Retrograde ejaculation - causes, symptoms, treatment

Retrograde ejaculation is a relatively rare disorder of ejaculation dynamics, in which sperm emission does not occur in the external environment, but in the opposite direction.

Mechanism and causes of pathology

In the physiological state, the erection of the penis is provided by the flow of blood to the cavernous bodies. This is accompanied by simultaneous swelling of the seminal tubercle located in the region of the posterior wall of the prostatic section of the urethra and reflex contraction of the internal sphincter of the bladder. All this creates conditions for the eruption of sperm along the urethra in one direction and prevents it from entering the bladder. In pathological conditions, the listed obstacles are absent, as a result of which the sperm current proceeds along the path of least resistance to the bladder.

Fig.1 - Mechanism of retrograde ejaculation.

The main causes of retrograde ejaculation are:

• decompensation of carbohydrate and other metabolic species for a long time in patients with type 1 diabetes mellitus complicated by polyneuropathy;
• multiple sclerosis, transmitted diseases of the spinal cord or brain( encephalitis, meningitis, meningoencephalitis, tumors), traumas of the lumbar or lower thoracic spine;In all the cases listed above, there may be a disturbance in the nervous regulation of the function of the sphincter of the bladder;
• endocrine dysfunction of the elderly;
• fractures of pelvic bones with damage to the internal organs, malignant neoplasms of the pelvic organs;
• surgical interventions in the area of ​​the bladder, urethra, prostate;
• benign prostatic hyperplasia, prostatitis and the use of alpha-adrenoblockers( cardura, omniks);
• widening of the veins of the spermatic cord and malformations of the genitourinary system, especially the embolism of the seminiferous tubules or the vas deferens into the bladder or ureters;
• progressive violation of microcirculation in the small pelvis as a result of prolonged blood stagnation;This occurs when the valves of the veins of the lower extremities are deficient, bowel, pulmonary, cardiac or liver failure, low physical activity, phlebitis of the hemorrhoidal veins;
• uncontrolled and prolonged use of antidepressants and some antihypertensive drugs that cause a decrease in the tone of the neck of the bladder;
• alcoholic, nicotine or narcotic intoxication.

Clinic and diagnosis

Retrograde ejaculation, depending on the amount of sperm released, is divided into incomplete and complete. For normal taken the amount of semen in a volume of 2-6 ml. The reason for going to the doctor is oligospermia( low semen content - 1-1.5 ml) or anejaculation( absence of sperm during ejaculation).Such violations are regarded by men as a "dry" sexual act, which in most cases occurs with a full, sometimes slightly reduced orgasm. Other symptoms in this disorder are turbid urine after sexual intercourse and infertility.

Already the presence of the listed characteristics is sufficient for the presumptive diagnosis. However, in a number of cases, the andrologist or urologist mistakenly interprets anejaculation as a sign of obstruction( obstruction) associated with the inflammatory processes of the genital organs, cicatricial changes after surgery, tumors, etc. This requires unnecessary additional invasive examination methods.

However, differential diagnosis is easy( with no abnormalities in the kidneys) performed by determining the level of protein in the urine through test strips or a laboratory test. When the semen is injected into the urinary bladder, the protein content in the urine after the sexual act due to the sperm will be high. In doubtful cases, a microscopic examination of the urine sediment is carried out, in which a large number of spermatozoa is determined.

Is retrograde ejaculation dangerous?

In the absence of treatment of retrograde ejaculation, a man does not have the possibility of conception of a child, as the sperm enters the bladder and undergoes destruction. Lack of timely treatment can lead to various disorders in the psychoemotional sphere, however, somatic complications from the organs with retrograde ejaculation are not observed.

Constant absence of seminal fluid during sexual intercourse can lead to a decrease in orgasm and a feeling of dissatisfaction, which causes many men to feel inferior. If you ignore such anxiety symptoms, a pathological dominant in the male brain develops, which leads to an unconscious refusal to maintain an active sexual life and reduce the potency.

The absence of correction of this condition can lead to congestive chronic prostatitis. Stagnant prostatitis is not a direct complication of retrograde ejaculation and occurs only under the influence of a complex of factors, including retrograde ejaculation.

For men's health, retrograde ejaculation is not harmful, but it disrupts the basic function of the male reproductive system - the conception of a child, which leads to its inferiority.

Treatment and prognosis of

Treatment methods depend on the causes of retrograde ejaculation. Sometimes after the beginning of exercise with physical exercises involving the muscles of the legs and pelvic floor( see pubic-coccygeal muscle), active lifestyles, stopping the use of psychotropic drugs and antidepressants, changing the antihypertensive drugs, the symptoms of the disorder are eliminated without the use of medicines.

Compensated diabetes, but complicated unexpressed polyneuropathy, effect can be achieved as a result of receiving thioctic( alpha-lipoic acid) or pharmaceutical preparations on its basis - "Thiogamma", "Berlition 600", "Oktolipen", "Thioctacid 600 T".Thioctic acid has an antioxidant effect, promotes the utilization of glucose in the form of glycogen, improves energy metabolism in the nervous tissue and disturbed in the nerve fibers blood flow.

Violation of sympathetic or parasympathetic innervation of the bladder and its sphincter( in the absence of hypertensive disease) can sometimes be compensated for by the use of sympathomimetics for several weeks. These include ephedrine, pseudoephedrine, midodrin, imipramine, etc.

For long-term disorders and the absence of the effect of treatment, it is recommended to have sexual intercourse with a filled bladder. In some cases, prior to sexual intercourse, it is advisable to use drugs that reduce the effect of the parasympathetic nervous system on the tone of the bladder or enhance the effects of the sympathetic system. These include antihistamine, alpha-adrenomimetic and anticholinergic drugs.

The prognosis of retrograde ejaculation due to acquired anatomical disorders or congenital pathology of the genito-urinary organs, as well as long-term chronic physical illness, is dubious or unfavorable in most cases.

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