Retrograde Ejaculation – Diagnosis and Treatment
Diagnosis
Doctors follow a few steps to find out if someone has retrograde ejaculation. They begin by asking about when the problem started and any related health issues, such as diabetes or spinal cord injury.
They also ask if the person has had prostate surgery or other operations in the pelvic area. Doctors review any medicines being used, since some can cause ejaculation problems.
A physical exam checks the penis, testicles, and rectum. If the main concern is no semen during climax, the next step is a special urine test.
The patient empties their bladder, masturbates until orgasm, and then provides a urine sample. A lab checks the sample for sperm.
If sperm are in the urine, semen is going into the bladder instead of out the urethra. If no sperm are found, doctors may look for problems with the bladder neck, nerve damage, or issues with the organs that make semen.
If the cause is still unclear, patients may need more tests or see a specialist.
Additional Details
Doctors sometimes use lists to review causes. These include diabetes, nerve damage, bladder or prostate surgery, and side effects of medication.
Blood and urine tests can help rule out other causes, such as poor sexual function or certain medical conditions.
Treatment
Medicine Strategies
Doctors may suggest certain medicines if nerve damage causes retrograde ejaculation. This problem can happen after surgery or from conditions like diabetes or multiple sclerosis.
Medicine may not help if surgery changed how the body works, such as after bladder neck surgery or a transurethral resection of the prostate.
Some medicines help keep the muscle between the bladder and urethra closed during ejaculation. These include:
| Medication Class |
|---|
| Tricyclic Antidepressants |
| Alpha-1 Adrenergic Agonists |
| Decongestants (Sympathomimetics) |
| Antihistamines (1st Generation) |
These drugs can raise blood pressure or heart rate. People with heart problems or high blood pressure need to be careful.
Doctors watch for side effects and possible drug reactions. If a person’s medicines are causing retrograde ejaculation, a doctor may change or stop them to see if symptoms improve.
Some depression medicines and drugs for high blood pressure, including alpha blockers, may be changed or stopped under a doctor’s care.
Treatments for Fertility
If medicine is not enough and a man wants children, a fertility specialist can help. Assisted reproductive technology gives more options.
Some ways to help include sperm recovery and insemination. Sperm can be collected from the bladder after ejaculation, washed, and used for intrauterine insemination.
If simple methods do not work, doctors may use in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). IVF joins sperm and egg outside the body, while ICSI puts a single sperm directly into an egg.
Treatment choice depends on the person’s health and family goals. A doctor or fertility specialist can help pick the best option.
Ways to Cope and Find Support
Changes in orgasm may reduce physical and emotional fulfillment, which can cause stress in relationships. Open conversations and finding support are important, especially for couples hoping to have a child.
A strong support system can help. Talking with a counselor can make it easier to handle emotional or relationship issues.
Professional guidance is useful when facing tough decisions. Most couples can try infertility treatments, but these may be expensive and stressful. It is helpful to check with insurance ahead of time to see what is covered.
Here are some steps that may help:
| Step | Why It Matters |
|---|---|
| Know the costs | Insurance might not pay for every service. |
| Talk to doctors | Specialists offer advice and choices. |
| Communicate openly | Partners need to understand each other’s needs and expectations. |
Working together can reduce stress and help couples face challenges as a team.
Getting Ready for Your Visit
Steps You Can Take Before Seeing the Doctor
To help your healthcare provider give the best care, it is useful to prepare before your visit. Using a checklist can make things easier.
List your current symptoms, even if they do not seem related to your dry orgasms. This gives a full picture of your health.
Record your personal history, including past surgeries, treatments like pelvic radiation, and major life changes or stresses. Gather details about any medicines, vitamins, or supplements you use.
Write down your questions to help you remember important topics during the visit.
Examples of good questions to ask the healthcare provider:
| Question | Purpose |
|---|---|
| What might be causing my symptoms? | To understand root causes |
| Are there other possible reasons for this problem? | To consider all options |
| What tests will I need? | To know what to expect |
| Is the problem short-term or long-lasting? | For future planning |
| What are the risks? | To learn about complications |
| Is treatment needed? | To set care goals |
| Can I still have children? | For family planning |
| Should I see a specialist? | To know if a referral is needed |
| Are there generic medications available? | To save on costs |
People trying to have a baby may want to discuss if medicines can help normal ejaculation, if sperm can be taken from the bladder for fertility options, or if advanced options like intrauterine insemination could help.
Ask which treatments are best for parenthood. Write down other questions as they come to mind. Having a note or phone to jot things down may be helpful.
What the Doctor May Do and Ask
When you see the healthcare provider, you can expect:
- Medical Questions: The doctor will ask about your symptoms and when the problems started. The doctor will also ask about any past health issues.
- Physical Check-Up: The doctor may examine your penis, testicles, and rectum. This helps check for signs of other health concerns.
- Detailed History: The doctor will ask about previous surgeries, cancer history, diabetes, or other medical problems.
Be ready for questions like:
Do you notice cloudy urine after sex?
When did dry orgasms begin?
Does any semen come out during orgasm, or is it always dry?
Which surgeries have you had before?
Have you ever had cancer, diabetes, or other long-term diseases?
What medicines, herbs, or supplements are you using?
Are you and your partner planning for a child?
If yes, how long have you been trying?
Tip: Bring a written list of your answers or medical records to help your appointment go smoothly.
