Retrograde ejaculation

Diagnosis

To identify retrograde ejaculation, your doctor could:

• Inquire about your symptoms and their duration, along with any pertinent medical history, surgeries, or instances of cancer, as well as your current medications.
• Conduct a physical examination, typically encompassing an assessment of your penis, testicles, and rectum.
• Evaluate your urine for semen presence post-orgasm. This process usually occurs at the doctor’s office, where you’ll be instructed to empty your bladder, achieve climax through masturbation, and provide a urine sample for laboratory assessment. If a significant amount of sperm is detected in your urine, retrograde ejaculation is diagnosed.

If you experience dry orgasms and no semen is detected in your bladder upon examination by your doctor, it could indicate an issue with semen production. This might stem from damage to the prostate or the glands responsible for semen production, often resulting from surgery or radiation therapy for pelvic area cancer.

If your doctor suspects that your dry orgasm is due to a cause other than retrograde ejaculation, additional tests or a referral to a specialist may be necessary to identify the underlying reason.

Treatment

Retrograde ejaculation typically does not require intervention unless it affects fertility. The choice of treatment hinges on the underlying cause.

Medication treatment options:

Medications may be effective for retrograde ejaculation resulting from nerve damage due to conditions like diabetes, multiple sclerosis, or certain medical procedures. However, if retrograde ejaculation stems from surgeries that permanently alter anatomical structures, such as bladder neck surgery or transurethral resection of the prostate, medications are generally ineffective.

Potential medications include:

• Imipramine: An antidepressant.
• Midodrine: A drug that constricts blood vessels.
• Chlorpheniramine and brompheniramine: Antihistamines for allergy relief.
• Ephedrine, pseudoephedrine, and phenylephrine: Common cold symptom relievers.

These medications work by helping to keep the bladder neck muscle closed during ejaculation. However, they may have side effects and can interact adversely with other medications. Particularly, they can raise blood pressure and heart rate, posing risks for those with cardiovascular conditions.

Impact of other drugs:

If current medications are suspected to disrupt normal ejaculation, a temporary discontinuation may be suggested. Drugs known to potentially cause retrograde ejaculation include certain antidepressants and alpha blockers, which are prescribed for high blood pressure and some prostate issues.

Infertility treatment:

For men experiencing fertility issues due to retrograde ejaculation, direct ejaculation of semen may not be feasible. In such cases, assisted reproductive technology becomes necessary. This may involve recovering sperm from the bladder, preparing it in a lab, and then using it for intrauterine insemination. More advanced techniques may also be required, and many men find success in conceiving with their partners after seeking appropriate treatment.