Retrograde Ejaculation: Is It Harmful, and Can It Be Reversed?

Not in any way the sources reviewed here describe. Semen that goes backwards into the bladder is passed later in urine, and the consequences recorded in the literature are a reduced or absent ejaculate, reduced satisfaction, and reduced fertility — nothing beyond that. None of those sources set out to test for physical harm, so this is what they describe rather than a study finding, and the page is explicit about that further down.

What is happening mechanically is that the bladder neck does not close hard enough against the pressure generated at ejaculation, so the semen takes the path of least resistance and goes into the bladder. Sperm production is usually untouched. It is the delivery step that fails, which is why this matters for conception and for very little else.

For the wider question of which ejaculation problems stop conception and which do not, and for the pregnancy figures once sperm has been recovered, see which ejaculation problems affect fertility. This page covers the condition itself.

More than a trace. The named test is a post-ejaculatory urinalysis — a urine sample given straight after orgasm, spun down and examined — and it is the right test. But it is widely reported as though any sperm in the urine settles the matter, and it does not.

The review by Gray and colleagues gives the diagnostic finding as 10 to 15 sperm per high-powered field. In the same passage it calls the test controversial, for a specific reason: some sperm turns up in post-ejaculation urine in 65% of fertile men, versus 73-90% of infertile men. A trace is close to normal. If you have been told you have retrograde ejaculation because sperm were seen in your urine, it is reasonable to ask how many.

Two other things prompt the test rather than settle it: a dry or nearly dry orgasm, and a low ejaculate volume on a semen analysis. Cloudy urine after orgasm is often described as a sign, and it is not a diagnosis — it is a reason to ask for the sample to be looked at.

Start with the collection. The commonest cause of a low-volume ejaculate is an incomplete collection or an abstinence period outside the recommended window — not retrograde ejaculation, and not anything structural. The same review puts the pathological causes, retrograde ejaculation among them, after that, and asks for two properly collected semen analyses before drawing a conclusion, with a third if the first two differ materially.

This is worth knowing before a single low number turns into a diagnosis. The first portion of the ejaculate carries most of the sperm, so losing it makes a normal sample read as a severely abnormal one.

The WHO 2021 lower reference limit for volume is 1.4 mL, revised from 1.5 mL in the 2010 edition, and it is a fifth centile of 3,589 men whose partners conceived within a year rather than a pass mark. Which edition your laboratory used changes where the line sits. There is more on that in how to read a semen analysis report, on the collection itself in how to prepare for a semen analysis, and on the volume finding in what low semen volume actually means.

Drugs that relax the bladder neck are the commonest reversible cause, and the size of the effect differs sharply between molecules in the same class. A meta-analysis pooling 23 randomised trials measured ejaculatory dysfunction against placebo:

• Alpha-blockers as a class — odds ratio 5.88 against placebo, across the 23 randomised trials pooled
• Silodosin — odds ratio 32.5, the highest of any drug in the analysis
• Tamsulosin — odds ratio 8.58, and significantly lower risk than silodosin
• Doxazosin and terazosin — no different from placebo
• 5-alpha-reductase inhibitors — odds ratio 2.73 as a class; finasteride 2.70 and dutasteride 2.81
• An alpha-blocker plus a 5-alpha-reductase inhibitor together — odds ratio 3.75 against an alpha-blocker alone

Read that as a reason to name your medicines at the appointment, not as a reason to stop one. The outcome those trials measured was ejaculatory dysfunction broadly rather than retrograde ejaculation specifically, so the odds ratios describe a wider category than this page. And whether an alternative exists, and whether switching is safe, is a decision for whoever prescribed it.

Beyond drugs, the same review groups the causes as mechanical — most often disruption of the bladder neck during prostate surgery — and neurological, including spinal cord injury, retroperitoneal lymph node dissection, abdominopelvic surgery, and the autonomic neuropathy of long-standing diabetes.

Sometimes, and it depends on the cause. Where a medicine is responsible, discontinuing it is the first step if that is possible. Where the bladder neck has been cut or resected, restoring it generally is not, and the route to a pregnancy is sperm recovery rather than reversal.

Where the cause is neurological, drugs are tried first, on evidence that is thinner than the confidence with which it is usually written up. In the largest of the retrieved studies, 33 diabetic men were given three sequential courses with no control arm:

• Imipramine 25 mg twice daily — antegrade ejaculate produced in 38.5% of the men with complete retrograde ejaculation (n = 33 participants overall, no control arm)
• Pseudoephedrine 120 mg twice daily — 47.8% of the same group, in the same uncontrolled study of 33 participants
• Both together — 61.5%, in that same study of 33 participants

A separate prospective trial dosed 20 men who had partial or complete retrograde ejaculation with pseudoephedrine before and on the day of a semen analysis, and reported improved semen parameters in 70% of those 20 participants — improvement in the numbers, which is not the same outcome as a pregnancy. Collagen injection at the bladder neck has also been described; a series in men with type 1 diabetes recorded a mean increase in ejaculate volume of 0.7 mL alongside improved anxiety and depression scores.

The systematic review of this whole area covered 34 studies, most of them observational, and concluded that the literature is insufficient to allow firm comparisons between the treatments, so treatment should be tailored to the individual. That is the honest summary. Drugs help some men, nobody can tell you in advance whether you are one of them, and the published comparisons are not strong enough to rank them.

The appointment is with a urologist or an andrologist, and the order of events is fairly settled even where the treatment evidence is not:

1. Two properly collected semen analyses, with the abstinence period recorded on each. If the first two differ materially, a third.
2. A post-ejaculatory urinalysis if the volume is low or the orgasm is dry — and a question about how many sperm were seen, not just whether any were.
3. A review of every medicine you take, including ones prescribed for the prostate, blood pressure, mood and diabetes.
4. A trial of a sympathomimetic, with or without imipramine, where the cause is neurological rather than anatomical.
5. If forward ejaculation cannot be restored, sperm recovery from the bladder, then insemination or ICSI.

Allow time between the tests rather than repeating one immediately. A cycle of sperm production was measured directly at a mean of 64 days in 11 men, on the shorter side of the traditional 60 to 70 day estimate, so a repeat arranged around three months out reflects a genuinely new population of sperm rather than the same one measured twice. If diabetes is the background here, the same autonomic neuropathy accounts for erectile difficulty too, and male fertility and diabetes covers that together.

One thing worth saying plainly: a dry orgasm is the kind of symptom men sit on for years rather than mention, and it is one of the more workable findings in male fertility when it is finally named. The sperm is usually still there.

Four gaps matter enough to name, because each of them is written about more confidently elsewhere than the data supports.

• That semen collecting in the bladder is harmless. No source retrieved here describes a physical harm from it, and none of them looked for one. That is an absence of a described harm, not a study showing none.
• That stopping the drug fixes it. Discontinuation is the recommended first step where a medicine is responsible, but no recovery rate after withdrawal was reported in anything retrieved here. The randomised trials measured how often ejaculatory dysfunction appeared on treatment, not how often it resolved off it.
• That any one restorative drug is better than another. The systematic review of 34 mostly observational studies states the literature is insufficient for firm comparisons, and the largest drug study retrieved had no control arm.
• That 10 to 15 sperm per high-powered field is an agreed cut-off. That figure rests on a single citation within one review, and the same review calls the test controversial. No consensus threshold was found.

An Indian prevalence figure for retrograde ejaculation was searched for and not found. The estimates in circulation come from small single-centre series in Europe and North America, and they should not be read as describing men in India.