Retrograde Ejaculation

Normally a small muscular valve at the neck of the bladder snaps shut during orgasm, which forces semen out along the only open path. In retrograde ejaculation that valve stays open, and the semen takes the path of least resistance, backward into the bladder.

Nothing is blocked, torn, or failing in the erectile sense. It is a plumbing redirect, not a breakdown, and physically it is usually harmless.

The most common cause is prostate surgery. Procedures that work on or near the bladder neck, including radical prostatectomy and some surgeries for an enlarged prostate, alter the mechanism permanently. After a radical prostatectomy, dry orgasm is expected, and every man going into that operation should hear it said plainly beforehand. Many report that nobody told them.

Medication is the second common cause. Alpha blockers prescribed for urinary symptoms, some blood pressure medications, and certain psychiatric medications can relax the bladder neck enough to produce the same effect. Diabetes and some neurological conditions can also be involved. Sorting which cause applies is a physician's job, and any medication change belongs with the prescriber. Never stop a prescribed medication over this on your own.

This is the one concrete consequence. If little or no semen exits the body, conception the ordinary way becomes difficult or impossible. For a man who wants children, that is significant, and there are established medical paths, including retrieving sperm for assisted reproduction. That conversation belongs with a urologist or a fertility specialist.

For a man whose family is complete, the fertility question is settled and what remains is almost entirely psychological.

Ejaculation is the visible proof of orgasm, for the man and often for his partner. When the proof disappears, men describe feeling that sex has become hollow, or that they are performing a function rather than having an experience, even when the physical sensation is intact. Partners sometimes read it as their own failure. None of that is in any medical pamphlet, and all of it is real.

After prostate cancer treatment it lands on top of everything else the surgery changed, which is its own conversation and has its own page: sex after prostate cancer.

The adjustment is workable. It involves accurate information, an honest conversation with a partner, and often a deliberate redefinition of what orgasm is for. Paul works with men on exactly this. He is an AASECT Certified Sexuality Educator, a Licensed Mental Health Counselor (NY), and a Licensed Professional Counselor (CT), and sessions are available to men in New York and Connecticut.

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