What is Delayed Ejaculation?
7 October 2025What is Retrograde Ejaculation?
Retrograde ejaculation is a condition in which semen does not exit the penis during sexual intercourse or masturbation, despite the sensation of orgasm. Normally, semen is expelled through the urethra during ejaculation. However, in this condition, semen flows back into the bladder and is expelled with urine after orgasm. Therefore, cloudiness in the urine may be noticeable. This condition is also known as "dry ejaculation" among the general public. It usually does not cause any pain, but it is an important finding during infertility investigations, especially in couples who are unable to conceive.
Causes
There are many different causes of retrograde ejaculation. Psychological factors include intense stress, anxiety, depression, and sexual pressures. Neurological and hormonal causes are also quite important; diabetes, multiple sclerosis (MS), and spinal cord injuries, in particular, can disrupt nerve transmission and prevent semen from being expelled. Hormonal imbalances can also affect the ejaculation mechanism.
Surgical procedures are one of the most common causes of retrograde ejaculation. This condition may occur after TURP operations for benign prostatic hyperplasia, bladder neck surgery, or procedures performed due to bladder cancer. Furthermore, certain surgeries for testicular or penile cancer may also disrupt the ejaculation mechanism.
Medications used are also noteworthy in terms of retrograde ejaculation. SSRIs (selective serotonin reuptake inhibitors), selective alpha-blocker medications used in prostate treatment (e.g., tamsulosin, silodosin), and some blood pressure medications can cause this condition. More rarely, congenital Wolffian duct abnormalities, Müllerian duct remnants, or structural anomalies such as Prune Belly syndrome may cause retrograde ejaculation.
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Symptoms
The most common symptom is the sensation of orgasm without semen being expelled from the penis. This is often described by patients as "I feel like I'm ejaculating, but nothing is coming out." Cloudy urine after orgasm indicates that semen has entered the bladder. It usually does not cause pain. However, in the long term, it can lead to infertility problems in couples who wish to have children.
Diagnostic Methods
The most important step in diagnosis is the patient's medical history. The doctor asks about how the problem started, under what conditions it occurs, and what medications are used, starting from the first ejaculation experience. Whether it occurs during sexual intercourse or masturbation is an important clue.
In laboratory tests, the presence of sperm in a urine sample taken after orgasm confirms the diagnosis. In addition, the testicles and prostate are examined. The evaluation of thyroid, testosterone, and prolactin levels also indicates whether there is a hormonal problem. Imaging methods such as ultrasound can be used to investigate duct blockages and structural problems.
Treatment Methods
Treatment is planned according to the underlying cause. If the problem stems from medication use, the medication may need to be discontinued or changed. Alpha agonist drugs, which strengthen the bladder neck, can help prevent semen from entering the bladder. Controlling blood sugar is very important in metabolic diseases such as diabetes.
Surgical methods may be used, particularly for retrograde ejaculation caused by bladder neck laxity or canal obstruction. Assisted reproductive techniques are available for couples who wish to have children. Sperm can be retrieved from the bladder after ejaculation and used in in vitro fertilisation (IVF/ICSI) procedures. Sperm can also be collected using methods such as penile vibrator stimulation or electroejaculation.
What is anejaculation?
Anejaculation is the absence of ejaculation. In some men, although they experience orgasm, no semen is released; this is called orgasmic anejaculation. In some cases, there is neither orgasm nor ejaculation; this is called anorgasmic anejaculation. This condition can negatively affect both sexual life and the chances of having children in men.
Causes
The most common cause of anejaculation is retrograde ejaculation. However, there are many other possible causes. Psychological causes include stress, intense anxiety, religious or cultural pressures, and concerns about sexual performance. Long-term and habitual masturbation techniques can also affect the ejaculation reflex.
Neurological and hormonal causes are also quite important. Diabetes, multiple sclerosis, and spinal cord injuries can affect the nervous system and prevent ejaculation. Hormonal disorders, particularly low testosterone, thyroid diseases, or high prolactin levels, can also disrupt the ejaculation process.
Surgical procedures are also a significant risk factor. Anejaculation may occur after prostate surgery, bladder neck operations, or testicular and penile surgery. Medications such as SSRI antidepressants, certain blood pressure medications, and alpha-blockers used in prostate treatments may cause ejaculation problems. Rarely, congenital duct abnormalities may also lead to anejaculation.
Symptoms
The most obvious sign is the complete absence of ejaculation during sexual intercourse. Some men report feeling orgasm but no semen being released, while others report no sensation of orgasm at all. This condition becomes a serious problem, particularly for couples who wish to have children, as pregnancy cannot be achieved.
Diagnostic Methods
A detailed patient history is crucial in diagnosing anejaculation. Questions are asked about the first ejaculation experience, masturbation habits, and whether the problem occurs with a partner or alone. During the physical examination, the testicles and prostate are assessed. Hormone tests measure testosterone, thyroid, and prolactin levels. Imaging methods such as ultrasound may also be used to detect blockages or structural issues in the ducts.
Treatment Methods
Treatment begins with determining the cause. In cases where psychological factors are prominent, psychotherapy, masturbation education, and couples therapy may be applied. Medication can be used to treat hormonal imbalances and restore hormonal balance.
From a urological perspective, duct blockages can be opened using surgical methods. Penile vibrator stimulation or electroejaculation methods can be used to stimulate the ejaculation reflex. In men who wish to have children, sperm taken from the testicles or bladder can be used in IVF procedures.