Normally, the sphincter of the bladder contracts before ejaculation forcing the semen to exit via the urethra, the path of least resistance. When the bladder sphincter does not function properly, retrograde ejaculation - one of the causes of male infertility, may occur. Men often notice during masturbation that they do not have semen release but there is an orgasm. Therefore, retrograde ejaculation is sometimes referred to as a "dry orgasm." 

Another underlying cause for this phenomenon may be ejaculatory duct obstruction. During a male orgasm, sperm are released from the epididymis and travel via small tubes called the vas deferens. The sperm mix with seminal fluid in the seminal vesicles, prostate fluid from the prostate gland, and lubricants from the bulbourethral gland. During climax, muscles at the end of the bladder neck tighten to prevent retrograde flow of semen. In retrograde ejaculation, these bladder neck muscles are either very weak or the nerves controlling the muscles have become damaged (for anatomical details see the picture gallery).

Overall, anatomical causes can involve the bladder neck, for example by being rendered incompetent by transurethral resection of the prostate or bladder neck incision; the urethra, such as urethral stricture or posterior urethral valves; or the extrinsic sphincter, such as failure to relax. Neurogenic causes can be a result of disease such as multiple sclerosis, or injury such as spinal cord injury, or following surgery due to disruption of the innervations such as retroperitoneal lymph-node dissection, after abdomino-perineal resection, or sympathectomy. Various drugs can also prevent normal ejaculation, such as alpha-antagonists, antidepressants or antipsychotics.

The treatment of retrograde ejaculation is based on underlying aetiology. Anatomical causes, for instance, after prostate surgery, are rarely curable, and sperm harvesting from the urine should be considered if pregnancy is desired. Pharmacological causes are generally reversible by withdrawing the causative drug(s). Patients with neurological conditions may respond to alpha-agonists, which work by closing the bladder neck and thus promoting antegrade ejaculation. There have been some reports on the role of penile vibratory stimulation for the treatment of ejaculatory difficulties, although most have targeted those with anejaculation, such as in spinal cord injury, rather than retrograde ejaculation.

Retrograde ejaculation can often be confused with anejaculation, especially in case of orgasmic anejaculation, and they share some fundamental aspects of the etiology. Diagnosis is usually performed by urinalysis when urine is examined for the presence of semen, shortly after ejaculation. In cases of retrograde ejaculation, the specimen will contain an abnormal level of sperm. If there are no sperm in the urine, it may be due to damage to the prostate as a result of surgery or prior radiation therapy.

Associated disease

  • ejaculatory duct obstruction
  • multiple sclerosis
  • spinal cord injury
  • depression
  • compression of parasympathetic nerves


  • infertility

Risk factors

  • transurethral resection
  • prostate incision
  • bladder neck incision
  • spinal cord injury
  • retroperitoneal lymph node dissection
  • abdomino- perineal resection
  • sympathectomy α- antagonists
  • antidepressants
  • antipschotics

Males with retrograde ejaculation are not irreversibly infertile because sperms are presented in urine and it is possible to isolate them with the help of assisted reproduction techniques. The  procedure includes adjustment of the osmolarity of the patient's urine by drinking water. The small amount of antegrade-produced ejaculate is collected in a plastic beaker, while the retrograde fraction of the ejaculate needs to be urinated immediately into a jar with culture medium containing human serum albumin to dilute the urine. Finally, the urine/medium mixture has to be centrifuged, resuspended and filtrated on the glass wool column where sperms are separated. When the sperm is isolate than it could be injected directly into the egg (which is maintained from woman by transvaginal oocyte retrieval). The following procedure is IVF-ICSI.

Ask your doctor if medications, which you take can caused retrograde ejaculation.

If you need to undergo surgery that can affect the bladder neck muscle (prostate or bladder surgery), there is risk of retrograde ejaculation. If you plan to have children in the future, you can preserve semen before the surgery in sperm bank.

  • absence of ejaculation
  • cloudy urine after orgasm
  • infertility

There is not any alternative therapy for this condition.


In pharmacoteherapy are used substances which help the bladder neck
muscle close during ejaculation. Following drugs are used:

  • imipramine, a tricyclic antidepressant
  • chlorpheniramine and brompheniramine, antihistamines sometimes used to treat cold symptoms
  • ephedrine, pseudoephedrine and phenylephrine, used in decongestant medications such as Silfedrine, Sudafed and others

Surgical therapy

In surgical intervention goal is restoration of bladder neck integrity. It is possible to injected collagen into the bladder neck of a male to achieve antegrade ejaculation. For men with spinal cord injury, electroejaculation is primarily used to achieve ejaculation.

If a couple is experiencing infertility as a result of retrograde ejaculation and medications are not helping, the male's urine with ejaculate may be centrifuged and the isolated sperm injected directly into the woman's oocyte during IVF-ICSI procedure. 

In more severe cases, where are no sperm present, surgical retrieval methods (TESE, micro TESE, etc.) may be used.

Find more about related issues


Retrograde ejaculation ―sourced from Wikipedia licensed under CC BY- SA 3.0
Sperm preparation for ART ―by Henkel and Schill licensed under CC BY 4.0
Intracytoplasmic sperm injection ―sourced from Wikipedia licensed under CC BY-SA 3.0
Membranous urethra ―by Mcstrother licensed under CC BY 3.0
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