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Retrograde Ejaculation: Causes, Treatments & Considerations

Mary Lucas, RN

Medically reviewed by Mary Lucas, RN

Written by Our Editorial Team

Last updated 12/08/2020

Retrograde ejaculation is an uncommon condition in which semen travels backwards into the bladder during ejaculation, rather than forward through the urethra. 

If you’re affected by retrograde ejaculation, you may only ejaculate a small amount of semen as you reach orgasm. In some cases, you may not ejaculate at all. This is occasionally referred to as a “dry orgasm” or “dry climax.”

While retrograde orgasm generally isn’t harmful to your health and wellbeing, it may cause you to become infertile unless it can be reversed.

Retrograde ejaculation can occur for a number of reasons. It’s sometimes linked to medications and surgery. Some diseases and health conditions, such as diabetes and multiple sclerosis, may also cause retrograde ejaculation.

A variety of treatments are available for retrograde ejaculation, including lifestyle changes that you can make and medications that your healthcare provider may recommend.

Below, we’ve explained how retrograde ejaculation develops, as well as the symptoms that you may experience if you’re affected. We’ve also listed the treatment options that are available for retrograde ejaculation, from medications to fertility treatments and more.

What Is Retrograde Ejaculation?

Retrograde ejaculation is a condition in which semen flows backwards into the bladder during orgasm and ejaculation.

When a man has an orgasm, semen typically travels forward through the urethra and is expelled from the body through the contraction of penis muscles. This forward motion of the sperm happens because the sphincter that separates the bladder from the urethra closes, preventing the semen from travelling backwards.

In men with retrograde ejaculation, the small sphincter that stops the backwards flow of semen doesn’t close when it should, allowing some or all of the semen to flow backwards into the bladder.

Because some or all of the semen flows backwards rather than forwards, men with retrograde ejaculation often only ejaculate a small amount, or don’t ejaculate any semen at all. Instead, the semen enters into the bladder and is excreted from the body during urination.

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Symptoms of Retrograde Ejaculation

The most obvious symptom of retrograde ejaculation is the release of little or no semen during orgasm. On average, a healthy man will ejaculate around a quarter to one teaspoon of semen when they reach orgasm.

If you’re affected by retrograde ejaculation, you will have  an orgasm but release no semen, or only release a very small amount. You may or may not experience a change in the pleasurable sensation associated with the orgasm.

You may also notice that your urine is overly cloudy after you have sex or masturbate. This is caused by your semen mixing with the urine in your bladder.

What Causes Retrograde Ejaculation?

Several things can cause retrograde ejaculation to occur. If you have retrograde ejaculation, it may be related to your use of medication, to surgery you’ve had or may be due to damage to the muscles or nerves near your bladder due to a medical condition such as diabetes.

Medications 

Several medications can potentially cause retrograde ejaculation, including medications used to treat benign prostatic hyperplasia (prostate enlargement) and hypertension. Some medications linked to retrograde ejaculation include:

  • Alpha blockers. Some alpha blockers, a class of medications used to treat high blood pressure and benign prostatic hyperplasia, may potentially cause ejaculation disorders such as retrograde ejaculation.

  • Other benign prostatic hyperplasia medication. Other medications used to treat benign prostatic hyperplasia and chronic prostatitis, tamsulosin (Flomax®), may cause retrograde ejaculation.

  • Antidepressants. Research suggests some antidepressants, including the SSRIs sertraline (Zoloft®) and fluoxetine (Prozac®), may cause retrograde ejaculation.

  • Antipsychotic medications. Some medications used to treat psychotic disorders, such as thioridazine, chlorpromazine, and risperidone (Risperdal®), may cause retrograde ejaculation.

Surgical Procedures

Some surgical procedures can damage the muscles and nerves near the bladder, potentially causing retrograde ejaculation. Surgeries that may cause retrograde ejaculation include:

  • Prostate surgery. Certain surgeries for the prostate may cause retrograde ejaculation.

  • Bladder surgery. Some surgeries that affect the bladder may contribute to retrograde ejaculation.

  • Cancer staging surgery. Some surgical procedures to determine the stage of cancer near the lower abdomen or pelvis, such as removal of lymph nodes in the pelvis, may cause retrograde ejaculation.

  • Other surgical procedures. Other surgeries may also cause retrograde ejaculation, including surgery to remove prostate, colon, testicular or rectal cancer and surgery for the lower spine.

Medical Conditions

Certain medical conditions can damage the nerves and muscles around the bladder and cause retrograde ejaculation to develop. These include diabetes and multiple sclerosis may both cause retrograde ejaculation.

Other medical causes of retrograde ejaculation include injuries to the spinal cord, some blood disorders, strokes, and certain birth defects.

Treatments for Retrograde Ejaculation

Several treatments for retrograde ejaculation are available. Because several factors may cause retrograde ejaculation, your healthcare provider will recommend the treatment that’s best suited to your needs. 

Changing Medications

If your retrograde ejaculation is linked to a medication that you use, such as an alpha blocker or antidepressant, your healthcare provider may recommend adjusting your dosage or switching to a different medication. 

After stopping your medication use or changing to a different medication, you may notice your ejaculation function returning to normal over time. 

Medications for Retrograde Ejaculation

Several medications can improve muscle tone in the bladder, helping you to ejaculate normally and avoid retrograde ejaculation. These medications may be used if you have damage to the muscle or nerves around your bladder and urethra. 

Medications used to treat retrograde ejaculation include the tricyclic antidepressant imipramine (Tofranil®) and the stimulant pseudoephedrine.

Other Options

In some cases, such as when retrograde ejaculation is caused by significant damage to your nerves or muscles, it may not be treatable.

Retrograde ejaculation isn’t a physically harmful condition, meaning it doesn’t always need to be treated with medication. If you’re okay with not ejaculating when you orgasm, your healthcare provider may not suggest any specific treatment.

If you have retrograde ejaculation and would like to have children in the near future, it’s best to talk to a fertility specialist. Several fertility procedures, including intrauterine insemination (IUI), intracytoplasmic sperm injection (ISCI) and in-vitro fertilization (IVF) may be effective.

In Conclusion

Retrograde ejaculation can be frustrating, but it isn’t dangerous. If you’re affected by retrograde ejaculation, you might be able to get normal ejaculatory function back by switching medications, or by using a medication to improve muscle tone in your bladder.

To do this, you should get in touch with your healthcare provider.

If retrograde ejaculation is affecting your ability to make your partner pregnant, you may benefit from a fertility treatment such as in-vitro fertilization (IVF). A fertility specialist can help you and your partner learn more about your options. 

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This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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