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Retrograde ejaculation

Ejaculation retrograde; Dry climax

Retrograde ejaculation occurs when semen goes backward into the bladder. Normally, it moves forward and out of the penis through the urethra during ejaculation.

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Causes

Retrograde ejaculation is uncommon. It most often occurs when the opening of the bladder (bladder neck) does not close. This causes semen to go backward into the bladder rather than forward out of the penis.

Retrograde ejaculation may be caused by:

• Diabetes
• Some medicines, including drugs used to treat high blood pressure and some mood-altering drugs
• Medicines or surgery to treat prostate or urethra problems

Symptoms

Symptoms include:

• Cloudy urine after orgasm
• Little or no semen is released during ejaculation

Exams and Tests

A urinalysis that is taken soon after ejaculation will show a large amount of sperm in the urine.

Treatment

Your health care provider may recommend that you stop taking any medicines that may cause retrograde ejaculation. This can make the problem go away.

Retrograde ejaculation that is caused by diabetes or surgery may be treated with drugs such as pseudoephedrine or imipramine.

Outlook (Prognosis)

If the problem is caused by a medicine, normal ejaculation will often come back after the drug is stopped. Retrograde ejaculation caused by surgery or diabetes often can't be corrected. This is most often not a problem unless you are trying to conceive. Some men do not like how it feels and seek treatment. Otherwise, there is no need for treatment.

Possible Complications

The condition may cause infertility. However, semen can often be removed from the bladder and used during assistive reproductive techniques.

When to Contact a Medical Professional

Contact your provider if you are worried about this problem or are having trouble conceiving a child.

Prevention

To avoid this condition:

• If you have diabetes, maintain good control of your blood sugar.
• Avoid drugs that can cause this problem.

Related Information

References

Bhasin S, Basson R. Sexual dysfunction in men and women. In: Melmed S, Auchus, RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 20.

McMahon CG. Disorders of male orgasm and ejaculation. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 71.

Niederberger CG, Ohlander SJ, Pagani RL. Male infertility. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 66.

Schlegel PN. Clinical management of male infertility. In: Robertson RP, ed. DeGroot’s Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023: chap 113.

Review Date: 1/1/2023  

Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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