WHAT IS RETROGRADE EJACULATION

Retrograde ejaculation occurs when semen goes back into the bladder (the organ that temporarily stores urine) rather than emerging through the penis during orgasm.

Under normal circumstances, ejaculation pushes semen forward through a man’s urethra (passageway inside the penis) and out of the penis. This is because a tiny sphincter (circular muscle) at the entrance to the bladder shuts the opening to the bladder and prevents semen from entering.

In RE, the muscle that shuts the bladder is defective. This allows all or part of the semen to go back (retrograde) into the bladder during ejaculation. When this happens, less semen comes out of the penis. This can sometimes be called a dry orgasm.

Retrograde ejaculation is not harmful, but it can cause male infertility because the sperm cannot reach your partner’s womb. Treatment for retrograde ejaculation is usually only needed to revive fertility.

SIGNS AND SYMPTOMS OF RETROGRADE EJACULATION

Retrograde ejaculation does not affect your ability to get an erection or have an orgasm — but once you ejaculate, semen goes into your bladder rather than out of your penis through the urethra. Retrograde ejaculation signs and symptoms include:

• Orgasms during which you ejaculate little or no semen out of your penis (dry orgasms).
• Urine that is cloudy after orgasm because it contains semen.
• Inability to make your partner pregnant (male infertility).

CAUSES OF RE

Retrograde ejaculation has several possible causes. These include:

Damage from surgery to the muscles of the bladder, or to the nerves that control these muscles. This damage can occur as a complication of the following surgical procedures; Prostate surgery, surgery on the bladder, extensive pelvic surgery, especially to treat cancer of the prostate, testicles, colon or rectum and certain types of surgery on the discs and vertebrae of the lower spine.

Nerve damage caused by medical diseases. This is usually common in men with multiple sclerosis or with long-term, poorly controlled diabetes.

Side effects of medication . Medications that may cause RE includes;

• tamsulosin , alfuzosin for treating symptoms of enlarged prostate gland.
• Anti-depressants such as fluoxetin , sertralineand several others.
• Anti-psychotics such as chlorpromazine, thioridazine and risperidone.

PROSTATE REMOVAL AND RETROGRADE EJACULATION

Men who have had a transurethral prostatectomy (removal of prostate tissue through the urethra) have a ten to fifteen percent chance of retrograde ejaculation. A radical prostatectomy (surgery to remove the entire prostate gland, either for cancer or benign enlargement) results in a higher risk of RE after the procedure.

FACTORS THAT INCREASE THE RISK FOR RETROGRADE EJACULATION

The following factors may increase your risk of RE:

• Diabetes or multiple sclerosis.
• If you had prostate or bladder surgery.
• If you take certain drugs for high BP or a mood disorder.
• You had a neural structure injury

COMPLICATIONS OF RE

Retrograde ejaculation is not harmful. However, potential complications include:

• Male infertility (inability to make a girl pregnant)
• Unpleasurable orgasm.

DIAGNOSING RE

In most cases, the diagnosis is made by a urologist, a specialist in male reproductive disorders and urinary tract problems. The doctor will ask questions about your medical history, previous surgery, sexual history and current medications.

These questions is by a thorough physical examination. The diagnosis usually can be confirmed if many semen are found in a urine sample after ejaculation.

TREATMENT OF RE

Retrograde ejaculation typically does not require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause.

• If your RE is a side effect of medication, your doctor probably will switch you to a drug that does not affect orgasm.
• If your retrograde ejaculation appears to be due to a mild nerve or muscle problem involving the bladder, then you will be treated with a drug that helps improve muscle tone at the bladder
• When RE results from severe damage to the nerves or muscles of the bladder, then it may be impossible to restore normal ejaculation. If this is the case, and you are hoping to father a child, a fertility specialist may be able to help.

The fertility specialist may collect sperm from your urine and use washed sperm for an assisted-fertilization procedure. In cases of RE, three of the more commonly used assisted fertilization procedures are:

1. Intrauterine insemination (using a small catheter to put washed sperm inside your partner’s womb at the time of ovulation).
2. In-vitro fertilization (incubating eggs and sperm together in the laboratory to produce fertilization).
3. Intracytoplasmic sperm injection (injecting a single sperm into your partner’s egg to cause fertilization)

PREVENTION OF RETROGRADE EJACULATION

RE can not be entirely prevented.

• Men who need treatment for an enlarged prostate should consider surgeries that are less invasive, such as transurethral needle ablation (TUNA) or transurethral microwave thermotherapy (TUMT) of the prostate. These surgeries are less likely to cause nerve and muscle damage.
• Controlling medical conditions that can cause nerve damage may also prevent RE. Men with diabetes should take the medications and should implement appropriate lifestyle changes as recommended by a doctor.

OUTLOOK OF RE

Simple therapies have a good chance of reducing RE enough to allow conception.

In men who do not respond to medication, fathering a child may still be possible with the help of assisted fertilization procedures.

I. O. Eriyo, MB.BS in view, certified content creator at PoliMed, licensed google writer and contributing writer at WikiMedia Foundation.