retrograde ejaculation

In the human male reproductive system, retrograde ejaculation occurs when semen, which would normally be ejaculated via the urethra, is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation forcing the semen to exit via the urethra, the path of least pressure. When the bladder sphincter does not function properly, retrograde ejaculation may occur.

Causes

A malfunctioning bladder sphincter, leading to retrograde ejaculation, may be a result of the autonomic nervous system or the operation of the prostate. It 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 however it may also occur as the result of Green Light Laser prostate surgery.

Retrograde ejaculation is a common side effect of medications, such as tamsulosin, that are used to relax the muscles of the urinary tract, treating conditions such as benign prostatic hyperplasia. By relaxing the bladder sphincter muscle, the likelihood of retrograde ejaculation is increased.

The medications that mostly cause it are antidepressant and antipsychotic medication; patients experiencing this phenomenon tend to quit the medications.^[1][2]

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, including infertility, as most sperm fail to enter the partner's vagina, lowering the chances of conception. To induce pregnancy, the male's urine may be centrifuged and the isolated sperm injected directly 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.^{[citation needed]}

Retrograde ejaculation and alternative medicine

Taoists and some fields of alternative medicine 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 was believed that doing this caused the sperm to travel into the head and nourish the brain, or that energy is conserved physically by keeping the sperm (and thereby, the "intelligence" that created it) in the body.^[3] This approach has since been discredited by modern medicine, as the retrograde-ejaculated sperm actually go into the bladder and are simply lost at the next urination.^[4] However, there are other Taoist perspectives on the general subject of ejaculation and techniques that do not involve retrograde ejaculation (see Taoist sexual practices).

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. Such pressure can cause numbness in the penis.

Notes

External links

• http://www2.rz.hu-berlin.de/sexology/ECE1/retrograde.html
• Sexual Medicine Society of North America's website: SexHealthMatters.org

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