Antihistamines (such as Benedryl)
- Tricyclic antidepressants
These medications—taken alone or in combination—are effective when the condition is caused by nerve damage from diabetes, multiple sclerosis, or a spinal cord injury. They can improve muscle tone and keep the bladder neck closed during ejaculation. Additionally, collagen injections into the bladder neck can strengthen the muscles and ensure a better contraction.
Surgical Correction
In rare instances, surgical intervention can treat retrograde ejaculation. Because other less-invasive treatments are available, surgery is not a common option. When necessary, the surgeon reconstructs the sphincter muscles so that they better contract.
Infertility Procedures
If medication or surgery fails, infertility procedures may be a viable option. While they don't correct the condition, they can aid in conception. In these cases, sperm can be harvested from the bladder or gathered from a post-ejaculation urine sample. The sperm are gathered, washed, and then used for artificial insemination procedures (either via intrauterine injection or in vitro fertilization).
Prognosis for Retrograde Ejaculation
If medication is causing retrograde ejaculation, the condition should be correctable. Even when nerve damage is involved, medication can help up to 40 percent of the time. When the condition is untreatable, assisted reproductive technologies can often provide help with conception, although success depends not only on a man's sperm viability but his partner's fertility.
References
Retrograde Ejaculation. (2012). A.D.A.M. Encyclopedia
Albala D, Morey A, Gomella L, & Stein P. (2011). Retrograde Ejaculation. Oxford American Handbook of Urology.
