Retrograde ejaculation is a condition where semen is not expelled out of the body during ejaculation, but instead, it is redirected into the bladder. This occurs when the muscle that normally closes the bladder during ejaculation is not working properly, allowing semen to flow backward into the bladder.

Retrograde ejaculation can be caused by several factors, including certain medications, nerve damage, prostate surgery, and some medical conditions like diabetes. In some cases, retrograde ejaculation may also be a side effect of certain treatments, such as radiation therapy or surgery for bladder or prostate cancer.

Symptoms of retrograde ejaculation can include a reduced or absence of semen during ejaculation and cloudy urine after ejaculation. While retrograde ejaculation itself is not usually harmful, it can cause infertility since sperm does not leave the body during ejaculation. However, retrograde ejaculation can be a sign of an underlying medical condition that requires treatment.

Diagnosis of retrograde ejaculation typically involves a physical exam and urine analysis. Treatment options may include medications that help to tighten the bladder neck muscles, which can help to prevent retrograde ejaculation. In cases where medications are not effective, a healthcare professional may recommend assisted reproductive techniques, such as intrauterine insemination, to help with fertility.

During a male orgasm, a tube called the vas deferens transports sperm to the prostate, where they mix with other fluids to produce liquid semen (ejaculate). The muscle at the opening of the bladder (bladder neck muscle) tightens to prevent ejaculate from entering the bladder as it passes from the prostate into the tube inside the penis (urethra). This is the same muscle that holds urine in your bladder until you urinate.

With retrograde ejaculation, the bladder neck muscle doesn't tighten properly. As a result, sperm can enter the bladder instead of being ejected out of your body through the penis.

Several conditions can cause problems with the muscle that closes the bladder during ejaculation. These include:

• Surgery, such as bladder neck surgery, retroperitoneal lymph node dissection surgery for testicular cancer or prostate surgery
• Side effect of certain medications used to treat high blood pressure, prostate enlargement and depression
• Nerve damage caused by a medical condition, such as diabetes, multiple sclerosis, Parkinson's disease or a spinal cord injury

A dry orgasm is the primary sign of retrograde ejaculation. But dry orgasm — the ejaculation of little or no semen — can also be caused by other conditions, including:

• Surgical removal of the prostate (prostatectomy)
• Surgical removal of the bladder (cystectomy)
• Radiation therapy to treat cancer in the pelvic area

If you take medications or have health problems that put you at risk of retrograde ejaculation, ask your doctor what you can do to lower your risk.

If you need to have surgery that might affect the bladder neck muscle, such as prostate or bladder surgery, ask about the risk of retrograde ejaculation. If you plan to have children in the future, talk with your doctor about options for preserving semen before the surgery.

Retrograde ejaculation typically doesn't require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause.

Medications

Medications might work for retrograde ejaculation caused by nerve damage. This type of damage can be caused by diabetes, multiple sclerosis, certain surgeries, and other conditions and treatments.

Drugs generally won't help if retrograde ejaculation is due to surgery that causes permanent physical changes of your anatomy. Examples include bladder neck surgery and transurethral resection of the prostate.

If your doctor thinks drugs you are taking might be affecting your ability to ejaculate normally, he or she might have you stop taking them for a period of time. Drugs that can cause retrograde ejaculation include certain medications for depression and alpha blockers — drugs used to treat high blood pressure and some prostate conditions.

Drugs to treat retrograde ejaculation are drugs primarily used to treat other conditions, including:

• Imipramine, an antidepressant
• Midodrine, a medicine that constricts blood vessels
• Chlorpheniramine and brompheniramine, antihistamines that help relieve allergies
• Ephedrine, pseudoephedrine and phenylephrine, medicines that help relieve symptoms of the common cold

These medications help keep the bladder neck muscle closed during ejaculation. While they're often an effective treatment for retrograde ejaculation, medications can cause side effects or adverse reactions with other medications. Certain medications used to treat retrograde ejaculation can increase your blood pressure and heart rate, which can be dangerous if you have high blood pressure or heart disease.

Infertility treatment

If you have retrograde ejaculation, you'll likely need treatment to get your female partner pregnant. In order to achieve a pregnancy, you need to ejaculate enough semen to carry your sperm into your partner's vagina and into her uterus.

If medication doesn't allow you to ejaculate semen, you will likely need infertility procedures known as assisted reproductive technology to get your partner pregnant. In some cases, sperm can be recovered from the bladder, processed in the laboratory and used to inseminate your partner (intrauterine insemination).

Sometimes, more-advanced assisted reproductive techniques are needed. Many men with retrograde ejaculation are able to get their partners pregnant once they seek treatment.