What Is Retrograde Ejaculation: Cause, Symptoms, Diagnosis And Care

Causes

In all likelihood, retrograde ejaculation is due to the inability of the bladder inlet to close during the ejaculatory act, as occurs under normal conditions; as a result, retrograde sperm flow cannot be prevented.

Failure to close the bladder inlet is caused, in turn, by physical trauma to the bladder or by congenital or acquired neurological deficits.
Retrograde ejaculation is a problem that affects many diabetics : diabetic neuropathy seems to be responsible for the damage to the nerve connection to the bladder.

Among other causative factors directly implicated in retrograde ejaculation,prostate , autonomic nervous system deficit , surgical complications affecting the prostate and bladder neck, and TURP (acronym for endoscopic trans urethral resection of the prostate , the best known intervention aimed at the treatment of prostatic hypertrophy ).

Retrograde ejaculation has also been diagnosed after targeted surgical interventions, such as endoscopic electroresection of benign prostate adenomas , prostatic adenomiectomy, spinal and pelvic organ surgery, retroperitoneal surgery.

Retrograde Ejaculation And Drugs

It has been demonstrated that the immoderate use of some classes of drugs can enhance the damage at the ejaculatory level, generating retrograde sperm emission during orgasm: in particular, neuroleptic and antihypertensive drugs increase the probability of generating this disorder. Investigating even more minutely, a clear correlation is evident between the administration of thioridazine and risperidone ( antipsychotics), and retrograde ejaculation: these drugs exert antiserotonin and antiadrenergic effects, causing a defect in the expulsion of the ejaculate, which is in fact emitted inside the bladder. In any case, the interruption of the pharmacological treatment allows the reversibility of the retrograde ejaculatory condition, that is to say a clear improvement of the symptomatological picture and a return to normality. [taken from Guidelines for the treatment of schizophrenia , by E. Sacchetti].

Retrograde ejaculation could also be found in patients undergoing pharmacological treatments with alpha-blockers, useful for the treatment of cervico-urethral obstruction; also in this case, the condition is reversible at the end of the therapy.

Dry Orgasm

Erroneously, many patients suffering from retrograde ejaculation speak of dry orgasm: it is necessary to clarify, since the two conditions are not synonymous.

1. Dry orgasm: produces orgasmic sensations comparable to physiological ones, but the emission of semen during ejaculation is denied. Probably, dry orgasm – or dry – is due to failure of prostatic, testicular and vas deferens peristalsis. The sensations generated by the dry orgasm, in humans, are the consequence of repeated contractions of the ischio/bulbo/cavernosus muscles. In medical terms, dry orgasm is termed anejaculation .
2. Retrograde ejaculation: Unlike dry orgasm , the emission of semen is present but the ejaculate travels to the bladder, resulting in subsequent leakage, together with the urine. Some patients with retrograde ejaculation also complain of psychological anorgasmia, caused by not seeing the sperm immediately.

Diagnosis

The urinalysis is indispensable in case of retrograde ejaculation, since, as already discussed, the ejaculate is emitted together with the urine, after coitus. Through urinalysis and urodynamics it is possible to verify the presence of germ line elements in the urine, thus diagnosing retrograde ejaculation.

In any case, in a patient suffering from azoospermia , the absence of sperm in the urine does not exclude retrograde ejaculation with certainty: in similar circumstances, the search for fructose in the urine is recommended. [taken from  Medical Sexology. Treatise on psychosexology and medicine of sexuality. FromEmmanuele A. Jannini, Andrea Lenzi, Mario A. Maggi].
Among other diagnostic strategies, transrectal prostatic ultrasound could also represent a valid aid for the investigation of possible morphological-structural anomalies of the seminal vesicles .

Care

Retrograde ejaculation should not be underestimated because it could be an obvious cause of sterility ; in this regard, it is necessary to contact the specialist as soon as the problem is noticed.
The treatment of choice is medical-pharmacological therapy: imipramine ( antidepressant drug ) and pseudo-ephedrine have proved to be remarkably advantageous for resolving retrograde ejaculation: it is estimated that, following this pharmacological therapy, the prognosis is excellent in 40% of cases.

However, the pharmacological substances used are not useful in all patients: another technique used is electroejaculation, in which the emission of sperm is favored by the introduction of a probe into the rectum, capable of stimulating the seminal vesicles.
When the treatments described above prove to be ineffective, and men affected by retrograde ejaculation want a child, they must make use of assisted fertilization : the seminal fluid is collected from a urine sample (after coitus), then subsequently used for assisted fertilization , with excellent results.

Summary

Retrograde ejaculation: in brief