Retrograde ejaculation: how dangerous and how to cure?

The health of the reproductive system of men is an opportunity not only to receive sexual satisfaction, but also to acquire offspring, 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 reconcile with the idea of infertility to those who have no problems with ejaculation. However, the sperm goes out unnaturally and not during its exit from the testes. Such a pathological ejaculation is characterized by retrograde ejaculation, which becomes a frequent cause of female frustration, as it presents difficulties in conceiving a child.

[1], [2], [3],

Causes of the retrograde ejaculation

With the question what happens in the body of a man during normal and retrograde ejaculation, we have already figured out, 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 seed hillock.

The causes of retrograde ejaculation are quite diverse, having either a hereditary or acquired character. First, it can be malformations of the genitourinary system in boys, which arose in the perinatal period:

• the presence of additional valves in the genitalia,
• deviations in the structure of the bladder and ducts, through which the sperm moves to the urethra (sometimes reveals a pathology in which the vas deferens go into the bladder and not into the urethra)
• bladder exstrophy
• defects of the walls of the urethra, etc.

In this case, the change in sperm flow is associated with the characteristics 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 disorders and manipulations in the genitourinary system:

• stricture of the urethra,
• sclerotic changes in the neck of the bladder,
• pelvic venous congestion.

All of the above causes are likely to lead to retrograde ejaculation. But there are other prerequisites for the development of this pathology, which are not always, but all can negatively affect the reproductive system of men. 

[4], [5]

Risk factors

Risk factors for the development of reverse ejaculation can be considered:

• various neurological disorders (polyneuropathy in the late stage of diabetes mellitus, the development of multiple sclerosis with the 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 department, etc.)
• trauma of 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 neuroregulation of the genitourinary system,
• impaired blood circulation in the small pelvis due to which the blood supply to the genital organ may be insufficient (such condition can be observed in hypodynamia, intestinal lesions (eg, hemorrhoids), cardiovascular pathologies, liver and lung diseases, inflammation of the vascular walls and occlusion of veins)
• age-related disorders of the hormonal background and metabolism associated with disruptions in the endocrine system, which lead to a decrease in the tone of the muscles of the bladder,

Sometimes retrograde ejaculation becomes a consequence of the treatment of other pathologies of the genitourinary system, for example, it can be observed after a TUR (transurethral resection) of the bladder or prostate, if the inflammatory process in it causes a strong increase in the organ, which results in a squeezing of the urinary tract and difficulty urinating. The same side effect can sometimes be observed after other operative procedures in the pelvic region (suprapubic adenomectomy, removal of the prostate gland, sympathectomy, retroperitoneal lymphadenectomy, surgical manipulations in the sigmoid and large intestine area).

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, to lower the tone of various parts of the bladder, antidepressants and antihypertensives that affect the nervous system are relaxing. If such drugs are taken often and in large doses, you can soon notice a negative change in the work of the genitourinary system.

And even some drugs designed to treat prostatic 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. So, retrograde ejaculation is often noted after the reception of "Omnik". The risk group includes such drugs as "Proloxin", "Urerek", "Fokusin" and some other alpha-blockers. To change during ejaculation did not frighten men taking different medications, they need to get familiar with their possible side effects before taking drugs, or even better consult with a doctor in this regard.

Violation of the nervous regulation of the body can be a consequence of his constant intoxication in the abuse of nicotine and alcohol, as well as drug dependence.

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

[6], [7], [8], [9], [10]

Pathogenesis

Ejaculation is the culmination moment of sexual intercourse, when a man reaches the peak of the highest pleasure. Normally, it is at this time that the seminal fluid from the urethra should erupt outward. However, this happens, alas, not always. With retrograde ejaculation, which is sometimes called a reversible (or dry orgasm), little or no sperm is released at the exit from the penis at all.

In order to understand why this happens, it is necessary to understand how the process of emergence of the seminal fluid is carried out during orgasm.

Stimulation of male erogenous zones causes activation of the ejaculatory center, which is located in the sacral region of the spinal cord. It is he who signals that the muscles of the vas deferens, the prostate and seminal vesicles begin to contract and the sperm begin to move towards the urethra.

The male urethra (it's the urethra) in men has its own characteristics, because unlike the female one it is divided into 2 parts: the anterior and posterior (prostate) urethra. The front is for urine output, and the rear one is for male seed. Switching between the anterior and posterior urethra is associated with blood filling of the penile components.

In the stage of orgasm, the male penis is filled with blood, an increase in the size of the seed hill occurs, the entrance to the front part of the urethra is closed. At the same time, the muscles of the sphincter of the bladder begin to contract and block the way to the semen inside the organ, thus, it has only one road - the posterior urethra, through which spermatozoa make up the seminal fluid and come out.

For certain reasons, the muscles of the urea cease to function, and the entrance to the organ remains open even during ejaculation. Sperm moves along the line of least resistance and falls into the wrong organ, instead of the urethra in the bladder. If this happens all the time, they say full reversive ejaculation.

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

The pathology itself does not carry any danger to the health of men, sperm mixes with urine and through the front urethra after a time goes outside during the act of urination, changing only the transparency of urine.

Retrograde ejaculation can not be called widespread among the male population of the planet by the pathology of ejaculation. According to  statistics, such a violation of the reproductive function is found only in 1% of the representatives of the stronger sex, i.e. He suffers from 1 man out of 100.

[11], [12], [13], [14]

Symptoms of the retrograde ejaculation

The clinical picture of the pathology is characterized by the scarcity 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 development of the above pathology are 2 symptoms:

• a small amount of sperm released during sexual intercourse, masturbation or other types of stimulation of orgasm in men (in norm this volume varies from 2-6 ml in different men if the amount of ejaculate decreases to 1-1.5 ml or sperm is not released at all, this indicates a violation of erectile function),
• a change in the transparency of the urine (if there is a marked clouding of urine against the background of a deficiency in the secreted sperm, it is most likely that the ejaculate enters the bladder rather than exits through the posterior urethra).

As for the first symptom, there are two possible variants of events, since there are 2 types of dry orgasm. With complete retrograde ejaculation, sperm during sexual intercourse or masturbation is not released at all with a preserved erection. Partial or incomplete reverse ejaculation is characterized by a small amount of ejaculated secretion, although a man experiences a full orgasm, after which the penis tension decreases markedly, as against normal ejaculation.

The second symptom is not permanent. A strong turbidity of urine is observed during the first urination after sexual intercourse. Then the urine gradually acquires a normal appearance. The symptom is repeated after each episode of copulation or masturbation.

Retrograde ejaculation, although considered a disease, manifests itself mainly during erection. At the same time, the man does not feel any discomfort or pain. Yes, and the erection basically remains preserved or slightly reduced. It's a little confusing to the patients, because they feel completely healthy.

A later, but no less indicative symptom of retrograde ejaculation is the impossibility of conceiving a child. The absence of sperm secretion during sexual intercourse is a direct way to male infertility. And even a small amount of sperm can be the reason that a couple can not get their children for a long time, although both parents seem to be quite capable of it.

Complications and consequences

Despite the fact that discomfort during and after sexual intercourse with retrograde ejaculation is absent, and a man and a woman get satisfaction from intimacy, the illness can not but affect the well-being of a stronger-sex person and the relationship 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 the bearer of a seed for a future life. Many men are psychologically very difficult to experience their inferiority. They are able to naturally give pleasure to a woman, but feel awkward at the same time, fearing that she will notice their awkward lack, especially if oral sex and some versions of role-playing games are practiced, when the seed is not poured into the vagina. Men are very sensitive to indelicate questions about the lack or small amount of sperm, disappointed or curious views on their defect.

Lack of sperm during intercourse, a man can perceive as an insurmountable obstacle to marriage, knowing that a woman at some point wants a child from him, and he will not be able to fulfill her dreams. In some cases, men in fear of disgracing themselves or failing to meet the expectations of a partner may completely abandon sexual life. Stagnant phenomena in the reproductive organs lead in this case to the development of prostatitis, and fear of criticism from women or friends and at all can provoke impotence.

If the violation of ejaculation was a consequence of health pathologies, when a man was already married, there is discomfort in connection with the loss of past abilities. And if, on the background of retrograde ejaculation, a couple can not conceive a child, this may entail not only a decrease in the self-esteem of a man, but also conflicts in the family.

Reversal ejaculation itself does not endanger the health of a man. Mixed with urine, the ejaculate unhindered outwards along the anterior urethra, without causing at the same time no inflammation, no discomfort in the bladder and urinary tract.

In some cases, the absence of sperm is a reliable and safe method of preventing unwanted pregnancies, if the couple, by virtue of circumstances, can not afford to have their children (for example, because of a woman's illness in which the bearing of a child and birth can be hazardous to her life and health ).

[15], [16]

Diagnostics of the retrograde ejaculation

In spite of the fact that retrograde ejaculation has quite pronounced symptoms, it is impossible to focus only on them when diagnosing a diagnosis. Described by the patient during admission from the andrologist or urologist the symptoms can only push the doctor in the right direction.

The study of anamnesis and symptoms on the patient's complaints is carried out during the initial examination. In parallel, the doctor must examine the penis and perform palpation of the prostate gland to identify possible tumor processes and obvious defects. Further, it may be necessary to have an additional consultation with a proctologist or surgeon.

Doctors prescribe the usual tests in this case. A general blood test and OAM help clarify the overall picture of the patient's health, allow suspect suspicious inflammatory processes.

A post-urinary analysis of urine is considered a more specific analysis, which makes it possible to diagnose reversible ejaculation with great accuracy. It requires special conditions: first you need to empty the bladder, then conduct an act of masturbation, and only after that you can take the analysis. Laboratory tests in this case will show the presence of protein and sperm in the urine.

But on this diagnosis does not end, because you need not only to diagnose, but also to find the cause of ejaculation disorders. Identify various malformations of the genitourinary system and the violation of the innervation of organs can be through instrumental diagnosis. To its methods, effective against the existing pathology, it is possible to carry: ultrasound of the bladder, prostate and other small pelvic organs, urethroscopy, electromyography, electroneurography, etc.

[17], [18], [19]

Differential diagnosis

Differential diagnosis is performed with other erectile pathologies. Most often, men turn to a doctor only after many fruitless attempts to conceive a child. But if the complete and partial retrograde ejaculation is diagnosed, then the possibility of having a child remains, albeit limited. After all, even in 1 ml of sperm there are several million spermatozoa, which, when hit accurately, are quite capable of fertilizing the egg. Perhaps the cause of male infertility was a different pathology not identified.

For example, the absence of sperm during sexual intercourse is also observed with anejaculation or akinospermia, but laboratory studies of the presence of sperm in the urine do not confirm. For the same reason, it is possible to reject the diagnosis of "oligospermia" (in this pathology, a small amount of sperm is observed during ejaculation, but remains clear in urine without impurities).

If the sperm in a small amount in a man still stands out, but the woman does not have a pregnancy, it requires a more detailed study of the ejaculate isolated. As an oligospermia (initially a small amount of ejaculate), To exclude azoospermia, which reveals the absence of sperm in the semen, a spermogram is performed.

The biochemistry of sperm, as well as the study of its interaction with mucus from the cervical canal of the woman, 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 available spermatozoa), teratozoospermia (anatomical disorders of the structure of spermatozoa affecting on the trajectory of their movement), etc.

One should also take into account the fact that clouding of urine, which is considered one of the main symptoms of reversible ejaculation, can be associated not only with the presence of sperm, but also protein, white blood cells, red blood cells, which is also a cause for concern, but can indicate on completely different health disorders (eg, kidney disease).

[20], [21], [22], [23], [24], [25], [26], [27], [28],

Treatment of the retrograde ejaculation

The variety of reasons for retrograde ejaculation requires the physician to take an individual approach to the development of a patient's treatment regimen, which should be aimed at restoring normal erection with the allocation of a sufficient amount of sperm during intercourse.

The easiest way is with patients, in whom retrograde ejaculation developed as a result of drug therapy of other diseases (psychotropic drugs, antidepressants, hypotensive drugs). In this case, it is sufficient to identify which particular drug caused this reaction, and to cancel it (or replace it with another one). After a time after the drug is canceled, ejaculation usually returns to normal.

In some cases, the only prescribed treatment that allows to normalize the work of the reproductive system, are physical exercises that are aimed at strengthening the musculature of the legs and pelvic floor.

If retrograde ejaculation is observed against a background of poorly expressed polyneuropathy, which is a complication of diabetes, you can try to correct the situation with the help of preparations of alpha-lipoic acid. In the treatment of ejaculation disorders due to polyneuropathy, drugs such as Tiogamma, Berlition 600, Oktolipen and other drugs that improve energy metabolism in the tissues of the nervous system and disturbed blood circulation in the lower part of the body have proven themselves well.

If the cause of ejaculation, in which the sperm moves in the wrong direction, is a violation of the innervation of the bladder and a weak tone of his sphincter, the patients are shown the reception of sympathomimetics "Ephedrine", "Midodrin", etc. It should be taken into account the fact that these drugs are not suitable for patients with arterial hypertension.

Since, against the backdrop of negative thoughts about their insolvency, some men may become depressed, in that case, counseling of the therapist and taking antidepressants (for example, Imipramine, Desipramine) may additionally be prescribed.

To improve the functionality of the nervous tissue, in parallel with the basic medicines, vitamins and vitamin-mineral complexes with a high content of B and magnesium vitamins are prescribed, which positively influence the work of the nervous system of the body.

In addition, the doctor can prescribe to the patient such procedures as stimulation of the prostate, electrostimulation of the bladder and urethra, improving the contractile ability of muscles, and other methods of physiotherapeutic treatment. Sometimes non-traditional techniques are used to treat retrograde ejaculation, for example, reflexology (acupuncture).

If the above treatment does not bring the desired result, and the couple wants to have children, you can try to remedy the situation by making love in an unusual way. This is a sexual act with a filled bladder. The valve that closes the entrance to the bladder, in this case is tightly pressed and does not pass the semen into the organ. She will have nothing else but to go outside through the urethra.

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

It must be said that, despite all the variety of methods of treatment, 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 a couple does not plan to have children and sex does not cause negative emotions in men, you can not change anything.

But if there is a great desire to become a father, you can either adopt a baby, or resort to an IVF procedure. The material for the procedure in the absence of sperm excretion during intercourse will be spermatozoa, which are extracted from a urine sample taken with a catheter immediately after ejaculation.

Medicines for retrograde ejaculation

It can not be said that retrograde ejaculation in all cases is successfully treated with the help of drug therapy. In pharmacies there are no such drugs, in the indications for the application of which retrograde ejaculation would be indicated. And the treatment is aimed primarily at combating the underlying disease that caused ejaculation disorders, therefore it is carried out depending on the revealed cause.

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

"Ephedrine" - a drug similar in its action to adrenaline, one of the important neurotransmitters, improving the conductivity of nerve impulses, and thus able to normalize the contractile function of the sphincter of the bladder.

"Ephedrine sulphate" with retrograde ejaculation doctors prescribe in a dosage of 10-15 mg with a frequency of reception 4 times a day.

Treatment of drugs in most cases occurs without side effects. Only sometimes after half an hour there may be a brief tremor, which has no negative consequences.

Unfortunately, the drug can not be used in all cases. Contraindications to the use of sympathomimetics are atherosclerosis of vessels and other vascular pathologies with circulatory disorders, organic heart diseases, hypertension, increased thyroid hormone production of thyroid hormones (hyperthyroidism and thyrotoxicosis).

"Midodrin" - a drug from the same group, which has an adrenaline-like effect.

With the pathology of ejaculation with insufficient amount of sperm, the drug is prescribed in a daily dosage of 15 mg, which must be divided into 3 divided doses.

Side effects of the drug can be considered increased blood pressure, a decrease in the pulse (bradycardia), hyperhidrosis, trembling with the appearance of goosebumps, a change in the frequency of urination.

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

With caution appoint the drug to patients with heart failure and severe kidney disease.

If the cause of weakening the functionality of the bladder becomes diabetes, and in particular diabetic polyneuropathy (prescribe special drugs that improve metabolism in tissues and nerve conduction.) By the way, such a symptom can be observed in neurological disorders of alcoholic nature, so treatment of patients whose retrograde ejaculation has become consequence of alcohol intoxication, is carried out by the same drugs.

One of these drugs is "Octolipen". Take medicine for 1-2 capsules (or tablets) for half an hour and breakfast, washed down with a large amount of water (about 1 cup).

Against the background of taking the drug, symptoms of dyspepsia (nausea with vomiting, heartburn), severe decrease in blood sugar, allergic reactions, including severe ones (against intolerance of the drug) may be observed.

The drug is not prescribed for hypersensitivity to components. The age of patients is at least 18 years old.

Very often, in the context of retrograde ejaculation, irritability and anxiety increase in men, they become more prone to depression because of the inability to have heirs. In this case, the appointment of a therapist to patients shows the use of antidepressants.

"Imipramine" - a drug from depression, which increases the mental and general tone of the body. However, with these drugs should be careful, because they have alpha-adrenoblokiruyuschim action, as well as drugs to treat the prostate gland, among whose side effects are indicated and retrograde ejaculation.

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

Admission of antidepressants can be accompanied by multiple side effects: headaches and dizziness, numbness and tremor of the extremities, convulsive syndrome, coordination and sleep disorders, hallucinations, vision impairment. There may be a decrease in pressure and a frequent pulse (tachycardia), changes in blood composition, drying of the oral mucosa, constipation, impaired liver and kidney function, and a decrease in sexual desire. Infrequently, patients complain about such symptoms as alopecia (baldness), weight gain, increased sweating, and increased photosensitivity.

Contraindications to the use of an antidepressant are deficiency of liver and kidney function, heart ischemia, tachycardia, decompensated heart failure, prostate adenoma, atony of the bladder. Do not prescribe medication with a tendency to convulsions, epilepsy, schizophrenia, glaucoma, and also if the patient has recently suffered a myocardial infarction.

If we talk about the effectiveness of drug therapy, then the worst case for diabetic polyneuropathy, but here it all depends on the degree of damage to nerve endings.

As for alternative treatment, then herbal treatment and homeopathy do not give a tangible result in this pathology. Their use can be justified only for the treatment of underlying diseases that caused retrograde ejaculation.

Prevention

Prevention of retrograde ejaculation is primarily the adoption of measures to prevent and treat health pathologies that can cause such a violation of ejaculation (bowel disease, diabetes mellitus, 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 for prostate adenoma is strictly under the supervision of a doctor, and if an ejaculation disorder occurs, consult about changing the drug to a drug that does not affect the erectile function. To men-hypertensive patients such consultation can be necessary and in connection with reception of some hypotensive agents.

By agreeing to the surgical treatment of prostate or bladder pathologies, it is recommended that men give preference to minimally invasive methods of therapy that 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 work of the nervous system.

Prevention of congenital malformations of the reproductive system in boys is the responsibility of the mother, who in time of bearing the son should take care of nutrition for herself and the fetus, abandon the bad habits, ensure a restful and unborn baby. 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 all the time.

[29], [30]

Forecast

The prognosis of such a pathology as retrograde ejaculation is rather difficult. It all depends on the cause that caused the disease, and the patient's mood. Fight with congenital pathologies of the structure of the genitourinary system can only be done in an operative way, otherwise the treatment will be inconclusive.

An unfavorable or precarious prognosis in many cases of diabetes mellitus, when the disease led to irreversible damage to the nerve endings in the bladder, which worsens the contractile function of the organ sphincter. Yes, and reverse ejaculation, which resulted from unsuccessful surgical intervention in the genitourinary system, almost can not be cured.

Although, by and large, retrograde ejaculation is such a disease with which one can live happily even without treatment. Since the violation of ejaculation does not affect the erection, the sex life does not suffer, both partners enjoy the copulation. The main thing that a man does not complex about his own shortcoming, which, incidentally, outwardly and not noticeable, if you engage in traditional ways of loving. And the opportunity to have a child gives either effective treatment or artificial insemination. In any case, the couple gets their coveted kid with a parent set of chromosomes, and the way he was conceived does not really matter anymore.

[31], [32], [33], [34]