What Is Retrograde Ejaculation?

Semen is pushed to the bladder rather than out of the body

Medically reviewed by Jamin Brahmbhatt, MD

Retrograde ejaculation is when semen moves into the bladder instead of being pushed out of the penis during an orgasm. Although retrograde ejaculation does not affect your ability to reach sexual climax, you may produce little or no semen when you ejaculate ("cum").

Retrograde ejaculation, also known as a dry orgasm, is not harmful but can cause male infertility. There are several causes, including bladder or prostate surgery, nerve damage, and certain medications. Retrograde doesn't necessarily need treatment unless it affects your ability to conceive.

This article explains the symptoms and causes of retrograde ejaculation and describes what is involved in the diagnosis and treatment of this uncommon urological condition.

A Note on Gender and Sex Terminology

Verywell Health acknowledges that sex and gender are related concepts, but they are not the same.

• Sex refers to biology: chromosomal makeup, hormones, and anatomy. People are most often assigned male or female at birth based on their external anatomy; some people do not fit into that sex binary and are intersex.

• Gender describes a person's internal sense of self as a woman, man, nonbinary person, or another gender, and the associated social and cultural ideas about the roles, behaviors, expressions, and characteristics.

Research studies sometimes don't use the terminology in this way. Terms that describe gender (“woman,” “man”) may be used when terms for sex (“female,” “male”) are more appropriate. To reflect our sources accurately, this article uses terms like "female," "male," "woman," and "man" as the sources use them.

Symptoms of Retrograde Ejaculation

Retrograde ejaculation is characterized by the absence of semen when a male ejaculates. Semen is the thick, white fluid made by the prostate gland and seminal vesicles. It carries sperm out of the body.

Retrograde ejaculation can happen acutely after a recent procedure or new medication. It can then become chronic (ongoing). When the person masturbates, very little (if any) semen is produced.

Three common symptoms characterize retrograde ejaculation, which are:

• Dry orgasms (orgasms that produce little or no semen)

• Cloudy urine (caused by the presence of semen in the bladder)

• Infertility (the inability to get a partner pregnant)

Retrograde ejaculation doesn't cause pain or discomfort and is considered harmless outside of fertility issues. Furthermore, studies have shown that the volume of semen produced during orgasm has no impact on how intensely a person experiences sexual pleasure.

Even so, retrograde ejaculation can be a source of anxiety for people trying to conceive.

Related Conditions

Retrograde ejaculation is a form of aspermia. This is a group of conditions characterized by the lack of semen during ejaculation. Other causes of aspermia include male hypogonadism (low testosterone) and ejaculatory duct obstruction (in which the blockage of the ejaculatory ducts prevents the flow of semen from the body).

Related: Causes of Painful Ejaculation

Causes

Retrograde ejaculation is caused by the redirection of the normal flow of semen. Under normal circumstances, a group of muscles called the bladder neck will automatically contract during ejaculation, preventing the release of urine from the bladder and the flow of semen into the bladder.

With retrograde ejaculation, something interferes with this reflex. Rather than semen leaving the body through the urethra (the tube through which urine and semen are normally expelled), it is pushed into the bladder by forceful ejaculatory contractions.

It is only later during urination that the semen will be expelled from the body in urine.

There are several causes for retrograde ejaculation, some of which are more easily treated than others.

How Common Is Retrograde Ejaculation?

The actual prevalence of retrograde ejaculation is unknown as it is often left unreported. With that said, around 4% of males with infertility are found to have retrograde ejaculation.

Dysautonomia

Ejaculation is the result of a complex series of autonomic (involuntary) functions that are coordinated so that semen is forcefully propelled from the body at the time of orgasm.

Dysautonomia describes the breakdown of autonomic functions, including those involved with blood pressure, digestion, body temperature, and sexual function. When the male reproductive system is affected, a person may experience any number of ejaculatory problems, including retrograde ejaculation, premature ejaculation, delayed ejaculation, or anorgasmia (the inability to orgasm).

With retrograde ejaculation specifically, dysautonomia impairs the contraction of the bladder neck muscles.

Dysautonomia can occur on its own in the absence of other diseases, referred to as primary dysautonomia. The underlying cause may be genetic (something inherited from your parents) or idiopathic (meaning of unknown origin).

Dysautomia can also occur as a result of another disease, referred to as secondary dysautonomia. This typically involves diseases that damage autonomic nerves.

Diabetes and Retrograde Ejaculation

Diabetes is one of the most common forms of secondary dysautonomia in people with retrograde ejaculation. When blood sugar is left uncontrolled, diabetes can cause progressive nerve damage that undermines the function of the bladder neck.

Some studies suggest that 1 in 3 males with diabetes age 35 to 55 have ejaculatory problems as a result.

Other forms of secondary dysautonomia linked to retrograde ejaculation include multiple sclerosis (MS) and Parkinson's disease.

Surgery

Different surgeries can cause damage to nerves that regulate the bladder neck contractions or alter the anatomy of the urethra making a person more prone to retrograde ejaculation.

One of the most common surgeries to cause retrograde ejaculation is transurethral prostate resection (TURP). This is a procedure in which the prostate gland is removed slice by slice with a scope inserted through the urethra.

As many as 75% of people who undergo TURP experience a degree of retrograde ejaculation. A TURP can be done with a bipolar generator or laser, both of which can increase risks of retrograde ejaculation.

Procedures for prostate cancer which include removal of the entire prostate (prostatectomy) can also lead to a dry orgasm. In this case, the dry ejaculate is not because of issues of the bladder neck but more because the organs that produce the ejaculate volume are removed during the procedure.

Retrograde ejaculation can also occur after retroperitoneal lymph node dissection. This is a procedure commonly used in people with testicular cancer in which lymph nodes are removed from the lower abdomen to diagnose or treat the disease.

Spinal Cord Injury

In the same way that secondary dysautonomia can damage nerves that regulate ejaculation, a spinal cord injury can damage the spinal nerve roots that service the genital and urinary tract.

Some studies suggest that retrograde ejaculation affects 17% to 29% of males with spinal cord injuries. What differentiates these injuries from conditions like MS and diabetes is that the symptoms can either be chronic or intermittent depending on the location and extent of the injury.

Medications

There are several medications that can cause retrograde ejaculation by affecting sympathetic nerves that are responsible for reflexes, such as the contraction of the bladder neck.

These include:

• Prostate medications like Flomax (tamsulosin) and Uroxal (alfuzosin)

• Attention deficit hyperactivity disorder (ADHD) medications like Strattera (atomoxetine)

• Antidepressants like Cymbalta (duloxetine)

• Antipsychotics like Clozaril (clozapine) and Risperdal (risperidone)

• High blood pressure medications like Cardura (doxazosin) and Minipress (prazosin)

If you experience problems with ejaculation, be sure to advise a healthcare provider of any medications you take, whether prescription, over the counter (nonprescription), herbal, or recreational.

Related: Semen Retention: Is Not Ejaculating Beneficial?

Diagnosis

Retrograde ejaculation is usually diagnosed with a urine specimen collected after ejaculation. For this test, your healthcare provider will ask you to empty your bladder and then masturbate to climax. You will then provide a fresh urine sample for the lab to check. If there is a high volume of semen in the sample, you have retrograde ejaculation.

To help narrow the possible causes, the healthcare provider will review your medical history and physically examine your penis, testicles, and rectum. This can ensure there are no anatomical causes of your symptoms. Based on the findings, other tests may be ordered.

If you have dry orgasms and no semen in the urine, you may have an ejaculatory duct obstruction or damage caused by high-dose radiation or surgery to the testicles or prostate gland.

Treatment

Retrograde ejaculation usually doesn't require treatment unless it causes infertility. In such cases, the treatment can vary based on the underlying cause. Some "fixes" may be easier than others.

For example, if retrograde ejaculation is caused by medications, your healthcare provider may change your dose or drug. This is especially true if you and your partner are trying to get pregnant.

Other treatments may require a fertility specialist or a urologist who specializes in diseases of the urinary tract and male reproductive system.

Medications

Medications can help tighten the bladder neck and increase the output of semen during ejaculation. This, in turn, can help improve the odds of pregnancy.

Tofranil (imipramine), a tricyclic antidepressant used to treat depression as well as enuresis (bed-wetting), is sometimes used as a first-line treatment.

Other drugs commonly used to treat other medical conditions but have proven effective in retrograde ejaculation include:

• Asenden (amoxapine), a tricyclic antidepressant

• Akovaz (ephedrine), a nasal decongestant

• Chlor-Trimeton (chlorpheniramine), an antihistamine

• Sudafed (pseudoephedrine), a nasal decongestant

• Proamatine (midodrine), a vasodilator used for low blood pressure

• Vazculep (phenylephrine), a nasal decongestant

• Veltane (brompheniramine), an antihistamine

These drugs are typically taken one to two hours before sex. While potentially useful, they can cause side effects like drowsiness, dizziness, and blurred vision.

Deflux Injections

Although highly experimental, there is evidence that Deflux, an injectable gel used to treat vesicoureteral reflux (the backflow of urine into the bladder), may help reverse retrograde ejaculation in some people.

Medications do not help if retrograde ejaculation is caused by permanent damage to the prostate or testicle due to radiation therapy.

Related: Can Frequent Ejaculation Prevent Cancer?

Infertility Treatment

If medications are unable to produce enough semen for fertilization, intrauterine insemination (IUI) may be recommended. This would involve collecting enough sperm to facilitate pregnancy, after which the sample is delivered to the partner's uterus.

The sperm collection can be accomplished by masturbating to climax and immediately urinating into a container. Sperm can be recovered by spinning the urine in a centrifuge. The retrieved sperm can then be injected into the partner's uterus during ovulation by a medical practitioner.

While retrograde ejaculation does not make getting pregnant impossible, the chances are reduced. With assisted fertility procedures like intrauterine insemination (IUI), the pregnancy rate per cycle can increase to as high as 24%, which is approaching the rate seen in couples without infertility.

If IUI doesn't accomplish pregnancy, in-vitro fertilization (IVF) and other procedures may be explored.

Related: IUI vs. IVF: Which Is Best?

Coping With Retrograde Ejaculation

Although retrograde ejaculation is not harmful and doesn't affect sexual pleasure, it can still cause awkwardness or embarrassment when "nothing comes out" during sex. This is a bigger issue than some people recognize.

According to a 2018 study in the Journal of Sexual Medicine, 13% of females equate their sexual attractiveness with the volume of semen produced by their partners. Others say their orgasms were far more intense when semen volumes were greater.

While the vast majority of female partners do not feel this way, a dry orgasm might suggest to some that their partner was "less excited" or experienced less sexual pleasure.

The simple solution, of course, is to talk. Rather than leaving things unspoken, let your partner know more about your condition and what you feel and experience during sexual climax.

The same is even more true if you and your partner are trying to get pregnant. By talking to each other and sharing your thoughts with a fertility specialist—including the costs and the expected outcomes—you can reduce stress and get a better handle on what to expect if retrograde ejaculation is standing in your way of pregnancy.

Summary

Retrograde ejaculation is when semen flows to the bladder rather than being pushed out of the body during orgasm. It is an otherwise harmless condition but one that can lead to infertility.

Causes include prostate or bladder surgery, medication side effects, spinal cord injury, and nerve-related complications of diabetes, multiple sclerosis, or Parkinson's disease.

Treatment is generally not needed unless retrograde ejaculation causes infertility. In such cases, medications can help tighten bladder muscles and increase semen output. Infertility treatments like intrauterine insemination (IUI) can also improve the odds of conceiving.

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