Ejaculation is the ejection of semen out of the urethra (passageway inside the penis) when a man has an orgasm. Under normal circumstances, ejaculation propels semen forward through a man's urethra and out the tip of his penis. This is because a tiny sphincter (circular muscle) at the entrance to the bladder shuts the opening to the bladder and prevents semen from entering. Retrograde ejaculation is when the semen travels backward into the bladder.In retrograde ejaculation, the muscle that shuts the bladder does not function normally. This allows all or part of the semen to travel backward (retrograde) into the bladder at the time of ejaculation. When this happens, less semen comes out the tip of the penis.

Retrograde ejaculation has several possible causes, including:

• Damage from surgery to the muscles of the bladder or to the nerves that control these muscles — This damage can occur as a complication of the following surgical procedures:
  
  
  • Men who have had a transurethral prostatectomy (removal of prostate tissue through the urethra) have a 10% to 15% chance of retrograde ejaculation. A prostatectomy (surgery to remove the entire prostate gland, either for cancer or benign enlargement) has a 40% to 90% chance of retrograde ejaculation after the procedure.
  • Surgery on certain parts of the bladder
  • Extensive pelvic surgery, especially to treat cancer of the prostate, testicles, colon or rectum
  • Staging surgery for cancer in the pelvis or lower abdomen (this surgery removes lymph nodes in the pelvis and lower abdomen to help determine how far cancer has spread)
  • Certain types of surgery on the discs and vertebrae of the lower spine



• Nerve damage caused by medical illness — This is especially common in men with multiple sclerosis or with long-term, poorly controlled diabetes.



• Side effects of medication — Certain medications can interfere with the function of nerves that control the muscles involved in ejaculation. They include:
  
  
  • Psychiatric medications — amitriptyline (Elavil), amoxapine (Asendin), chlorpromazine (Thorazine), thioridazine (Mellaril)
  • Drugs for treating prostate enlargement — tamsulosin (Flomax) or terazosin (Cardura)
  • Certain drugs to treat high blood pressure — guanethidine (Ismelin), reserpine (Serpasil)

Retrograde ejaculation does not interfere with a man's ability to have an erection or to achieve orgasm, but it can cause infertility because the sperm cannot reach the woman's uterus. Retrograde ejaculation is responsible for about 1% of all cases of male infertility in the United States.

Normally, a healthy adult male ejaculates one-half to 1 teaspoonful of semen during orgasm, but the amount varies widely. In men with retrograde ejaculation, the amount of semen is decreased dramatically or there is a dry climax (orgasm without semen).

In most cases, the diagnosis will be made by a family doctor or a urologist, a doctor who specializes in male reproductive disorders and urinary tract problems. The doctor will ask questions about your medical history, previous surgery, sexual history and current medications. These questions will be followed by a thorough physical examination. The diagnosis usually can be confirmed if sperm are found in a urine sample after ejaculation.

How long this problem lasts depends on the cause. If your retrograde ejaculation is a side effect of medication, the problem may go away when your doctor switches you to a different drug. On the other hand, if your retrograde ejaculation is caused by severe nerve or muscle damage, the condition may be permanent.

There now are innovative, minimally invasive forms of prostate surgery for enlarged prostates (not cancer) that may cause less retrograde ejaculation than the standard procedures. These newer procedures, such as transurethral needle ablation of the prostate (TUNA) and transurethral microwave thermotherapy (TUMT), are among several being evaluated by the U.S. National Institutes of Health for their success rate and side effects. Even if these procedures cause fewer cases of retrograde ejaculation, however, they may not be appropriate for all patients.

Most men who have retrograde ejaculation do not need specific treatment. If the condition is a side effect of medication, your doctor may be able to switch you to a different drug that does not cause the problem. In other men, all that is needed is reassurance that retrograde ejaculation is not a serious medical problem and that it is not a sign of a serious condition such as cancer.

In some men, retrograde ejaculation requires treatment because it interferes with fertility. This treatment varies depending on the cause. If your retrograde ejaculation is a side effect of medication, your doctor probably will switch you to a drug that does not affect ejaculation. If your retrograde ejaculation appears to be related to a mild nerve or muscle problem involving the bladder, then your doctor will treat you with a drug — such as pseudoephedrine (sold under many brand names) or imipramine (Tofranil) — that improves muscle tone at the bladder entrance.

If your retrograde ejaculation is the result of severe damage to the nerves or muscles of your bladder, then it may not be possible to restore normal ejaculation. If this is the case, and you are hoping to father a child, a fertility specialist may be able to help. The fertility specialist may collect sperm from your urine and use washed sperm for an assisted-fertilization procedure. In cases of retrograde ejaculation, three of the most commonly used assisted fertilization procedures are:

• Intrauterine insemination (using a small catheter to put washed sperm inside your partner's uterus at the time of ovulation)
• In-vitro fertilization (incubating eggs and sperm together in the laboratory to produce fertilization)
• Intracytoplasmic sperm injection (injecting a single sperm into your partner's egg to cause fertilization)

Contact your doctor if you produce little or no semen when you ejaculate, especially if you are hoping to father a child.

When retrograde ejaculation is treated with medication, up to 40% of men experience normal ejaculation.

In men who do not respond to medication, fathering a child may still be possible with the help of assisted fertilization procedures.

National Institute of Diabetes & Digestive & Kidney Disorders
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American Urological Association
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Phone: 410-689-3700
Toll-Free: 1-866-746-4282
Fax: 410-689-3800
Email: aua@auanet.org
http://www.urologyhealth.org/

RESOLVE: The National Infertility Association
7910 Woodmont Ave.
Suite 1350
Bethesda, MD 20814
Phone: 301-652-8585
Fax: 301-652-9375
Email: info@resolve.com
http://www.resolve.org/