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Patient Instructions

Retrograde ejaculation refers to the entry of semen into the bladder instead of going out through the urethra during ejaculation.

Retrograde ejaculation may be caused by prior prostate or urethral surgery, diabetes, some medications, including some drugs used to treat hypertension (high blood pressure) and some mood-altering drugs. The main reason is that the bladder neck does not close off so semen goes backwards into the bladder rather than forward out of the penis.

The condition is relatively uncommon and may occur either partially or completely. The presence of semen in the bladder is harmless. It mixes with the urine and leaves the body with normal urination. Men with diabetes and those who have had genitourinary tract surgery are at increased risk of developing the condition.

• Little or no semen discharged from the urethra in conjunction with the male sexual climax (during ejaculation)
• Possible infertility
• Cloudy urine after sexual climax

A urinalysis performed on a urine specimen that is obtained shortly after ejaculation will reveal a large amount of sperm in the urine.

If retrograde ejaculation is caused by drugs, your doctor may recommend that you stop taking such drug. This can make the problem go away.

Retrograde ejaculation caused by diabetes or after genitourinary tract surgery may be treated with epinephrine-like drugs (such as pseudoephedrine or imipramine).

If retrograde ejaculation is caused by medications, discontinuation of the medication often restores normal ejaculation. If retrograde ejaculation is caused by surgery or diabetes, it is often not correctable.

The condition may cause infertility.

Call for an appointment with your health care provider if you are having difficulty conceiving a child or you are concerned about retrograde ejaculation.

Maintaining good blood sugar control may help prevent this condition in men who have diabetes. Avoiding drugs that cause retrograde ejaculation will also prevent this condition.

Ejaculation retrograde

Lipshultz LI, Thomas AJ, Khera M. Surgical management of male infertility. In: Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 20.

Ohl DA, Quallich SA, Sønksen J, Brackett NL, Lynne CM. Anejaculation and retrograde ejaculation. Urol Clin N Am. 2008;35:211–220.

Updated by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.