Retrograde ejaculation: causes and treatment

The NHS lists three main ejaculation problems: premature, delayed and retrograde. Retrograde ejaculation is the rarer one. It happens when semen travels backwards into the bladder instead of through the urethra. Diabetes.co.uk explains it as semen entering the bladder during orgasm rather than coming out, and describes it as uncommon.

It is different from being unable to ejaculate at all. Fluid is released, but it goes the wrong way. The NHS notes that the semen in the bladder makes the first urine passed after sex look cloudy.

The NHS explains that the muscles around the neck of the bladder normally close tightly at the moment of orgasm, which stops semen entering the bladder. If the surrounding muscles or nerves are damaged, the bladder neck may not close and semen goes into the bladder rather than up through the urethra.

Diabetes.co.uk describes the same mechanism and notes that retrograde ejaculation does not affect the ability to get an erection. The problem lies at the bladder neck, not in sensation or desire.

The NHS lists two main symptoms: producing no semen, or only a small amount, during ejaculation, and cloudy urine when you first pass urine after sex, because the semen is in it. Diabetes.co.uk describes the same pattern as dry orgasms and adds that infertility may be the first sign for some men.

The NHS says men still feel orgasm. Some find the change surprising or worrying, particularly after surgery, so it helps to know that it is recognised and that it does not harm health.

• A dry orgasm, with little or no visible semen.

• Cloudy urine after sex.

• Difficulty conceiving, if you and a partner have been trying for some time.

• Normal erection and normal feeling of orgasm.

The NHS lists prostate gland surgery, bladder surgery, diabetes, multiple sclerosis, and alpha blockers, which are often used to treat high blood pressure. Diabetes.co.uk says that in diabetes, poor blood sugar control over a long period can lead to nerve damage affecting the bladder, called autonomic neuropathy, and that medicines for mood disorders, prostate enlargement or spinal cord injury can also have this effect.

Diabetes.co.uk adds that a dry orgasm can also result from surgical removal of the prostate or bladder, and from radiotherapy for cancer in the pelvis, in which case semen may be absent rather than redirected. Not every dry orgasm is retrograde ejaculation.

The NHS advises visiting a GP for a persistent ejaculation problem. The GP will discuss it with you, may examine you or refer you to a specialist. Diabetes.co.uk says the doctor asks about medicines, sexual history and past surgery, examines the penis, testicles and rectum, and that the diagnosis is confirmed if a urine test after ejaculation shows a large amount of sperm.

It is useful to make a list of any new medicines or operations before the appointment, since the cause is often found in the history. If you are on prescription medicines, do not stop them without speaking to your GP, as the NHS advises.

The NHS says most men do not need treatment, because they can still enjoy a healthy sex life and there are no adverse effects on health. Treatment is usually sought for fertility. The NHS says pseudoephedrine, commonly used as a decongestant, has proved effective for retrograde ejaculation caused by diabetes or surgery. It also says that if the cause is a medicine, normal ejaculation usually returns once it is stopped, but treatment may not be possible if there has been significant muscle or nerve damage.

Diabetes.co.uk lists pseudoephedrine and imipramine as medicines used to keep the bladder neck closed, and says that controlling blood sugar is an important step in men with diabetes. It states that retrograde ejaculation caused by surgery to the bladder neck or prostate is often not correctable because of the permanent changes.

For men who want children, the NHS says sperm can be taken from urine or the testicles for intrauterine insemination or IVF. Diabetes.co.uk describes washed sperm being used to inseminate a partner during ovulation.

See a GP if you notice dry orgasms or cloudy urine after sex, particularly after starting a new medicine or having surgery. The NHS page on infertility says it is a good idea to see a GP if a couple has not conceived after a year of trying, and sooner if one of you already knows about a fertility problem.

The NHS suggests involving a partner as much as possible when seeking treatment for sexual difficulties. Private urology and fertility services are available, and the choices described above are the same in either setting.