Orgasms do not always look like what you expect or even what you would like. Many men deal with dry orgasm, or retrograde ejaculation, which causes semen to travel in the opposite direction. Instead of exiting the body through the urethra, it goes backwards into the bladder. The result? A seemingly dry orgasm.

What causes retrograde ejaculation? Is dry ejaculation harmful? We’ll tackle these questions in this guide, exploring the condition, potential causes and treatment options to help you tackle the issue and find a solution.

What Is Retrograde Ejaculation?

What is a dry orgasm? It may sound simple enough, but many men actually mistake the lack of semen during the experience. While no semen exits the urethra, it does flow back into the bladder. This means that your body is sending the semen in the opposite direction, hence the name retrograde ejaculation.

Why does retrograde ejaculation happen? In a typical orgasm, semen moves forward through the urethra because of the sphincter that separates it from the bladder. When this sphincter doesn’t work properly, the muscle at the opening of the bladder (bladder neck) does not work. The bladder neck muscle dysfunction ultimately causes semen to flow backwards instead of forward.

Symptoms of Retrograde Ejaculation

The most obvious sign of retrograde ejaculation is a lack of semen during orgasm. Other possible symptoms include:

• Cloudy urine post-orgasm
• Weak ejaculation with little semen
• Difficulty conceiving a child

A dry orgasm feels just like a typical one, but the key difference is the extremely low amount or absence of semen [1].

Causes of Retrograde Ejaculation

Retrograde ejaculation has many potential causes, ranging from side effects of medication to certain surgical procedures. Men with a history of erectile dysfunction may also suffer from retrograde ejaculation.

Medications

There are a variety of medications that can affect erectile dysfunction and possibly cause retrograde ejaculation. These include:

- Medications for an enlarged prostate (Benign Prostatic Hyperplasia (BPH))

- Antidepressants

- Antipsychotic medications such as risperidone, thioridazine, iloperidone, and clozapine.

Research has found that selective serotonin uptake inhibitors (SSRIs) and drugs used to treat an enlarged prostate (BPH) are more likely to cause retrograde ejaculation [2].

Certain medications may cause retrograde ejaculation by relaxing the bladder sphincter. This leads to a partially closed bladder neck, which reduces pressure near the verumontanum, a bulge on the urethra that gets surrounded by contracting muscles during ejaculation.

Medications that contain Alpha-1a blockers can also cause issues because they lead to smooth muscle relaxation. This can decrease fluid emission from the body and cause the bladder neck to remain partially open during ejaculation.

Surgical Procedures

Several types of surgical procedures can affect how your body performs during sexual activity. Namely, prostate surgery, bladder surgery and cancer staging surgeries near the lower abdomen or pelvis can cause erectile dysfunction or retrograde ejaculation.

Whenever nerves around the bladder neck or urethra become damaged, as they may be during surgery, men can experience negative side effects in the bedroom. Common procedures that may cause retrograde ejaculation include:

- Transurethral resection of the prostate (TURP)

- Prostatectomy (Removal of the prostate gland)

- Anterior lumbar interbody fusion (1.2-45% chance of retrograde ejaculation) [3]

Medical Conditions

Medical conditions that affect the bladder muscles may also impact ejaculation. People with multiple sclerosis, a spinal cord injury, birth defects, or a history of stroke may have this issue. It can also occur in men with diabetes due to a complication called autonomic neuropathy, nerve damage caused by low blood sugar levels [4].

Is Retrograde Ejaculation Harmful or Dangerous?

It’s normal to wonder, “Is retrograde ejaculation harmful?” because the thought of semen entering the bladder may sound possibly dangerous. There is a positive and negative to the answer: Retrograde ejaculation is not harmful to your health, but it can cause infertility.

Struggling to ejaculate can ultimately hinder your ability to conceive. This can lead to feelings of guilt and shame that may also increase stress levels and anxiety. In turn, these emotional struggles could negatively impact your relationship and even cause erectile dysfunction.

Not ejaculating won’t hurt you, but it can get in the way of helping you fulfill your desire to have a family. It may also indicate potentially underlying health issues with your prostate, bladder or urethra, so seek medical attention if you have concerns.

Retrograde Ejaculation Treatment

So, the real question is, how do you fix retrograde ejaculation? You can’t make your body do something it is physically unable to, but you can look for treatment options that may increase your chance of achieving a typical orgasm.

First, you will need to speak with a medical professional who can make a formal diagnosis. They will likely perform a urinalysis to look for the presence of semen in the urine. They will also take your full medical history to identify possible causes of your retrograde ejaculation.

Treatment Options

There are several treatment options available that can help men achieve a typical orgasm. The first is the most straightforward: consider changing medications that are causing your dry orgasm. This would possibly resolve all your issues, but it must be done under the supervision of your prescribing physician or psychiatrist.

Make sure that you only stop taking medication, change medications or adjust dosages with a provider’s approval.

Taking new medications can also introduce other side effects, so it’s important to discuss all the possible consequences before committing to a new treatment plan. Ultimately, your health and well-being are what come first, so you have to consider what conditions need the most treatment.

For example, if you have BPH, then you need medication to manage that condition more than you need medication to fix issues with ejaculating. Or you may have struggled to find antidepressants that actually work for you, and the thought of changing them or going through the adjustment period all over again just isn’t worth it. That’s okay — your mental health is more important.

You can choose not to treat retrograde ejaculation, but it will impact your fertility rates or ability to ever conceive a child with a partner.

Fertility Considerations

Without treatment, retrograde ejaculation dramatically lowers a man’s ability to conceive a child with a partner. The best thing to do is consult a fertility specialist who can help you explore other avenues to parenthood, like IUI, ISCI and IVF.

Here’s how each one works:

IUI

IUI stands for intrauterine insemination. It involves placing sperm directly into the uterus during the ovulation period to increase the odds of fertilization. Sperm can come from you or a donor. If you’re unable to produce semen, then you and your partner might explore the option of a sperm donor. This can be chosen from an agency or be someone you know.

ISCI and IVF

Intracytoplasmic sperm injection (ICSI) directly injects sperm into an egg to fertilize it. It’s typically used as a part of in-vitro fertilization (IVF) to treat male infertility. The embryo is fertilized outside of the body, then inserted into the uterus.

Can Viagra help with retrograde ejaculation?

Results are mixed; some sources claim that Viagra can improve ejaculate volume by relaxing the muscles around the bladder and prostate, while others say it has no impact. Because Viagra is focused on helping men get erections, it may have no effect on their semen levels or how much they ejaculate during an orgasm [5].

Can not ejaculating cause problems?

No, there are no proven negative side effects to not ejaculating, whether it’s due to abstinence or a health condition. However, men who want to conceive a child and struggle with ejaculation will need to consult with a doctor and possibly explore fertility treatments.

The biggest problem not ejaculating can cause is psychological distress. For some people, it is a huge source of shame and embarrassment. If this affects you, know that it isn’t your fault. Speaking with a sex therapist may also help you rebuild confidence and learn to accept yourself and your body as it is today, regardless of how it may change in the future.

Furthermore, couples who are struggling with intimacy due to a partner’s difficulty ejaculating may want to speak with a sex therapist who can help them overcome the challenge and find other ways to connect physically.

Living With Retrograde Ejaculation

If you have to live with retrograde ejaculation, it’s important to remember that this is a medical condition and not a reflection of any failure on your behalf. It’s natural to feel disappointed and discouraged, especially if you and your partner want to have a child together. But low fertility rates happen among even the healthiest people, and there are treatment options available that can help you achieve your dream to have a baby.

Remember that while the condition isn’t physically dangerous, living with retrograde ejaculation can take a toll on your emotions. Be open with your partner about your experience; let them know how you feel, and discuss alternative physical activities or other forms of intimacy that might help you both share a deep physical connection without the stress and anxiety of dry orgasm.

It is, of course, also okay to accept that you have dry orgasms and simply carry on as you always have. What matters most is that you feel comfortable with the situation and that you and your partner are on the same page.

When to See a Doctor

You should have your issues with ejaculation checked out by a urologist to ensure that there are no serious underlying issues that need treatment. You should also talk to a doctor when your issues with ejaculation are affecting your relationship, mental health or family planning.

Conclusion

In summary, retrograde ejaculation can happen to any man, but it’s more commonly a side effect of medications, nerve damage, birth defects or surgical procedures. If necessary, you can seek treatment options or pursue fertility treatments that can help you live your life confidently — with or without dry orgasms.

Sources

[1] https://www.healthline.com/health/mens-health/retrograde-ejaculation

[2] https://www.health.harvard.edu/a_to_z/retrograde-ejaculation-a-to-z

[3] https://www.sciencedirect.com/science/article/abs/pii/S152994301201203X

[4] https://www.diabetes.co.uk/diabetes-complications/retrograde-ejaculation.html

[5] https://pubmed.ncbi.nlm.nih.gov/17337426/