Retrograde ejaculation treatment, What are its causes?

What is retrograde ejaculation?

During ejaculation (orgasm), normally, the semen flows towards the urethra (penis), then outwards, As this direction (moving outwards) is the only open path open for the semen. In this article I discuss how semen, normally, is forced to move to the urethra, not to the bladder? What are the available treatment options for retrograde ejaculation?

Semen has two options: either to move forward toward to the urethra, then out, or backward to the bladder. The bladder neck muscles tightens (bladder gets closed) during ejaculation, Therefor, semen has no open path except to move forwards to the urethra.

Retrograde ejaculation occurs when semen moves into the bladder, and no (or very little) semen to be ejaculated. Therefore, semen does not come out of the penis. Even though, you can reach reach climax. This is also called dry orgasm, (or dry ejaculation).

In general, retrograde ejaculation does not negatively impact health, but it may cause infertility. Usually, it is not necessarily to be treated, unless for infertility cases. Despite it has no health complications, it may distress the man, it maybe accompanied with some other symptoms, such as symptoms of enlarged prostate, diabetes, or prostate surgery.

Prevalence:

Retrograde ejaculation occurs in 75% of men after surgery for transurethral resection of the prostate (TURP) and, to a lesser extent, following bladder neck incision. The problem in both cases, is due to iatrogenic bladder neck incompetence. (iatrogenic= due to treatment)

Causes

Retrograde ejaculation occurs due to different causes, which can affect the muscles that close the bladder neck during orgasm. Nerve damage may contribute more to the problem than physical damage.

Some of these causes are the following:
1- Aside from certain medical reasons, men who are practicing semen retention, trying to achieve orgasm without ejaculation, may damage the bladder neck. 
2- Medical causes:
– Surgery near bladder. Bladder neck surgery, retroperitoneal lymph node dissection for testicular cancer or prostate surgery can result in that problem.
– Medicines. Some medicines as those used to treat high blood pressure and enlarged prostate (alfa blockers). Also, medicines used in cases of depression can cause the problem.
– Diseases (Neurological diseases). Nerve damage due to a medical condition, such as: diabetes, Parkinson’s disease, injury – a wound – the spinal cord, or multiple sclerosis,

Dry orgasm – dry ejaculation

Dry orgasm is the main symptom of retrograde ejaculation, in which semen does not exit from the penis, instead it moves backwards into the bladder. Dry orgasm — ejaculation of little or no semen — can be caused by other conditions and diseases, where semen path is blocked or disturbed. Here are some of the causes:
– Surgical removal of the prostate (prostatectomy)
– Surgical removal of the bladder (cystectomy)
– Radiation therapy to treat cancer in the pelvic area

How can you tell if you’ve had a retrograde ejaculation?
– If you pee in a glass cup, and you notice any viscous or milky semen-like fluids in your urine,
that’s a tell-tale sign that you’ve had a retrograde ejaculation.

Retrograde ejaculation treatment

I mentioned above that, usually, no one seeks treatment for backward ejaculation except in cases of infertility. Unfortunately, the situation cannot always be corrected. Some persons may opt to seek treatment even if they don’t need to have children, just for satisfaction.

The problem (backward ejaculation). itself, is difficult to correct. However, there are some medications that can be used to improve the condition. Its treatment depends mainly on treating the disease that caused the problem. If the cause is medications, changing medicines usually solves the problem. But when it is caused by severe nerve damage, it may not be reversible. Also surgery (bladder neck reconstruction), can used for treatment

Medications for Retrograde ejaculation

There are some medications that can improve the bladder neck muscles and help maintain its contraction during ejaculation. Among those drugs are the following:
– Brompheniramine (Ala-Hist, J-Tan, Veltane) – anti-allergic.
– Chlorpheniramine (Aller-Chlor, Chlor-Trimeton, Polaramine, Teldrin) – anti-allergic.
– Ephedrine – a central nervous system stimulant (need special prescription).
– imipramine (Tofranil), used to treat symptoms of depression (need special prescription).
– Midodrine, used to treat orthostatic hypotension.
– Phenylephrine (Sudafed Children, Pediacare, Vasculib), used as a decongestant, to dilate the pupils, to increase blood pressure, and to relieve hemorrhoids.
– Pseudoephedrine (Silphedrine, Sudafed, Sudoges, Sophedrine), used as a nasal/sinus decongestant, and high-dose stimulant (need special prescription).

Sources for more reading:
– https://www.mayoclinic.org/diseases-conditions/retrograde-ejaculation/symptoms-causes/syc-20354890
– https://pubmed.ncbi.nlm.nih.gov/17337426/
– https://www.medicalnewstoday.com/articles/320332
– http://nhs.uk/conditions/ejaculation-problems/Pages/Introduction.aspx
– Ejaculatory Disorders: Pathophysiology and Management (medscape.org)