Retrograde ejaculation

In males, retrograde ejaculation occurs when the fluid to be ejaculated, which would normally exit the body via the urethra, is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts and the ejaculate goes to the urethra, the area of least pressure. In retrograde ejaculation, this sphincter does not function properly.

Causes
Causes may be in the autonomic nervous system or the operation of the prostate. Retrograde ejaculation is a common complication of trans-urethral resection of the prostate, a procedure in which prostate tissue is removed, slice by slice, through a resectoscope passed along the urethra. It can also be caused by a Retroperitoneal Lymph Node Dissection for Testicular cancer if nerve pathways to the bladder sphincter are damaged with the resulting retrograde ejaculation being either temporary or permanent. Modern nerve-sparing techniques seek to reduce this risk.

Retrograde ejaculation is a common side effect of medications such as Tamsulosin that are used to relax the muscles of the urinary tract for various purposes. These medications may cause the bladder sphincter to relax as well and fail to contract fully.

The medications that mostly cause it are antidepressant and antipsychotic medication; patients experiencing this phenomenon tend to quit the medications.

Retrograde ejaculation can also be a complication of diabetes, especially in cases of diabetics with long term poor blood sugar control. This is due to neuropathy of the bladder sphincter.

Diagnosis
Diagnosis is usually by way of a urinalysis performed on a urine specimen that is obtained shortly after ejaculation. In cases of retrograde ejaculation, the specimen will contain an abnormal level of sperm.

Especially in case of orgasmic anejaculation, anejaculation can often be confused with retrograde ejaculation, and they share some fundamental aspects of the etiology. Urinalysis is used to distinguish between them.

Potential treatments
Retrograde ejaculation may cause a couple to experience problems such as infertility, as most sperm do not get to the vagina and the rest of the female reproductive system. As a method to induce pregnancy, the retrograde ejaculator's urine is centrifuged and the isolated sperm is then injected into the woman.

In most cases those suffering from retrograde ejaculation are advised that a normal sex life is to be expected. However, a significant number of those patients with retrograde ejaculation have reported reduced sensation during orgasm.

Retrograde ejaculation and alternative medicine
Taoists and some fields of alternative medicine actually recommend and teach deliberate retrograde ejaculation as a way of "conserving the body's energy". One manner of achieving this is by applying pressure to the perineum during orgasm. It is believed the energy is conserved physically by keeping the sperm (and thereby, the "intelligence" that created it) in the body; however, there is no scientific basis for this, as the retrograde-ejaculated sperm are simply lost at the next urination. Others believe the sensation of sperm passing through the urethra causes intense physical sensations that can drain the body of "sexual energy."

Due to its aforementioned effects on fertility, there is a potential misconception that inducing this condition can be used as a method of contraception. However, it is neither reliable nor effective, due to some sperm still potentially emerging. Many doctors also do not recommend inducing retrograde ejaculation, due to the risk of putting pressure on the pudendal nerve, as such pressure can cause numbness in the penis. It is also possible—through repeated use over a long period—that the muscle can become stuck in this configuration, a condition that can be difficult to correct.