What is retrograde ejaculation?

Retrograde ejaculation is when semen passes backwards into the bladder instead of out through the urethra at orgasm, due to failure of the bladder neck to close.

It causes absent or reduced ejaculate ('dry orgasm') and cloudy urine afterwards (sperm in urine), and can cause male subfertility. Causes include diabetic neuropathy, bladder neck/prostate surgery, and certain drugs (alpha-blockers).

Clinical relevance. Recognising retrograde ejaculation ('dry orgasm', cloudy urine) identifies a cause of male subfertility and directs management.

More Detail

Retrograde ejaculation

Retrograde ejaculation is misdirection of semen into the bladder.

What it is

• At orgasm, semen passes backwards (retrograde) into the bladder instead of forwards out of the urethra (antegrade).
• Due to failure of the bladder neck (internal urethral sphincter) to close during ejaculation.

Features

• Absent or markedly reduced ejaculate ('dry' or low-volume orgasm).
• Cloudy urine after intercourse (semen/sperm in the urine - confirms the diagnosis).
• Can cause male subfertility.

Causes

• Diabetic autonomic neuropathy.
• Bladder neck or prostate surgery (e.g. transurethral resection of the prostate).
• Drugs - alpha-blockers (e.g. tamsulosin); spinal cord injury.

Management

• Treat/review the cause; sympathomimetic drugs may help in some; for fertility, retrieve sperm from urine for assisted reproduction.