Retrograde ejaculation



Retrograde ejaculation occurs when semen that normally would be ejaculated via the urethra is redirected to the urinary bladder. 



Referred to as dry orgasm.



Before ejaculation the sphincter of the bladder contracts, sealing the bladder


preventing  a reflux of seminal fluids into the male bladder during ejaculation. 



Normally, semen is forced to exit via the urethra, the path of least resistance. 



Bladder sphincter dysfunction may lead to retrograde ejaculation.



Retrograde-ejaculated semen, that enters the  bladder, is excreted with the next urination.



Retrograde ejaculation may be a cause of male infertility.



Retrograde ejaculation during masturbation is not associated with semen release, but an orgasm occurs.



Am ejaculatory duct obstruction may cause RE.



During a male orgasm, sperm are released from the epididymis and travel via the vas deferens. 



Sperm then mix with seminal fluid in the seminal vesicles, prostate fluid from the prostate gland, and lubricants from the bulbourethral gland. 



During orgasm, muscles at the end of the bladder neck tighten to prevent retrograde flow of semen. 



These bladder neck muscles are either very weak or the nerves controlling the muscles have been damaged when there is retrograde ejaculation.



Malfunctioning bladder sphincter, leading to retrograde ejaculation, may be due to: 



Autonomic nervous system dysfunction. 



Complication of transurethral resection of the prostate.



Retroperitoneal lymph node dissection for testicular cancer.



Green Light Laser prostate surgery. 



Surgery on the bladder neck accounted for about ten percent of the cases of retrograde ejaculation..



RE is a common side effect of medications, such as tamsulosin.



Medications used to relax the muscles of the urinary tract for treating conditions such as benign prostatic hyperplasia, increases the likelihood of retrograde ejaculation is increased: mostly antidepressant and antipsychotic medications.



Can  be a complication of poorly controlled diabetes, due to neuropathy of the bladder sphincter. 



May be associated with urethral stricture, and can also result from pinching closed the urethral opening, to avoid ejaculation, known as Hughes’ technique.



Associated with medications to treat high blood pressure, benign prostate hyperplasia, mood disorders, surgery on the prostate and nerve injury, which may occur in multiple sclerosis, spinal cord injury or diabetes.



Diagnosis is confirmed by urinalysis obtained shortly after ejaculation: the specimen will contain an abnormal level of sperm.



Urinalysis is used to distinguish between 


anejaculation and retrograde ejaculation.



The treatment depends on the cause: Medications work only in a few cases. 



Surgery rarely is beneficial.



Medications do not help if there has been permanent damage to the prostate or the testes from radiation or surgery.



Medications only work if there has been mild nerve damage from diabetes, multiple sclerosis, or mild spinal cord injury.



Tricyclic antidepressants like imipramine. antihistamines like chlorphenamine, decongestants like ephedrine and phenylephrine tighten the bladder neck muscles



These drugs prevent semen from going backwards into the bladder. 



Such medications have many side effects, must be taken at least 1–2 hours prior to sexual intercourse. 



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