Retrograde ejaculation

Retrograde ejaculation (RE) is a condition that occurs when the man has an orgasm but the ejaculate or “come” is dry, or in the colloquial term “ there is no come when I come”. This is a very distressing condition as most men expect to “come when they come”, except if they are faking it. Yes! Men can fake orgasms!{{more}}

There are many reasons why this condition occurs and interestingly it can occur in young persons also. The main reasons why this is being discussed is that a fair number of men suffer in silence from this problem. Most of these men are older and have given up on ever being helped because they have had it for a long time. In younger men the issue of infertility arises, as these men cannot impregnate their partners naturally. Some men also complain that the orgasm is not as pleasurable as when the ejaculate was “wet” and obviously some women find it less pleasurable that they are not being “wet up” during lovemaking.

What really causes RE? There are many: from medications to surgery to other diseases. In older men the main reasons are diabetes mellitus and medications, while in younger men neurological diseases and medications predominate. Other conditions like benign prostate disease (BPH or a swollen prostate) can cause RE, because as the prostate enlarges, it distorts the bladder neck and prevents the ejaculation valve at the bladder neck from closing, hence leading to the “back flow” of semen into the bladder.

Last week we discussed the way an orgasm works. We established that there is a valve at the neck of the bladder, just before you enter the prostatic fossa, as you leave the bladder. We said this valve closes at the time of ejaculation, so preventing the backflow of the ejaculate when the prostate and its fossa are squeezed at the time of “coming”. If this valve does not “close off” properly at the time of “coming”, then the ejaculate flows along the path of least resistance, back into the bladder where it stays until it is “peed” out. The causes of RE can then be understood because diabetes and other neurological diseases, like spinal cord injuries and multiple sclerosis, damage the nerve that causes the ejaculation valve to close, so the valve remains open during ejaculation. Surgery to the back of the bladder or in the pelvis where the nerves end also causes this problem, as does surgery at the back of the belly (the retroperitoneum) which can damage the nerve where it begins.

Operations which cut the prostate, whether with an electrical knife or laser, damage the closing mechanism of the valve and cause RE. Some medications used to treat high blood pressure and a swollen prostate, called alpha blockers (e.g. cardura, hytrin, prazosin and flomax) can relax the ejaculation valve the same way they relax the blood vessel muscle and prostate muscle. Other medications, like those used to treat anxiety and depression, can cause the nerves which control the valve to dysfunction, thus leading to RE.

As mentioned before the problem with dry ejaculation is mainly infertility, although some men worry about “where does the ‘come’ go when they come”, as they think it poisons them to have the ejaculate remain inside them. These men and their partners need reassurance that the “come” goes back into the bladder and they will pass it out when they “pee”. If reassurance does not help, there are various medications that can be used; but these medications are not without their side effects. Before we give patients medication, we would generally do a complete check up and stop or change the medications that the man may be taking that can cause RE.

For men who suffer from infertility (inability to get their girlfriend/wife pregnant) the aim of treatment is to get his partner pregnant. This is done by stopping any medication the man may be taking that can cause RE. If this is not the cause (i.e. he is not on any such medications) or this measure does not help, then he may be given medications to help to tighten the ejaculation valve. If both measures fail, then the couple will need assisted fertilization. The sperms that are peed out are collected, washed of the urine, concentrated and inseminated into the female partner to effect fertilization. Alternatively, the couple might just decide to have sperms harvested from the epididymis of his testicle and not from the urine, especially if the quality of the sperms urinated is poor or the female has other fertility problems. The egg can then be fertilized in the woman (in utero) or harvested from the woman and fertilized in a test tube (in vitro). These will be discussed in another forum on infertility.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com