DEAR DOCTOR K:
For the past few months, I haven’t been ejaculating, even when I have an orgasm. Why not? What’s wrong?
It sounds like retrograde ejaculation. To explain that, we need to talk about anatomy. There is one tube, the urethra, which leads from the bladder and through the center of the penis. The urethra carries urine out of the body.
Two tubes, one on each side of the urethra, lead from the seminal vesicles and open into the urethra. The seminal vesicles are tiny glands that make semen. (The prostate gland helps make semen, too). Semen is a thick fluid that helps nourish sperm. Semen really has no other purpose: It is produced onlyto help sperm.
And sperm, of course, deserves to be pampered: Without healthy sperm, the human species cannot last. Sperm is made in the testicles and passes up to the opening of the seminal vesicles in still another pair of tubes. There, sperm mixes with the semen.
Here’s what is supposed to happen when a man ejaculates: The mixture of semen and sperm is thrust forward through a man’s urethra and out the tip of his penis. However, the urethra is an open tube. While one part of the tube leads forward and out of the body, the other part of the tube leads backward into the bladder.
To make sure that the semen and sperm move forward, and not backward, a tiny circular muscle at the bladder entrance shuts the opening to the bladder during ejaculation. This prevents semen from entering, and creates more pressure pushing semen and sperm out through the penis.
In retrograde ejaculation, the tiny circular muscle does not function normally. As a result, all or part of the semen travels backward into the bladder. And less — or no — semen comes out of the penis. Here are illustrations showing normal and retrograde ejaculation:
Retrograde ejaculation does not interfere with a man’s ability to have an erection or to achieve orgasm. But it can cause infertility because sperm cannot reach the woman’s uterus.
Retrograde ejaculation has several possible causes. Damage that occurs during prostate, lower back, pelvic or bladder surgery may cause the condition. So might nerve damage that can result from multiple sclerosis or diabetes. The condition is also a possible side effect of certain medications taken for prostate enlargement, depression and psychosis.
Only if the condition interferes with fertility does it require treatment. Treatment varies depending on the cause. If it is a side effect of medication, your doctor will switch you to a drug that does not affect ejaculation.
Sometimes it is not possible to restore normal ejaculation. That may be the case when the condition results from severe damage to bladder nerves or muscles. If this is the case, and you want to father a child, a fertility specialist may be able to help.