Rigi10™ Malleable Penile Prosthesis
Also Known As
Dry orgasm, anejaculation (partial or complete), wstępujący wytrysk (Polish)
Definition
Retrograde ejaculation is a medical condition where semen, the fluid containing sperm, travels backward into the bladder instead of being expelled forward through the penis during orgasm¹˒²˒³˒⁴. Normally, during male orgasm, sperm is transported from the vas deferens to the prostate, where it mixes with other fluids to form semen. Simultaneously, the bladder neck muscle, which is the same muscle that controls urination, tightens to prevent semen from entering the bladder and directs it into the urethra for ejaculation from the penis¹˒³˒⁴. In retrograde ejaculation, this bladder neck muscle fails to tighten adequately, allowing some or all of the semen to flow into the bladder¹˒⁴. While the individual still experiences the sensation of orgasm, there may be very little or no visible semen ejaculated, a condition sometimes referred to as a dry orgasm¹˒².
Retrograde ejaculation itself is not generally harmful to the individual’s physical health and does not typically affect the ability to achieve an erection or experience orgasm¹˒⁴. However, it is a significant cause of male infertility because the sperm does not reach the female reproductive tract¹.
Clinical Context
Retrograde ejaculation is typically identified when a man reports little to no semen during orgasm (dry orgasm) or when cloudy urine is observed after orgasm due to the presence of semen¹˒³. It is often a concern for men attempting to conceive, as it can lead to infertility¹. The condition can arise from various underlying causes that affect the normal functioning of the bladder neck muscle. These causes include:
- Surgical procedures: Surgery on the prostate (such as transurethral resection of the prostate – TURP for benign prostatic hyperplasia), bladder neck surgery, or extensive retroperitoneal lymph node dissection for testicular cancer can damage the nerves or muscles controlling the bladder neck¹˒⁴.
- Medications: Certain medications can have retrograde ejaculation as a side effect. These include some drugs used to treat high blood pressure (e.g., alpha-blockers like tamsulosin, which relax the bladder neck), prostate enlargement, and depression¹˒³.
- Nerve damage (neuropathy): Medical conditions that cause nerve damage can affect the bladder neck muscle. Common examples include diabetes (diabetic neuropathy), multiple sclerosis, Parkinson’s disease, and spinal cord injuries¹˒³˒⁴.
Diagnosis often involves a medical history review, a physical examination, and a post-orgasmic urinalysis. If semen is found in the urine sample collected after orgasm, the diagnosis of retrograde ejaculation is confirmed¹˒⁴. Treatment is generally only necessary if fertility is a concern or if the condition causes significant distress. Treatment options depend on the underlying cause and may include:
- Medication changes: If a medication is suspected to be the cause, switching to an alternative drug may resolve the issue, if medically appropriate¹.
- Medications to improve bladder neck function: Drugs like pseudoephedrine or imipramine can sometimes help close the bladder neck during ejaculation, though their use may be limited by side effects and underlying health conditions (e.g., high blood pressure, heart disease)³˒⁴.
- Fertility treatments: For men wishing to conceive, sperm can often be retrieved from the urine after orgasm and used for assisted reproductive techniques such as intrauterine insemination (IUI) or in vitro fertilization (IVF)³.
Expected outcomes vary depending on the cause and the treatment pursued. In some cases, medication can restore antegrade (forward) ejaculation. When fertility is the primary concern, assisted reproductive technologies often offer a successful path to conception¹.