Retrograde ejaculation is a troubling medical condition where semen fires backwards, into the bladder, instead of in the proper direction. For a better understanding of what contributes to it, how you can tell it’s happening, and what forms of treatment exist for it, keep reading.
Causes
Retrograde ejaculation may arise from a malfunctioning bladder sphincter. This can happen in a handful of ways.
- “Dysautonomia,” an autonomic dysfunction within the nervous system.
- It can occur as a consequence of a procedure where prostate tissue is excised with a tool known as a resectoscope that passes through the urethra.
- It can arise from dissecting the retroperitoneal lymph node during a test for testicular cancer, provided that the nerve pathways to the bladder sphincter become damaged. This form of retrograde ejaculation may be temporary or permanent.
This condition is also a side effect of medications like tamsulosin, which relax muscles found within the urinary tract and are common in treating conditions like benign prostatic hyperplasia. This relaxation in the muscle raises the chances that ejaculate fires backwards. The main categories of medication known to cause this issue are antidepressants, antipsychotics, and NRIs like atomoxetine. Lastly, retrograde ejaculation can arise out of diabetes, especially when a patient has had prolonged difficulty maintaining a healthy level of blood sugar.
Young males who have completed puberty, around ages 17 to 20, and experience multiple episodes of retrograde ejaculation are often diagnosed with urethral stricture disease soon after the first complaint. It remains unknown if congenital malformation of the urethra is to blame or if constant pressure against the base of the penis or perineum before ejaculation leads to damaging the urethra. This damage is often present within half a centimeter of the ejaculatory duct.
Symptoms
Retrograde ejaculation, also known as “dry orgasm,” is one of the symptoms of male infertility. A man may observe that no ejaculation is released despite achieving orgasm. Alternatively, this may be caused by an obstruction in the ejaculatory duct.
When a male orgasms, sperm fire from the epididymis through the vas deferens. There, they interact with the seminal vesicles, prostate, and bulbourethral gland and blend with seminal fluid, prostate fluid, and lubricant. Upon reaching climax, the muscles at the end of the bladder neck tighten up as a precaution against the retrograde seminal flow. In short, retrograde ejaculation happens when the muscles of the bladder neck, or the nerves that control those muscles, have suffered damage.
Treatment
When it comes to retrograde ejaculation treatment, there is more than one approach. While some medications are prescribed, they are few and far between.
Known Medications for Treating Retrograde Ejaculation
- Tricyclic antidepressants (imipramine).
- Antihistamines (chlorphenamine).
- Decongestants (phenylephrine).
These constrict the bladder’s neck muscles, allowing semen to go forward. However, these medications can have side effects and require to be taken one to two hours before engaging in sexual intercourse. Most medications fail to work on the first use because male orgasms can be hard to predict. Furthermore, medications are useless if either the prostate or testes have been permanently damaged by radiation or the relevant muscles or nerves have suffered damage. Generally speaking, medications are only considered for retrograde ejaculation in cases of mild, diabetes-derived nerve damage, multiple sclerosis, or a mild injury to the spinal cord.
Infertility Treatments
In cases where infertility results from insufficient medications and retrograde ejaculation, there is a special procedure that may help. The patient alkalinizes urine, drinking 3g of sodium bicarbonate. This is consumed once before going to bed and then a second time after completely emptying the bladder immediately before going to a lab. Before collecting the patient’s semen, the patient must masturbate into one container, and then the bladder must be emptied into another container. The ejaculate may then be centrifuged from the voided urine and the remaining sperm can then be directly injected via intrauterine insemination. In more extreme cases, in-vitro fertilization with an intracytoplasmic sperm injection is considered.
Wrapping Things Up
Retrograde ejaculation is a condition where sperm goes in the wrong direction upon climax. This condition’s main symptom is a failure to ejaculate through the duct, and it is often caused by damage to muscles or nerves.
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