Retrograde ejaculation: definition, causes, diagnosis and treatment

What is retrograde ejaculation?

Retrograde ejaculation occurs when a man experiences normal sexual intercourse with his partner or similar sexual stimulation, and has normal orgasm and ejaculation sensations, but little or no semen is expelled from the urethra and instead flows into the bladder.

Causes of retrograde ejaculation

Inside the prostate gland lies a special Y-shaped "three-way junction." After the ejaculatory duct merges with the urethra, the upward passage leads to the bladder, while the downward passage leads to the penile urethral opening. Within this junction are two sphincter muscles: the bladder neck sphincter ascends, and the membranous urethral sphincter descends. After ejaculation, these two sphincter muscles work closely together, each fulfilling its function. Most men experience this during sexual intercourse: even when intentionally attempting to urinate during extreme sexual arousal, urine doesn't easily flow out. This is because the bladder neck sphincter contracts tightly under the control of the sympathetic nervous system, while the membranous urethral sphincter relaxes under the control of the parasympathetic nervous system, allowing the accumulated semen to be ejaculated directly from the body.

There are many causes of bladder neck sphincter dysfunction. Common causes include chronic inflammation of the bladder, urethra, and seminal colliculus causing irritation; congenital urethral stricture that increases ejaculatory resistance; and the use of improper methods such as squeezing the base of the penis during ejaculation to prevent contraception. These can all lead to bladder sphincter dysfunction. In addition, prostate, bladder, and rectal surgeries can also cause local nerve dysfunction; patients with diabetes or those taking antihypertensive drugs such as guanethidine and reserpine long-term may also experience retrograde ejaculation.

Diagnosis of retrograde ejaculation

Retrograde ejaculation may occur if a man experiences normal orgasm and ejaculation during normal sexual intercourse or under similar sexual stimulation, but ejaculates little or no semen, or if his wife has not conceived for an extended period after marriage. This can be diagnosed by examining urine after ejaculation; the presence of a large amount of sperm and fructose in the urine confirms a diagnosis of retrograde ejaculation.

Examinations such as ultrasound, CT scans, and X-rays can further clarify the nature of the disease. A urinalysis or urine culture can also reveal whether there is an infection in the bladder or urethra, which is particularly important for individuals with a history of ejaculation. These diagnoses guide the understanding of prognosis and the appropriate treatment.

Treatment for retrograde ejaculation

Treatment for retrograde ejaculation is divided into two main categories: surgical treatment and drug treatment.

Surgical treatment is indicated for patients with a history of bladder neck surgery, and bladder neck YV plasty can be performed after the disease has been diagnosed.

The main indication for drug treatment is for patients with sympathetic nerve dysfunction. Adrenergic drugs can be used for treatment, and anticholinergic drugs can also be used depending on the specific situation. All of these drugs should be taken under the guidance of a specialist doctor in a regular hospital to avoid adverse reactions.

Retrograde ejaculation caused by chronic infection can be treated with antibiotics such as norfloxacin and metronidazole. When Western medicine is ineffective, traditional Chinese medicine can be selected based on syndrome differentiation. The advantage of traditional Chinese medicine lies in its holistic treatment and treatment based on syndrome differentiation, which can effectively improve symptoms and alleviate the condition.

For diabetic patients, the primary disease should be actively treated; retrograde ejaculation will naturally improve after recovery. For patients with hypertension, alternative medications or therapies can be used to lower blood pressure, and medications with adverse effects should be avoided as much as possible. Those with chronic cystitis, chronic urethritis, or chronic seminal vesiculitis should avoid excessive consumption of spicy foods and alcohol, and should increase their water intake appropriately. For couples eager to conceive, artificial insemination can be used, provided the husband's semen does not have any substantial pathological changes.