Retrograde ejaculation: what is dangerous and how to cure?

The health of a man's reproductive system is an opportunity not only to receive sexual satisfaction, but also to have children, which is important for every self-respecting man. The inability to conceive a child is a very painful topic for a man. It is especially difficult to come to terms with the idea of infertility for those who have no problems with ejaculation. However, sperm comes out unnaturally and not during its exit from the testicles. Retrograde ejaculation is characterized by such pathological ejaculation, which often becomes a cause of female disappointment, since it presents difficulties with conceiving a child.

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Causes retrograde ejaculation

We have already dealt with the question of what happens in a man's body during normal and retrograde ejaculation, now it's time to find out the reasons that can lead to the appearance of pathology, affecting the functionality of the circular muscle (it is called the sphincter) on the neck of the bladder and the seminal hillock.

The causes of retrograde ejaculation are quite varied, being either hereditary or acquired. Firstly, these may be malformations of the genitourinary system in boys that arose in the perinatal period:

• the presence of additional valves in the genital organ,
• abnormalities in the structure of the bladder and the ducts through which sperm moves to the urethra (sometimes a pathology is detected in which the vas deferens exit into the bladder, and not into the urethra),
• bladder exstrophy
• defects of the urethral walls, etc.

In this case, the change in sperm flow is associated with the peculiarities of the anatomical structure, and its manifestations can be observed even during puberty. But changes in anatomy can be not only hereditary, but also acquired over time due to various health problems and manipulations in the genitourinary system:

• urethral stricture,
• sclerotic changes in the bladder neck area,
• pelvic venous congestion.

All of the above reasons can lead to retrograde ejaculation with a high degree of probability. But there are other prerequisites for the development of this pathology, which not always, but all can negatively affect the reproductive system of a man.

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Risk factors

Risk factors for the development of reverse ejaculation include:

• various neurological disorders (polyneuropathy in the late stages of diabetes mellitus, development of multiple sclerosis with loss of neurological control over various functions of the body, including neuroregulation of contractions of the sphincter of the bladder, lesions of the spine in the lumbosacral region, etc.),
• injuries to the lower thoracic and lumbar spine, brain (as well as inflammatory pathologies such as encephalitis, meningitis, etc., tumor processes), pelvic organs, as a result of which the neuroregulation of the genitourinary system suffers again,
• impaired blood circulation in the pelvis, due to which the blood supply to the genital organ may be insufficient (this condition can be observed with physical inactivity, intestinal lesions (for example, with hemorrhoids), cardiovascular pathologies, liver and lung diseases, inflammation of the vascular walls and venous obstruction),
• age-related hormonal and metabolic disorders associated with disruptions in the endocrine system, which lead to a decrease in the tone of the bladder muscles,

Sometimes retrograde ejaculation is a consequence of the treatment of other pathologies of the genitourinary system, for example, it can be observed after TUR (transurethral resection) of the bladder or prostate, if the inflammatory process in it causes a strong enlargement of the organ, as a result of which the urinary ducts are compressed and urination is difficult. The same side effect can sometimes be observed after other surgical interventions in the pelvic area (suprapubic adenomectomy, prostate removal, sympathectomy, retroperitoneal lymph node dissection, surgical manipulations in the sigmoid and colon).

But not only surgical treatment can affect a man's ability to reproduce a new life. Sometimes the cause of dry orgasm is drug therapy. For example, antidepressants and hypotensive drugs that have a relaxing effect on the nervous system can reduce the tone of various parts of the bladder. If such drugs are taken frequently and in large doses, negative changes in the functioning of the genitourinary system can soon be noticed.

And even some drugs intended for the treatment of prostate dysplasia (prostate adenoma) can lead to the development of retrograde ejaculation. This applies to some alpha-blockers that have a similar side effect, which is noted in the instructions for the drugs. Thus, retrograde ejaculation is often noted after taking Omnic. The risk group also includes such drugs as Profloxacin, Urorek, Fokusin and some other alpha-blockers. So that changes during ejaculation do not frighten men taking various medications, they need to familiarize themselves with their possible side effects before starting to take the drugs, and even better, consult with their doctor about this.

Disruption of the nervous regulation of the body's functioning can be a consequence of its constant intoxication due to nicotine and alcohol abuse, as well as drug addiction.

Men with premature ejaculation can also be included in the risk group for retrograde ejaculation. Such patients often try to restrain themselves during sexual intercourse, strongly straining the groin muscles. Regular muscle strain in this case can negatively affect their tone, and as a result, lead to a violation of sperm outflow. Premature ejaculation is not a field for experiments to amuse male pride, but a reason to seek help from a specialist doctor.

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Pathogenesis

Ejaculation is the culmination of sexual intercourse, when a man reaches the peak of the greatest pleasure. Normally, it is at this moment that the seminal fluid from the urethra should be ejected outward. However, unfortunately, this is not always the case. With retrograde ejaculation, which is sometimes called reverse (or dry orgasm), very little sperm is released or there is none at the exit of the penis.

In order to understand why this happens, you need to understand how the process of seminal fluid release during orgasm occurs.

Stimulation of male erogenous zones activates the ejaculatory center, which is located in the sacral part of the spinal cord. It is this center that signals the muscles of the vas deferens, prostate, and seminal vesicles to contract and the sperm to move toward the urethra.

The male urethra (aka the urethra) in men has its own characteristics, since, unlike the female one, it is divided into 2 parts: the anterior and posterior (prostate) urethra. The anterior is designed to excrete urine, and the posterior is for male semen. Switching between the anterior and posterior urethra is associated with the blood filling of the penis components.

During the orgasm stage, the male penis fills with blood, the seminal mound increases in size, and the entrance to the anterior urethra closes. At the same time, the sphincter muscles of the bladder begin to contract and block the path of sperm into the organ, so that it has only one path left - the posterior urethra, through which spermatozoa in the seminal fluid exit.

For certain reasons, the bladder muscles stop performing their function, and the entrance to the organ remains open even during ejaculation. The sperm moves along the line of least resistance and ends up in the wrong organ, instead of the urethra, in the bladder. If this happens constantly, it is called complete reverse ejaculation.

Incomplete (or partial) retrograde ejaculation is characterized by the fact that the movement of seminal fluid during orgasm occurs in two directions. In this case, a certain amount of ejaculate enters the bladder, the entrance to which is half blocked, and the rest - into the urethra. In this case, ejaculation during intercourse occurs, but the volume of sperm released from the male member remains insignificant.

The pathology itself does not pose any danger to a man’s health; sperm mixes with urine and eventually exits through the anterior urethra during urination, changing only the transparency of the urine.

Retrograde ejaculation cannot be called a common pathology of ejaculation among the male population of the planet. According to statistics, such a violation of reproductive function is found in only 1 percent of the representatives of the stronger sex, i.e. 1 man out of 100 suffers from it.

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Symptoms retrograde ejaculation

The clinical picture of the pathology is characterized by a paucity of symptoms indicating the development of retrograde ejaculation. However, these symptoms are so obvious and specific that they help to establish an accurate diagnosis with a high degree of probability.

The first signs of the development of the above pathology are considered to be 2 symptoms:

• a small volume of sperm released during sexual intercourse, masturbation or other types of stimulation of orgasm in men (normally this volume in different men fluctuates between 2-6 ml, if the amount of ejaculate decreases to 1-1.5 ml or sperm is not released at all, this indicates erectile dysfunction),
• change in urine transparency (if, against the background of a deficiency of excreted sperm, a noticeable cloudiness of urine is observed, most likely the ejaculate enters the bladder and does not exit through the posterior urethra).

As for the first symptom, there are two possible scenarios, since there are two types of dry orgasm. With complete retrograde ejaculation, sperm is not released at all during intercourse or masturbation while the erection is preserved. Partial or incomplete reverse ejaculation is characterized by a small amount of ejaculate released, although the man experiences a full orgasm, after which the tension in the penis decreases noticeably, as with normal ejaculation.

The second symptom is not constant. Severe cloudiness of urine is observed during the first urination after sexual intercourse. Then the urine gradually acquires a normal appearance. The symptom recurs after each episode of intercourse or masturbation.

Retrograde ejaculation, although considered a disease, manifests itself mainly during an erection. At the same time, the man does not feel any discomfort or pain. And the erection generally remains preserved or slightly reduced. This confuses patients a little, because they feel quite healthy.

A later, but no less indicative symptom of retrograde ejaculation is the inability to conceive a child. The absence of sperm secretion during sexual intercourse is a direct path to male infertility. And even a small amount of sperm secreted can be the reason why a couple cannot have children for a long time, despite the fact that both parents seem to be quite capable of it.

Complications and consequences

Despite the fact that there are no unpleasant sensations during and after sexual intercourse with retrograde ejaculation, and the man and woman receive satisfaction from intimacy, the disease cannot but affect the well-being of the stronger sex and relationships in the family.

What is the danger of retrograde ejaculation? First of all, it is a blow to the self-esteem of a representative of the stronger sex as a carrier of semen for future life. Many men experience their inferiority very hard psychologically. They are able to naturally give pleasure to a woman, but they feel awkward, afraid that she will notice their awkward shortcoming, especially if oral sex and some types of role-playing games are practiced, when semen is not ejaculated into the vagina. Men are very sensitive to indelicate questions about the absence or small amount of sperm, disappointed or curious looks at their defect.

A man may perceive the absence of sperm during sexual intercourse as an insurmountable obstacle to marriage, realizing that at some point a woman will want a child from him, and he will not be able to fulfill her dreams. In some cases, men, in fear of being disgraced or not living up to their partner's expectations, may completely refuse sexual life. Stagnation in the reproductive organs in this case leads to the development of prostatitis, and the fear of criticism from women or friends can even provoke impotence.

If ejaculation disorder is a consequence of health pathologies when the man was already married, discomfort arises due to the loss of former abilities. And if, against the background of retrograde ejaculation, the couple cannot conceive a child, this can lead not only to a decrease in self-esteem in the man, but also to conflicts in the family.

Reverse ejaculation itself does not pose a danger to a man's health. Mixed with urine, the ejaculate freely exits through the anterior urethra, without causing any inflammation or discomfort in the bladder or urinary tract.

In some cases, the absence of sperm is a reliable and safe method of protection against unwanted pregnancy if a couple, due to circumstances, cannot afford to have their own children (for example, due to a woman’s illness, in which bearing a child and giving birth may pose a danger to her life and health).

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Diagnostics retrograde ejaculation

Despite the fact that retrograde ejaculation has quite pronounced symptoms, it is impossible to rely solely on them when making a diagnosis. The symptoms described by the patient during an appointment with an andrologist or urologist can only push the doctor in the right direction.

The study of the anamnesis and symptoms according to the patient's complaints is carried out during the initial examination. In parallel with this, the doctor is obliged to examine the penis and palpate the prostate gland to identify possible tumor processes and obvious defects. Further, an additional consultation with a proctologist or surgeon may be required.

Doctors prescribe the usual tests in this case. General blood analysis and OAM help to clarify the general picture of the patient's health, allow to suspect hidden inflammatory processes.

A more specific analysis that allows for a more accurate diagnosis of reverse ejaculation is post-ejaculation urine analysis. Special conditions are required for its implementation: first, you need to empty your bladder, then masturbate, and only then can you take the test. In this case, laboratory tests will show the presence of protein and sperm in the urine.

But the diagnostics do not end there, because it is necessary not only to make a diagnosis, but also to find the cause of the ejaculation disorder. Various malformations of the genitourinary system and disorders of the innervation of organs can be identified through instrumental diagnostics. Its methods, effective in relation to the existing pathology, include: ultrasound of the bladder, prostate gland and other pelvic organs, urethroscopy, electromyography, electroneurography, etc.

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Differential diagnosis

Differential diagnostics are carried out with other erectile pathologies. Most often, men consult a doctor only after many fruitless attempts to conceive a child. But if partial, rather than complete retrograde ejaculation is diagnosed, then the possibility of having a child remains, albeit limited. After all, even 1 ml of sperm contains several million spermatozoa, which, if accurately hit, are quite capable of fertilizing an egg. Perhaps the cause of male infertility was another undetected pathology.

For example, the absence of sperm during sexual intercourse is also observed with anejaculation or akinospermia, but laboratory tests do not confirm the presence of sperm in the urine. For the same reason, the diagnosis of "oligospermia" can be rejected (with this pathology, an insignificant amount of sperm is observed during ejaculation, but the urine remains transparent without impurities).

If a man still secretes a small amount of sperm, but the woman does not become pregnant, a more detailed study of the ejaculate is required. such as oligospermia (initially a small amount of ejaculate), To exclude azoospermia, which reveals the absence of sperm in the seminal fluid, a spermogram is performed.

Biochemistry of sperm, as well as the study of its interaction with mucus from the woman's cervical canal, will help to exclude or confirm such diagnoses as oligozoospermia (when a very small number of spermatozoa are found in the ejaculate), asthenozoospermia (low activity of existing spermatozoa), teratozoospermia (anatomical abnormalities in the structure of spermatozoa that affect the trajectory of their movement), etc.

It is also necessary to take into account the fact that cloudy urine, which is considered one of the main symptoms of reverse ejaculation, may be associated not only with the presence of sperm in its composition, but also protein, leukocytes, erythrocytes, which is also a cause for concern, but may indicate completely different health problems (for example, kidney disease).

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Treatment retrograde ejaculation

The variety of causes of retrograde ejaculation requires the doctor to take an individual approach to developing a treatment plan for the patient, which should be aimed at restoring normal erection with the release of a sufficient amount of sperm during sexual intercourse.

The easiest situation is with patients who developed retrograde ejaculation as a result of drug therapy for other diseases (psychotropic drugs, antidepressants, hypotensive drugs). In this case, it is enough to identify which drug caused such a reaction and stop it (or replace it with another). After some time after stopping the drug, ejaculation usually returns to normal.

In some cases, the only treatment prescribed to normalize the functioning of the reproductive system is physical exercises aimed at strengthening the muscles of the legs and pelvic floor.

If retrograde ejaculation is observed against the background of mild polyneuropathy, which is a complication of diabetes, you can try to correct the situation with the help of alpha-lipoic acid preparations. In the treatment of ejaculation disorders due to polyneuropathy, the following preparations have proven themselves well: "Thiogamma", "Berlition 600", "Octolipen" and other drugs that improve energy metabolism in the tissues of the nervous system and impaired blood circulation in the lower part of the body.

If the cause of ejaculation disorder, in which sperm moves in the wrong direction, is a disorder of the innervation of the bladder and a weak tone of its sphincter, patients are prescribed sympathomimetics "Ephedrine", "Midodrine", etc. It is necessary to take into account the fact that these drugs are not suitable for patients with arterial hypertension.

Since some men may become depressed due to negative thoughts about their failure, in such cases a consultation with a psychotherapist and taking antidepressants (for example, Imipramine, Desipramine) may be additionally prescribed.

To improve the functionality of the nervous tissue, in parallel with the main medications, vitamins and vitamin-mineral complexes with a high content of B vitamins and magnesium are prescribed, which have a positive effect on the functioning of the nervous system of the body.

Additionally, the doctor may prescribe the patient such procedures as prostate stimulation, electrical stimulation of the bladder and urethra, which improve muscle contractility, and other methods of physiotherapy. Sometimes, non-traditional methods are used to treat retrograde ejaculation, such as reflexology (acupuncture).

If the above treatment does not bring the desired result, and the couple wants to have children, you can try to fix the situation by making love in an unconventional way. We are talking about sexual intercourse with a full bladder. The valve that closes the entrance to the bladder is tightly pressed in this case and will not let sperm into the organ. It will have no choice but to exit through the urethra.

It is more complicated if the cause of retrograde ejaculation is anatomical defects in the development of the genitourinary system. In these cases, the optimal solution is surgical treatment. In the absence of contraindications, sphincteroplasty of the bladder or urethral plastic surgery can be prescribed, during which the internal structure of the genitourinary organs is corrected.

It should be said that, despite all the variety of treatment methods, it is not always possible to achieve a positive result. In principle, retrograde ejaculation does not particularly affect the quality of sex, so it does not always require extreme measures. If the couple does not plan to have children and sex does not cause negative emotions in men, nothing can be changed.

But if there is a strong desire to become a father, you can either adopt a child or resort to the IVF procedure. The material for the procedure in the absence of sperm secretion during sexual intercourse will be spermatozoa that are extracted from a urine sample taken using a catheter immediately after ejaculation.

Medications for retrograde ejaculation

It cannot be said that retrograde ejaculation is successfully treated with medication in all cases. There are no drugs in pharmacies that would include retrograde ejaculation in their indications. And treatment is primarily aimed at combating the underlying disease that caused the ejaculation disorder, so it is carried out depending on the identified cause.

If reverse ejaculation is not a consequence of anatomical prerequisites or irreversible neurological disorders (for example, damage to the nerves responsible for the innervation of the bladder and urethra during abdominal surgery), drug therapy can show fairly good results associated with the use of sympathomimetics.

"Ephedrine" is a drug similar in its action to adrenaline, one of the important neurotransmitters that improve the conductivity of nerve impulses, and therefore can normalize the contractile function of the sphincter of the bladder.

For retrograde ejaculation, doctors prescribe "Ephedrine sulfate" in a dosage of 10-15 mg, taken 4 times a day.

Treatment with drugs in most cases occurs without side effects. Only sometimes after half an hour a short-term tremor may be felt, which has no negative consequences.

Unfortunately, the drug cannot be used in all cases. Contraindications to the use of sympathomimetic agents include atherosclerosis of blood vessels and other vascular pathologies with circulatory disorders, organic heart diseases, hypertension, increased production of thyroid hormones by the thyroid gland (hyperthyroidism and thyrotoxicosis).

"Midodrine" is a drug from the same group that has an adrenaline-like effect.

In case of ejaculation pathology with insufficient sperm count, the drug is prescribed in a daily dosage of 15 mg, which should be divided into 3 doses.

Side effects of the drug include increased blood pressure, decreased pulse rate (bradycardia), hyperhidrosis, tremors with the appearance of "goose bumps", and changes in the frequency of urination.

Contraindications to taking the drug are high blood pressure, tumor process in the adrenal glands, pathologies in which a decrease in the lumen of peripheral vessels is observed, thyrotoxicosis, prostate adenoma, and increased intraocular pressure.

The drug is prescribed with caution to patients with heart failure and severe kidney disease.

If the cause of weakening of bladder functionality is diabetes mellitus, and in particular diabetic polyneuropathy (special drugs are prescribed that improve metabolism in tissues and nerve conduction. By the way, a similar symptom can also be observed in neurological disorders of alcoholic origin, therefore, treatment of patients whose retrograde ejaculation is a consequence of alcohol intoxication is carried out with the same drugs.

One of such drugs is "Octolipen". The medicine should be taken 1-2 capsules (or tablets) half an hour before breakfast, washed down with plenty of water (about 1 glass).

While taking the drug, symptoms of dyspepsia (nausea with vomiting, heartburn), a strong decrease in blood sugar, allergic reactions, including severe ones (due to intolerance to the drug) may be observed.

The drug is not prescribed in case of hypersensitivity to the components. Patients must be at least 18 years old.

Very often, against the background of retrograde ejaculation, men experience increased irritability and anxiety, they become more susceptible to depression about the inability to have heirs. In this case, as prescribed by a psychotherapist, patients are prescribed antidepressants.

"Imipramine" is a drug for depression that increases mental and general tone of the body. However, you should be careful with such drugs, because they have an alpha-adrenergic blocking effect, as do drugs for the treatment of the prostate gland, among the side effects of which is indicated retrograde ejaculation.

Depending on the patient's condition, the doctor may prescribe the drug in a dosage of 25-75 mg per day (1 tablet 1 to 3 times a day), starting treatment with minimal doses.

Taking antidepressants may be accompanied by multiple side effects: headaches and dizziness, numbness and tremors of the extremities, convulsions, coordination and sleep disorders, hallucinations, and vision impairment. There may be a decrease in blood pressure and a rapid pulse (tachycardia), changes in blood composition, dry mouth, constipation, deterioration of liver and kidney function, and decreased sexual desire. Rarely, patients complain of symptoms such as alopecia (baldness), weight gain, increased sweating, and increased sensitivity to light.

Contraindications to taking the antidepressant are liver and kidney failure, cardiac ischemia, tachycardia, decompensated heart failure, prostate adenoma, and bladder atony. The drug is not prescribed for those with a tendency to seizures, epilepsy, schizophrenia, glaucoma, or if the patient has recently suffered a myocardial infarction.

If we talk about the effectiveness of drug therapy, the worst situation is with diabetic polyneuropathy, but here too everything depends on the degree of damage to the nerve endings.

As for folk treatment, herbal treatment and homeopathy do not give a noticeable result for this pathology. Their use can be justified only for the treatment of the main diseases that caused retrograde ejaculation.

Prevention

Prevention of retrograde ejaculation is, first of all, taking measures to prevent and treat health pathologies that can cause such a violation of ejaculation (intestinal diseases, diabetes, neurological pathologies, pelvic injuries), as well as compliance with the doctor's requirements in the postoperative period on the pelvic organs.

For example, in diabetes mellitus, it is necessary to strictly control the amount of glucose entering the body and its level in the blood. Drug treatment of prostate adenoma should be carried out strictly under the supervision of a doctor, and if ejaculation disorders occur, consult about replacing the drug with a drug that does not affect erectile function. Hypertensive men may also need such a consultation in connection with the use of certain hypotensive drugs.

When agreeing to surgical treatment of pathologies of the prostate gland or bladder, men are advised to give preference to minimally invasive methods of therapy, which have fewer side effects.

In order to prevent retrograde ejaculation, it is recommended to avoid uncontrolled use of antidepressants and other types of drugs that depress the nervous system.

Prevention of congenital defects of the reproductive system in boys is the responsibility of the mother, who during the period of bearing her son should have taken care of adequate nutrition for herself and the fetus, given up bad habits, provided herself and the unborn baby with adequate rest. Any negative impact on a woman during pregnancy, including stress factors, does not have the best effect on the development of the fetus, and this must be remembered constantly.

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Forecast

It is quite difficult to make a prognosis for such a pathology as retrograde ejaculation. Everything depends on the cause of the disease and the patient's attitude. Congenital pathologies of the genitourinary system can only be treated surgically; other treatments will be ineffective.

An unfavorable or questionable prognosis in many cases of diabetes mellitus, when the disease has led to irreversible damage to the nerve endings in the bladder, which worsens the contractile function of the sphincter of the organ. And reverse ejaculation, which occurs as a result of unsuccessful surgical intervention in the genitourinary system, is practically untreatable.

Although, by and large, retrograde ejaculation is a disease with which you can live quite happily even without treatment. Since the disorder of ejaculation does not affect erection, then sexual life does not suffer, both partners enjoy intercourse. The main thing is that the man does not have complexes about his shortcoming, which, by the way, is not outwardly noticeable if you make love using traditional methods. And the opportunity to have a child is given either by effective treatment or artificial insemination. In any case, the couple gets their desired baby with the parental set of chromosomes, and the method by which he was conceived no longer has much importance.

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