What is ejaculation? Ejaculation is a physiological process of ejection of seminal fluid (semen) from the penis, which is controlled by the autonomic nervous system. Ejaculation consists of two main phases – emission and expulsion (actual ejaculation). The main organs involved in ejaculation are the distal epididymis (epididymis), vas deferens, seminal vesicle, prostate, prostatic urethra, and bladder neck. During normal ejaculation, seminal fluid (sometimes called ejaculate) is pushed through the urethra and out of the penis. Ejaculate can come out of the penis because a small muscle called the bladder sphincter closes the opening to the bladder, preventing sperm from entering the bladder. What is retrograde ejaculation? Retrograde ejaculation occurs when the bladder sphincter does not function properly and the bladder may not close completely, which can cause ejaculate to travel back into the bladder instead of exiting the penis. This condition is also called dry orgasm. Some men with retrograde ejaculation still ejaculate but notice less fluid than before. In some men, retrograde ejaculation causes infertility. When too little ejaculate comes out (or no ejaculate comes out) from a man’s penis, the chance of sperm fertilizing an egg varies from low to zero. However, retrograde ejaculation is responsible for only 0.3-2 percent of infertility cases. Retrograde ejaculation is not a dangerous or painful condition and does not always require treatment. Affected men, when they ejaculate small amounts of seminal fluid, may not even notice that they are suffering from this disorder. Some men report cloudy urine immediately after ejaculation, possibly due to semen entering the bladder mixing with urine. Men with retrograde ejaculation can also have fertility problems. What are the causes of retrograde ejaculation? Retrograde ejaculation can be caused by: Diabetes. Blood sugar that remains uncontrolled for a long time can damage organs and nerves, affecting the muscles of the bladder; Damage to the nervous system. Injuries and diseases that damage the nervous system, such as multiple sclerosis and spinal cord injuries, can damage the nerves and muscles of the bladder. Lower spine surgery may have a similar effect; Surgery. Surgery on the prostate, testicles, colon, rectum, bladder, or lower spine can cause retrograde ejaculation; Medicines. Some medications can prevent ejaculation. These include drugs for an enlarged prostate, some antidepressants, and some antipsychotic drugs. Surgical removal of part of the prostate is one of the most common causes of retrograde ejaculation. About 10 to 15% of men who undergo this surgical proceduremay develop the condition because the surgery may damage the muscles and nerves of the bladder. How can retrograde ejaculation be prevented? Retrograde ejaculation is not completely preventable. Men who need treatment for an enlarged prostate should consider surgeries that are less invasive, such as transurethral microwave thermotherapy (TUMT) or transurethral needle ablation (TUNA) of the prostate. These surgeries are less likely to cause nerve and muscle damage. Controlling underlying conditions that may be causing nerve damage can also prevent retrograde ejaculation from occurring. Men with diabetes should take the medications prescribed by their doctors and should make appropriate changes in their lifestyle as recommended by the specialist. References: 1. Jefferys, A., Siassakos, D., & Wardle, P. (2012, February). The management of retrograde ejaculation: A systematic review and update. Fertility and Sterility 2. ScienceDirect. Kam, J., Tsang, VH, & Chalasani, V. (2017, January). Retrograde ejaculation: A rare presenting symptom of type 1 diabetes mellitus 3. National Center for Biotechnology Information (NCBI). Parnham, A., & Serefoglu, EC (2016, August). Retrograde ejaculation, painful ejaculation and hematospermia 4. Harvard Health. Retrograde Ejaculation 5. Medical News Today. What is a retrograde ejaculation