Dear Alice,

One of my textbooks makes mention of retrograde ejaculation. It says that semen is released into the urinary bladder but it doesn't talk about the functional aspects. Can the problem be corrected? Is it a painful problem?

Dear Reader,

During ejaculation, the internal sphincter, a muscle located between the prostate and the bladder, closes tightly, preventing a man from ejaculating and urinating at the same time. If this muscle relaxes, it can force some of the ejaculate backwards into the bladder, rather than out of the urethral tip. This is called retrograde ejaculation. The next time a man with this condition urinates, the urine is noticeably cloudy because it has been mixed with ejaculate. Health care providers or urologists can confirm the diagnosis of retrograde ejaculation by testing a man's urine for the presence of sperm.

Retrograde ejaculation has many causes. Certain medications that treat hypertension and prostate conditions; genital surgery; or, diseases, such as diabetes, which can cause nerve impairment in and around the bladder, cause ejaculate to flow backward. Often, retrograde ejaculation is a first sexual side effect for men with diabetes, who are the most commonly affected group. It's important to get an accurate diagnosis by a health care provider or urologist. Depending upon the cause of retrograde ejaculation, treatments and outcomes vary. Medications are usually used first, often pseudoephedrine initially, or imipramine.

Men with retrograde ejaculation still produce sperm. Sperm can be medically retrieved from the first urine sample after ejaculation. This sperm can be used for artificial insemination.

Men feel no pain, and usually no sensation at all, from having retrograde ejaculation. Strange and unfamiliar, however, may come to mind when they notice their orgasm is not accompanied by a "burst" of semen. Since orgasm and ejaculation are two separate physiological processes, a man with retrograde ejaculation can still feel intense pleasure and contractions during orgasm.


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