Dear Dr G,I am in my early fifties and want to discuss an unusual change in my sex life over the last three months. As I reach middle age, I struggle with urinary symptoms like waking up at night and dribbling after urination.The slow flow and dribbling are manageable, but the night-time waking affects my productivity. I also face a weakening erection, which I assume is due to lack of sleep and stress.I consulted a specialist who said my symptoms are related to my aging prostate. He started me on medication and assured me that the situation with my prostate is benign.Since starting the medication three months ago, my erection, urinary flow, and night-time urination have improved. However, while I still get my libido and an erection, my semen volume has decreased.I initially thought it was my imagination, but during masturbation last week, I saw no ejaculate. I was puzzled as I was accused of faking an orgasm.I read online about retrograde ejaculation. Can you explain what happened to my semen? Do men “dry up” due to an enlarged prostate?Could this be a medication side effect? Is lack of ejaculation harmful? I’m frustrated with this two steps forward, one step back situation with my prostate. How can I restore the “happy ending”?Regards,Retrograde Reynold The lack of ejaculation occurs when semen, instead of being ejaculated outward, is redirected into the bladder. This backward flow of sperm is called retrograde ejaculation, often referred to as a dry orgasm. Sperm delivery and semen emission are complex processes ensuring sperm reach the female reproductive tract. During arousal, sperm is released from the epididymis, travels via the vas deferens, and mixes with prostatic fluid, awaiting ejaculation. During climax, muscle contractions at the bladder neck and the prostate propel semen through the urethra, the path of least resistance. Retrograde ejaculation’s causes are easily identifiable. Weak bladder neck muscles causing backward semen flow are linked to neurological issues, surgery, or medications. Nerve damage from conditions like diabetes, multiple sclerosis, and Parkinson’s disease are generally irreversible. Surgical interventions for prostate issues are also irreversible causes of retrograde ejaculation. The only reversible cause is medications like antidepressants, antihypertensives, and prostate enlargement drugs such as Alpha Blockers. Anticholinergics for overactive bladder also cause this. These drugs relax muscles to ease blood and urine flow, but can cause retrograde ejaculation in up to half of men taking them. Stopping the medication usually restores sexual function without long-term effects. Retrograde ejaculation is generally harmless, as it doesn’t affect libido, erection, or orgasm intensity. Semen entering the bladder may cause slightly cloudy urine post-orgasm. The main health concern is potential infertility. Retrograde ejaculation indicates a challenge to the sexual organs’ neurophysiology. Identifying the cause usually helps change the outcome. When men face medication challenges affecting ejaculation, Dr G’s response is that “a happy ending is possible by temporarily stopping the medicine, accepting one step forward, and two steps back!”
