How it happens
At the moment of ejaculation, the neck of the bladder must close tightly so that the seminal fluid goes through the only accessible route - out through the urethra. The smooth muscles of the internal sphincter, controlled by the sympathetic nervous system, are responsible for this closure.
If the sphincter does not close—due to damage during surgery, nerve dysregulation, or medication—sperm travels along the path of least resistance, which is back into the bladder. It is then excreted in the urine the next time you urinate.
Hence the typical picture: orgasm feels normal, but there is no ejaculate, and the first portion of urine after intercourse is cloudy. This phenomenon is also called “dry orgasm”.
Reasons
- TURP of the prostate and other operations on the prostate gland are the most common cause; retrograde ejaculation is an expected consequence of these interventions
- Transurethral incision of the bladder neck
- Adenomectomy
- Diabetes mellitus with autonomic neuropathy
- Taking alpha-blockers prescribed for prostate adenoma
- Some antidepressants and antipsychotics
- Injuries and operations in the pelvis and retroperitoneum, including lymphadenectomy
- Spinal cord injury, multiple sclerosis
- Operations on the rectum
- Congenital anomalies of the bladder neck
Symptoms
- Absence or significant decrease in ejaculate volume with preserved orgasm
- Cloudy urine when urinating for the first time after intercourse
- Maintained erection and normal sensations of orgasm
- No pain
- Inability to conceive with regular sexual activity
- Sometimes - a decrease in the intensity of sensations during orgasm
Diagnostics
- Analysis of urine collected immediately after ejaculation - detection of sperm confirms the diagnosis; this is a key and very simple study
- Spermogram with ejaculate volume assessment
- Examination by an andrologist and collection of data on operations and medications
- Blood glucose and glycated hemoglobin - rule out diabetes
- Ultrasound of the prostate and seminal vesicles
- Hormonal profile if other causes are suspected
- Neurological examination for suspected neurogenic disorders
- TRUS for suspected obstruction of the ejaculatory ducts
Differential diagnosis is important: the absence of ejaculate can also be a consequence of obstruction of the ejaculatory ducts or a disorder in the production of seminal fluid. A urine test after orgasm quickly answers this question.
Treatment
- Review of medications taken - if there is a medicinal reason, stopping or replacing the drug together with the prescribing doctor often solves the problem
- Compensation for diabetes mellitus
- Drug therapy that increases the tone of the bladder neck is effective for neurogenic and medicinal forms, but not for anatomical damage after surgery
- The technique of ejaculation with a full bladder - sometimes helps with partial form
- Obtaining sperm from urine after special preparation for use in intrauterine insemination, IVF or ICSI programs
- Surgical treatment for obstruction of the ejaculatory ducts
- Psychological support with a significant impact on self-esteem
What is important to know before prostate surgery
- Ретроградная эякуляция — не осложнение, а ожидаемое последствие ТУР простаты и инцизии шейки мочевого пузыря; о нём должны предупредить заранее
- На эрекцию и способность испытывать оргазм это не влияет
- Если вы планируете детей, обсудите вопрос с хирургом ДО операции: возможны альтернативные методики или предварительная криоконсервация спермы
- Мужчинам старшего возраста, не планирующим детей, это последствие обычно не создаёт значимых проблем
- Мутная моча после полового акта — нормальное явление в этой ситуации, а не признак инфекции
Where to get examined in Tashkent
To confirm the diagnosis, an appointment with an andrologist, a spermogram and a urine test after ejaculation is sufficient.
In Tashkent, such an examination and selection of tactics, including preparation for reproductive programs, are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you are planning children and are about to undergo prostate surgery, be sure to discuss this issue with your urologist in advance - solutions exist, but it is easier to make them before the intervention. Clinic contacts are below.
