High But Dry: What To Do When Retrograde Ejaculation Leaves You Wanting More

Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.

In this segment, Dr. Mistry and Donna Lee answer a listener's question about what may be causing his "dry orgasms." This condition is referred to as "retrograde ejaculation" and occurs when semen is redirected into the bladder instead of out the tip of the penis as with a typical orgasm. While there can be a few causes of retrograde ejaculation, far and away the most common cause is medication. Tamsulosin and Silodosin, which are prescribed for enlarged prostate, are frequent offenders, but sometimes antidepressants can be at fault, too. If the cause is not a medication, it is possible a neurologic issue could be the culprit. Sometimes abnormal musculature leads the neck of the bladder to fail to close during an orgasm as it should and the semen is redirected there. Diabetes can be also play a role in developing abnormal bladder musculature, as can back surgeries or other catastrophic neurologic issues. Crucially, however, the listener should be aware that ejaculation itself contributes very little to the experience of orgasm and therefore isn't necessarily a problem. There are supplements and medications prescribed off-label that we use at NAU Urology Specialists to help enhance orgasmic sensation, however, so if you or your loved one are not getting as much bang for your buck as it were than you used to, please give us a call today. No matter the issue, we can help get your love life back on track! 

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Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Phone: (512) 238-0762

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Transcript

Speaker 1 0:07

Welcome to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry 0:14

Welcome to the Armor Men's Health Hour. I'm Dr. Mistry, your host, here as always with my ebullient and multitalented cohost Donna Lee.

Donna Lee 0:22

Oh, I love it when you use a big word. Ebullient! That's like the other big words.

Dr. Mistry 0:26

I can't make backhanded compliments to you anymore because I'm afraid that we'll have a riot amongst the listenership.

Donna Lee 0:32

That's right. They do side with me. Thank you. Thank you all.

Dr. Mistry 0:35

I'm a board certified urologist. My name really is Dr. Mistry.

Donna Lee 0:39

M-I-S-T-R-Y.

Dr. Mistry 0:41

And it is not some gimmicky name as we were accused early in our show.

Donna Lee 0:44

I think you're still holding on to his little anger.

Dr. Mistry 0:46

Perhaps, but now we're known worldwide.

Donna Lee 0:49

We are worldwide.

Dr. Mistry 0:50

People are going to mispronounce the other mystery.

Donna Lee 0:52

That's right. Mys-tery. Dr. Mystery.

Dr. Mistry 0:59

Miss-try. This show is brought to you by NAU Urology Specialists. It's the urology specialty practice started in 2007. We have four physicians, four, excuse me, five mid-level providers. We offer pelvic floor physical therapy, sex therapy. We believe strongly in sleep apnea as a mechanism for diseases within the urologic community. So we offer in-office sleep testing. What else do we do?

Donna Lee 1:23

We do a lot. I wasn't listening. I'm sorry.

Dr. Mistry 1:27

Donna, I think I'm going to fire you.

Donna Lee 1:28

I'm sorry. I was reading what you wrote.

Dr. Mistry 1:30

You're just preparing for the show.

Donna Lee 1:32

I'm a good producer like that.

Dr. Mistry 1:34

When comes to urologic issues, we've got you covered. But really when it comes to wellness and your health, we're a men's health show, but we are a men and women's health wellness clinic. In fact, a lot of the wellness type offerings that we have, including hormone therapy, functional medicine training, diet, nutrition--these things are what women complain of all the time. Chronic bloating, irregular bowel movements...

Donna Lee 1:56

Low libido.

Dr. Mistry 1:57

Low libido, vaginal...

Donna Lee 1:59

Hair falling out.

Dr. Mistry 1:59

Hair falling out, you know.

Donna Lee 2:01

Oh, wait, I'm talking about myself.

Dr. Mistry 2:02

That's right. This is just you now. Don't mention your terrible reflux.

Donna Lee 2:06

Oh yeah. And vomiting for no reason during the day. Is that a problem?

Dr. Mistry 2:09

One time we had that, that Dr. Buckley on, and he's an awesome reflux surgeon. I just sent a patient to him today that's going to take care of, for somebody with chronic reflux. And when Donna was mentioning her symptoms to him, he goes,"You really need to come in right now. You can't be living like this."

Donna Lee 2:24

He even reached out to me afterwards. He was like,"I really think you should be seen."

Dr. Mistry 2:27

"I'm really worried about you."

Donna Lee 2:28

I'm like,"It's not normal to just go vomit really quick and then come back to work at my desk and feel fine?" That's a stress thing, right there.

Dr. Mistry 2:35

That's right. So we are seeing patients in a safe manner. We are a fully vaccinated clinic amongst all the providers and all the clinical staff. And so you'll be in a safe environment. We're ready to resume your urologic care. And Donna, we are the in, in the Austin, what, what size are we?

Donna Lee 2:52

We are number two!

Dr. Mistry 2:53

We are number two.

Donna Lee 2:54

We are number two. I'm going to get a t-shirt.

Dr. Mistry 2:56

And number two just works a little harder.

Donna Lee 2:58

We can also take care of your two, sometimes.

Dr. Mistry 3:00

Sometimes if you have some fecal incontinence, it's something else we take care of

Donna Lee 3:03

Yeah. Remember the fecal incontinence guy who was an Uber Eats driver?

Dr. Mistry 3:06

No.

Donna Lee 3:07

Yeah.

Dr. Mistry 3:07

Is there a joke there?

Donna Lee 3:08

No.

Dr. Mistry 3:09

Oh my lord.

Donna Lee 3:09

Sorry. That was just it.

Dr. Mistry 3:11

Do you have any jokes?

Donna Lee 3:11

I do have a joke. This made me laugh out loud."My urologist was once a gospel singer. Her name is Urethra Franklin." That made me laugh out loud. Okay. One more."What's the difference between a urologist and a podiatrist? One is a lot more impressed if you show them a foot."

Dr. Mistry 3:30

That's pretty good. It reminds me of the joke of the guy who went to the urologist and asked for some Viagra. And the guy's like,"You're, you're too old. Who do you have sex with? What are you doing?" He goes,"No, I just don't want to pee on my shoes anymore." I'm terrible at the jokes.

Donna Lee 3:43

You are terrible at the jokes. That's why people ask for me in the clinic.

Dr. Mistry 3:46

That's right. So again, this is a men's health show. We really thrive off of your questions. You need to send your questions to the armor(A-R-M-O-R) menshealth@gmail.com. If you go to our website, it's northaustinurology.com, you can also send us a message there and of course, call us. So Donna, what's our next question?

Donna Lee 4:05

This is very similar to when we had before, but since it came back up--no pun intended--I thought I'd ask it again. This gentlemen started listening to our show recently. He said,"For the past couple of months, I've been having dry orgasms. Nothing comes out like they did before. My wife is not happy. Is this just normal with aging?"

Dr. Mistry 4:21

So it point, it really...

Donna Lee 4:23

Is that ever normal?

Dr. Mistry 4:24

This hits on several different issues. So, number one, I'm always wondering if the wife really does care or not.

Donna Lee 4:29

I don't think so.

Dr. Mistry 4:30

Like I've been married for a while. I'm pretty sure. I just don't feel like she would care. You know?

Donna Lee 4:37

We're begging you to not have sex, so if you have a dry orgasm...

Dr. Mistry 4:41

Now, what's interesting is that I'm wondering if there's a concern that maybe the man really isn't orgasming and maybe he's faking it. I think, you know, maybe the wife is concerned that he's faking it, because I hear it all the time. You know, like,"Oh, this happened or I can't get an erection. And my wife's worried I'm cheating on her." And I just, I just don't understand that. I mean, is that what happens when you cheat on your spouse? You don't get erections anymore with your spouse?

Donna Lee 5:03

Isn't it a lot of work for a man to fake an orgasm. Like women can do it pretty easily, but you guys didn't have to go through a lot.

Dr. Mistry 5:09

Maybe you just want to go to sleep. Maybe, maybe you're just tired. So, what we're talking about with a dry ejaculate...

Donna Lee 5:15

Oh, I forgot, he's 70.

Dr. Mistry 5:16

...is something called a retrograde ejaculation, and 9 times out of 10 it's because he was started on a medicine and they forgot to tell him that it causes retrograde ejaculation.

Donna Lee 5:26

9 times out of 10?

Dr. Mistry 5:26

9 times out of 10.

Donna Lee 5:27

What medication?

Dr. Mistry 5:28

There's a number of them. So there's, the most common it's going to be Tamsulosin or Silodosin, which are for an enlarged prostate. But there are some interestingly enough antidepressants out there, especially some of the newer ones that lead to hypoorgasmia or dry ejaculate. And so the first thing that we do is make sure we look at his medication list and maybe he's on a supplement that may kind of have been contaminated with one of these drugs as well. So if it's only been the last couple of months, medications are by far and away the most common. And I get a patient every week that was started on Flomax by their primary care doctor and they weren't told about the retrograde ejaculation and are wondering where the magic show left.

Donna Lee 6:14

Really?

Dr. Mistry 6:15

Absolutely.

Donna Lee 6:16

I feel like we need to educate the PCPs maybe? Maybe they know that, the primary care docs.

Dr. Mistry 6:21

You have like eight minutes to talk to that patient about his blood pressure and diabetes. And then he's like,"Oh, I can't pee." You're like,"Oh, here's some Flomax." And then to expect that guy to have to sit down with the patient and explain the intricacies of how retrograde ejaculation is not an inorgasmia, is not this...I just don't like, I feel like, like it would be skipped over many, many times.

Donna Lee 6:43

And I blame the insurance, cause they won't, they won't let that poor doctor take more time to explain it.

Dr. Mistry 6:48

It's the man again.

Donna Lee 6:49

It's the man. The man, the male insurance member.

Dr. Mistry 6:54

So medication can lead to dry orgasm.

Donna Lee 6:56

What's the other 1% though?

Dr. Mistry 6:56

The other 1% is going to be something neurologic, neurologic. So if the, anatomically, what happens is the semen is emitted or is, is, is sent into the urethra in the prostate level. And then everything's squeezes in, it pops out the tip of the penis. But what's closer, the closer opening is not the tip of the penis is actually the backwards into the bladder, that's closer. But what, what, why the, all the semen doesn't go backwards is because the neck of the bladder closes. And so people who've had surgery on the neck of the bladder, like people who've had prostate surgery or people who have abnormal musculature most common as a result of diabetes, they will have retrograde ejaculation and a dry ejaculate. So medications first and then something neurologic. It is, it is rare to have something catastrophic neurologic, but if you had back surgery, sometimes certain back surgeries can lead to, um, this retrograde ejaculation problem.

Donna Lee 8:04

That's terrible.

Dr. Mistry 8:05

It is terrible.

Donna Lee 8:06

Have you ever had this problem yourself?

Dr. Mistry 8:08

No. No. I'm not sure anybody would complain. I'm not sure anybody be like,"Sonny, what are you doing? Who are you doing it with?"

Donna Lee 8:19

"Why are you faking this?"

Dr. Mistry 8:20

"Why are you faking this?"

Donna Lee 8:21

"Who have you been seeing?"

Dr. Mistry 8:22

And what accent am I using? I don't even know. A Southern accent. In any case...

Donna Lee 8:26

A Louisiana accent.

Dr. Mistry 8:26

That's right. Too much time around your husband. So, I don't think that, so I've always felt like most men that have a dry ejaculate really aren't bothered by the dry ejaculate, but they're truly bothered by the association of a less felt orgasm. So they don't feel it as much. And in our minds, we might think that the feeling of the fluid going through our penis is actually what makes the orgasm, when in fact it really very little. And what adds, what adds most is just the feeling of orgasm. So although that's not what this listener specifically mentioned in previous episodes of this radio show, as well as you can find on our podcast, I've talked about medications and mechanisms that can allow us to enhance the orgasmic experience. We offer PRP injections of the penis. We offer medications like yohimbine, oxytocin, cabergoline. We offer medicines like Wellbutrin, all of which are used in an off-label way which means that they're not FDA approved for these uses, but one of the side effects is that they improve orgasmic intensity. And if we find out you're on a medicine that affects your orgasm...

Donna Lee 9:42

Just stop the medicine.

Dr. Mistry 9:43

No, we'll, we'll find an alternative for you.

Donna Lee 9:45

Well yeah, cause you can't stop it, right?

Dr. Mistry 9:46

Yeah, we don't want...but if you're on prostate medicine, there are alternatives that don't lead to it. And we have a number of minimally invasive prostate surgeries that we can do that gets you off the pill. So we'd love to see you, take care of you.

Donna Lee 9:57

That's right. What is another word for urologist?

Dr. Mistry 9:59

...and get your wife not mad at you. What?

Donna Lee 10:02

Erectrician.

Dr. Mistry 10:04

Erectrician. Very good. Thank goodness you're partially Asian so that you can get away with that joke.

Donna Lee 10:10

Oh, that's true. I didn't think about the sensitivity issue right now. You can call us during the week at(512) 238-0762. And our website is armormenshealth.com and you can send your questions to armormenshealth@gmail.com. Thank you so much, Dr. Mistry.

Dr. Mistry 10:25

Thank you, Donna.

10:26

The Armor Men's Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth, edgy, gmail.com.