It can be a bit startling, can’t it? You reach that moment of intimacy, and then… well, not much happens, or at least not what you expect. If you’re noticing little to no semen during orgasm, you might be wondering what’s going on. This experience, sometimes called a “dry orgasm,” could be due to a condition we call Retrograde Ejaculation. It sounds a bit technical, I know, but let’s break it down.
So, What Exactly is Retrograde Ejaculation?
Normally, when a man orgasms, semen travels out through the urethra – that’s the tube in the penis. There’s a little circular muscle, a kind of gatekeeper, at the entrance to your bladder called the bladder sphincter (or urethral sphincter). Its job is to clamp down tight during ejaculation to make sure the semen goes forward, out of the body, and not backward into the bladder.
With Retrograde Ejaculation, that little gatekeeper muscle doesn’t close properly. So, instead of the semen exiting the penis, it flows backward into the bladder. It’s not dangerous, but it can certainly be a surprise and, for some men, a cause of concern, especially if they’re trying to conceive. It’s actually more common than you might think, particularly after certain prostate surgeries.
Some folks also call it:
- Retro ejaculation
- Dry orgasm
- Retrograde orgasm
Signs You Might Be Experiencing This
How do you know if this is what’s happening? Well, the signs are usually quite clear:
- You orgasm, but very little or no semen comes out. This is the main one.
- Your urine looks cloudy right after an orgasm. That’s because the semen has mixed with your urine in the bladder.
- You might be having trouble with fertility if you’re trying for a baby, as the sperm aren’t reaching their destination.
Does It Affect Sex Otherwise?
Good question. Generally, Retrograde Ejaculation doesn’t interfere with your ability to get an erection or experience an orgasm. The sensation of orgasm itself should still be there. However, the experience of not seeing semen can sometimes cause stress or anxiety for some men, and that, in turn, might affect sexual pleasure. If it’s making you feel off or worried, that’s a perfectly good reason to chat with us.
Why Does Retrograde Ejaculation Happen?
So, why does that little gatekeeper muscle decide not to do its job? There are a few common reasons:
- Surgery in the area: This is a big one. Procedures like transurethral resection of the prostate (TURP) or other prostate surgeries (like a prostatectomy) or even surgery on the urethra (urethrectomy) can sometimes affect the muscle or the nerves controlling it. Surgeries in the pelvis or rectum can also play a role.
- Medications: Certain drugs can have this as a side effect. We see it sometimes with medications for:
- Benign Prostatic Hyperplasia (BPH) – an enlarged prostate.
- High blood pressure (hypertension).
- Depression.
- Nerve damage: Conditions that affect the nerves can also impact this muscle. Think of things like:
- Diabetes
- Multiple Sclerosis (MS)
- Spinal cord injuries
- Structural issues: Sometimes, there might be an issue with the urethra itself.
If you have Retrograde Ejaculation, the semen isn’t lost. It simply mixes with the urine in your bladder and then leaves your body the next time you pee.
You might be more likely to experience this if you’ve had the surgeries mentioned, have conditions like diabetes or MS, a spinal cord injury, or if you’re on those specific types of medications.
How We Figure This Out: Diagnosis
If you come to see me, or another healthcare provider, concerned about this, we’ll start by having a good chat about your medical history and your symptoms. A physical exam is also part of the process.
If we suspect Retrograde Ejaculation, we might suggest a couple of simple tests:
- Semen samples: We might ask you to provide a couple of samples. If the volume of semen is consistently very low, it points towards this condition.
- Urine test after orgasm: This is a key test. We’ll ask you to provide a urine sample right after you’ve had an orgasm. Semen contains a type of sugar called fructose (it gives sperm energy to swim!), which isn’t normally found in urine. If the lab finds fructose, or a significant number of sperm, in your post-orgasm urine, that’s a strong indicator of Retrograde Ejaculation.
What Can We Do About It? Treatment Options
First off, it’s important to know that Retrograde Ejaculation isn’t usually painful or harmful to your physical health. So, if it’s not bothering you, and you’re not trying to have biological children, you might not need any treatment at all. And that’s okay!
However, if it is a concern, or if fertility is a goal, we do have options:
- Medications: Sometimes, certain medicines can help that bladder neck muscle close more effectively. These might include:
- Imipramine: An older type of antidepressant.
- Antihistamines: Like pseudoephedrine (yes, the kind in some cold medicines!) and chlorpheniramine.
- Midodrine: A medication typically used for low blood pressure.
If you’re taking any of these, we’d keep an eye on your blood pressure and heart rate, as they can sometimes cause increases.
- Changing medications: If a drug you’re currently taking for another condition is the culprit, we might be able to switch you to a different one that doesn’t have this side effect. We’d, of course, weigh the pros and cons carefully.
- Assisted Reproductive Technology (ART): If medications don’t help enough, or aren’t suitable, and you want to have a biological child, fertility treatments are a very real possibility. We can often retrieve sperm from a urine sample (collected after orgasm) or sometimes through a minor procedure like microsurgical testicular sperm extraction (microTESE).
What About Exercises?
You might have heard about Kegel exercises – those exercises that strengthen your pelvic floor muscles. They’re great for things like urinary incontinence and can give you better ejaculatory control in general. But, honestly, they aren’t likely to force the semen out through the penis if the bladder neck muscle isn’t closing properly. They won’t hurt, but they probably won’t fix Retrograde Ejaculation on their own.
When to Chat With Your Doctor
It’s always a good idea to reach out to us if:
- You’re trying to conceive and it’s not happening.
- You feel uncomfortable or distressed about the experience of a dry orgasm.
- You’re already getting treatment, but it doesn’t seem to be working.
When you come in, feel free to ask questions! Things like:
- What do you think is causing my Retrograde Ejaculation?
- If I need surgery in that area, how likely am I to develop this?
- What treatment options do you think are best for me?
- Are there any other signs or complications I should watch out for?
- Can you give me a full list of medications that might cause this?
- Should I see a specialist, like a urologist (a doctor specializing in the urinary tract and male reproductive system)?
What’s the Outlook?
The outlook for Retrograde Ejaculation is generally good. As I mentioned, it’s not typically harmful. If it doesn’t bother you and you’re not concerned about fertility, treatment might not even be necessary. If you do want treatment, options are available for both the condition itself and for any related fertility issues.
How long it lasts really depends on the cause. If it’s medication-induced, it often resolves pretty quickly once the medication is stopped or changed. If it’s due to something more permanent, like significant nerve damage from surgery or a long-standing condition, it might be a long-term thing. We can give you a better idea based on your specific situation.
Can It Be Prevented?
Unfortunately, you can’t always prevent Retrograde Ejaculation. If you have a condition or are taking medications known to cause it, we’ll discuss the risks.
If you have an enlarged prostate (BPH) and are considering surgery, there are some newer, minimally invasive procedures like a prostatic urethral lift or the Rezūm procedure. These might have a lower risk of causing Retrograde Ejaculation compared to older surgical techniques. It’s worth discussing these options with your urologist.
And a really important point: if you need surgery that carries a risk of Retrograde Ejaculation and you think you might want to have biological children in the future, please talk to us before the surgery about sperm banking. It’s a way to preserve your fertility options.
A Few More Common Questions
What does retrograde ejaculation actually feel like?
The physical sensation of orgasm should be the same as a typical ejaculation (which we sometimes call antegrade ejaculation). However, for some men, not seeing any semen can feel a bit odd, disappointing, or even worrying. If it makes you uncomfortable in any way, please don’t hesitate to talk to a healthcare provider.
Can not ejaculating cause problems?
There’s no evidence that not ejaculating (if semen is produced but doesn’t come out, like in Retrograde Ejaculation) causes any physical harm. Your body simply reabsorbs any sperm that aren’t released externally or, in this case, they pass out with urine.
So, you do pee out the semen with retrograde ejaculation?
Yes, exactly. The semen goes into the bladder and is then expelled from the body when you urinate.
Is there an age when men stop ejaculating?
Many men notice changes in their sex drive (libido) and sexual function as they get older. However, there’s no set age when ejaculation stops. Some men might experience difficulties, perhaps even Retrograde Ejaculation or other issues, starting in their 30s or 40s, while others continue to ejaculate well into their 70s, 80s, or even beyond. It’s very individual.
Take-Home Message
Here are the key things I’d like you to remember about Retrograde Ejaculation:
- It means semen goes into your bladder instead of out your penis during orgasm.
- The main signs are little/no semen and cloudy urine after orgasm.
- It’s often caused by surgery, medications, or nerve damage.
- It’s usually not harmful, but can affect male fertility.
- Treatments are available if it’s bothersome or if you’re trying to conceive.
- Don’t hesitate to talk to your doctor if you have concerns about Retrograde Ejaculation.
You’re not alone in this. It’s something we see and can help you navigate. So please, if this is on your mind, let’s talk.
