Retrograde Ejaculation: Causes, Symptoms, and What to Do

If you’re doing the deed or enjoying solo play, but nothing comes out when you finish, you may be experiencing retrograde ejaculation (RE). To learn more about the causes and symptoms of retrograde ejaculation as well as what to do if sperm is not coming out how you’d like it to, we talked to the experts.

Here's what we found out.

What is retrograde ejaculation (RE)?

Before we explain what retrograde ejaculation is, we need to understand what “normal” ejaculation looks like.

According to James Hook, D.C., a medical professional at Neurogan Health, during normal ejaculation, “sperm passes from the testicles via the vas deferens, mixes with seminal fluid from the prostate and seminal vesicle, then empties out the urethral.” 

But, with RE, the sperm does not exit out of the urethra as it should.

“Conversely, sperm experiences retrograde ejaculation — that is, they return to the bladder via the urethral path instead of the other way around,” Dr. Hook says. 

In simpler terms, when you have RE, your semen travels to your bladder rather than being pushed out of through your penis.

Causes and Symptoms

Common symptoms of retrograde ejaculation include:

• Reduced ejaculation
• Dry orgasm (an orgasm that produces little or no semen)
• Cloudy urine (semen in the bladder)
• Infertility 

There are a few reasons why you might experience internal ejaculation. More than 80% of retrograde ejaculation cases are caused by:

• Diabetes 
• Dysautonomia 
• Certain medications, such as psychotropic medications and alpha-adrenergic blockers
• Bladder neck surgery 
• Transurethral resection of the prostate (for prostate cancer)

Is retrograde ejaculation harmful?

Thankfully, retrograde ejaculation doesn’t cause any pain or physical damage, nor does it affect sexual pleasure or performance. 

However, RE may lead to fertility issues for men and people assigned male at birth (AMAB).

“Retrograde ejaculation may induce infertility by means of the sperm not exiting the body in the usual manner,” Dr. Hook says.

According to research published in the World Journal of Men's Health, when sperm travels back into the bladder, it can lead to a lower sperm count, which can reduce the chances of conceiving. 

If you’re starting or expanding your family and you have RE, there are several techniques that can help encourage fertility, including:

• Centrifugation and re-suspension of post-ejaculatory urine specimens
• The Hotchkiss technique
• Ejaculation with a full bladder

A fertility specialist can provide further guidance on which treatments can help you conceive with RE.

Other potential concerns

Though RE isn't harmful, it can lead to issues that negatively impact your physical, mental, and emotional wellbeing. Here are some potential concerns related to internal ejaculation:

Psychological impact

It can be very frustrating and even embarrassing not to have the ability to ejaculate “normally.” Sexual dysfunction like retrograde ejaculation can cause mental health problems like anxiety, depression, and low self-esteem. It may also cause issues in your relationships, especially if you're trying to conceive.

If RE is affecting your mental health and relationships, please seek support by talking to your healthcare provider or seeking couples counseling with your partner. 

Dry orgasm

A dry orgasm is like any other orgasm but with the absence of semen. It primarily affects men and people AMAB, but it can happen to women and people assigned female at birth, too. RE is one of the leading causes of dry orgasm.

Dry orgasm is not a significant cause for concern and is not a danger to your health. But, if you want to conceive, you may want to get this checked out with your healthcare provider.   

When to See a Doctor

In most cases, treatment is not necessary for abnormal ejaculation.

However, you probably should seek medical help from a licensed healthcare provider if you:

• Want to have children but are having fertility issues.
• Are uncomfortable with the sensations you feel when you orgasm.
• Are receiving treatments for RE, but they aren’t working.

Treatment varies depending on the underlying causes as to why you’re not releasing semen during sex. Your healthcare provider can give personalized medical advice on what treatments are best for you. 

The Bottom Line

If you deal with retrograde ejaculation, know that it’s not the end of the world. RE is not a harmful sexual dysfunction to live with. If you have this condition, talking with your partner(s) about what’s going on is crucial. This is especially important if you want to conceive with them. Any partner who truly cares for you will understand your situation and be willing to make adjustments to ensure you both are satisfied in the bedroom.

If you want to have children or just want to know the underlying causes of your RE, please reach out to your healthcare provider. They can guide you through diagnosis and treatment for RE (if needed) and refer you to a fertility specialist if you want to conceive. 

Know that you can continue to have a satisfying sex life regardless of whether or not you cum “normally.”