Understanding and Managing a Hidden Cause of Male Infertility

Ejaculation is typically a forward-moving event—but in some cases, semen can flow backward into the bladder, leading to little or no visible ejaculation. This condition is called retrograde ejaculation (역행 사정 – yeokhaeng sajeong), and while it’s often harmless to general health, it can significantly impact male fertility and sexual satisfaction. At specialized clinics like Gangnam J Urology Clinic, retrograde ejaculation is thoroughly evaluated and treated with a combination of diagnostic testing, medical therapy, and fertility support.

What Is Retrograde Ejaculation?

Retrograde ejaculation occurs when the muscles at the bladder neck fail to contract during orgasm. Instead of semen exiting through the urethra, it is redirected into the bladder. As a result:

• Little to no semen is ejaculated externally during climax
• Urine may appear cloudy after intercourse due to semen mixing in the bladder
• Fertility may be impaired, despite normal sexual function and arousal

The condition is often overlooked, as orgasm and erection may remain intact.

Common Causes of Retrograde Ejaculation

Retrograde ejaculation can occur due to:

• Surgery involving the prostate, bladder, or urethra (e.g., TURP, prostatectomy)
• Diabetes affecting the autonomic nerves controlling ejaculation
• Certain medications, especially those for high blood pressure or prostate issues (e.g., alpha-blockers)
• Spinal cord injury or neurologic conditions like multiple sclerosis
• Congenital abnormalities or idiopathic causes (no identifiable reason)

A thorough evaluation is essential to pinpoint the cause and guide treatment.

Symptoms to Watch For

You may suspect retrograde ejaculation if you experience:

• Dry orgasm or noticeably reduced semen volume
• Cloudy urine after climax
• Difficulty conceiving despite normal libido and erectile function
• History of prostate or bladder surgery

In many cases, patients don’t realize the issue until a fertility workup uncovers it.

How Is Retrograde Ejaculation Diagnosed in Korea?

At clinics like Gangnam J Urology Clinic, diagnosis is discreet and efficient:

1. Medical Interview
   Your urologist will ask about your sexual function, medical history, medications, and past surgeries.
2. Post-Ejaculatory Urine Test
   You will be asked to urinate immediately after orgasm. The urine is then examined for the presence of sperm—a key indicator of retrograde ejaculation.
3. Semen Analysis (if needed)
   A standard semen analysis may show very low or absent sperm count, prompting further testing.
4. Additional Tests
   If nerve damage or anatomical abnormalities are suspected, the doctor may order hormonal tests, ultrasound, or urodynamic studies.

Treatment Options for Retrograde Ejaculation

Treatment depends on the underlying cause and your reproductive goals:

• Medication Adjustments: If medications like alpha-blockers are responsible, switching drugs may resolve the issue.
• Sympathomimetic Medications: Drugs like pseudoephedrine or imipramine can strengthen bladder neck closure and redirect ejaculation outward. These are often the first-line option.
• Fertility Techniques:
• If medications don’t work and pregnancy is desired, sperm can be retrieved from post-ejaculate urine and used in IUI or IVF.
• Electroejaculation may be considered in certain neurological cases.
• Lifestyle and Medical Management: For patients with diabetes or neurologic conditions, optimizing underlying disease control is crucial.

Why Choose Gangnam J Urology Clinic?

• Expert Urologists familiar with male sexual dysfunction and fertility
• Accurate Diagnostic Tools, including post-ejaculation urine analysis
• Fertility Collaboration with reproductive clinics for sperm retrieval and assisted reproduction
• Discreet, Supportive Care for an often-sensitive condition
• English-Speaking Staff, ideal for expats and international patients
• Holistic Treatment Planning combining medications, testing, and counseling as needed

Cost of Retrograde Ejaculation Evaluation in Korea

With NHIS (if medically necessary):

• Doctor consultation: ₩5,000 – ₩20,000
• Urine and sperm testing: ₩10,000 – ₩30,000
• Medication: ₩5,000 – ₩10,000
• Total with NHIS: Approx. ₩20,000 – ₩60,000

Without NHIS (out-of-pocket):

• Consultation: ₩50,000 – ₩100,000
• Testing and lab work: ₩50,000 – ₩100,000
• Medication or fertility-related care: ₩30,000 – ₩100,000+
• Total without NHIS: Approx. ₩130,000 – ₩300,000+

What Happens Next?

Depending on your diagnosis and goals:

• You may start medication therapy and monitor changes in ejaculate
• If fertility is the goal, collaboration with a fertility specialist may be arranged
• Follow-up urine tests or semen analyses may be scheduled
• If needed, psychosexual counseling or additional testing (e.g., hormone levels) can be added



Retrograde ejaculation may be invisible—but its impact on fertility and quality of life is very real. Fortunately, with proper testing and guided treatment, most men can regain control of their sexual health and pursue fatherhood if desired. With expert care, discretion, and full diagnostic capabilities, Gangnam J Urology Clinic offers a safe and supportive place to address this often-overlooked issue.