Hi all, I am 63 years old and have been suffering symptoms of BPH since 2010. I have been taking doxazosin which is an alpha blocker, (similar to flowmax, tamsulosin, etc. ) almost about the same time, starting with 2mg and ended with 4 mg in 2016. I also experienced retro ejaculation (RE). 6 months ago I discovered that I have urinary retention and the result was my kidney was backed up with urine, causing mild decline in kidney functions. Uro wanted to do TURP. I decided to self cath (CIC) instead, waiting for something better.
The issue here is every where I look, every thing is blamed for RE, including all procedures as well as all meds, without any explanations (mechanism) on how they should be blamed for. As far as I understand, the culprit here should be the prostate. It enlarges at the wrong place and squeezes the urethra and prevents the semen from reaching the penis during ejaculation. Having no place to go, the semen ended up going nowhere or going up to the bladder if there is less obstruction that way.
I did not have any procedures so I did not have any experience to share. However, all the meds try to is to relax the prostate. That should helps, not hurts the normal ejaculation. Right ? I feel that the meds have been falsely accused. Some people even stopped taking their meds and found out that RE did not go away. So they started saying things like "It may take months after stopping meds for RE to go away." Sure. This scares many men from taking drugs into suffering needlessly and/or having some procedures that outcomes are uncertain or could be worse.
My experience with doxazosin is whenever I increase its dosage, to 6mg or 8mg, RE is improved significantly, to the point of normal ejaculation. So I proved my point to myself. However, I keep wondering perhaps there is some better explanations or experiences out there that I am missing that any of you can share.
Another experience that I can share is that CIC also improves my RE. This makes sense since the catheter open up the obstruction and may keep it open for a while. During this time, especially very soon after the CIC, there is a path for the semen to reach its supposed destination. So for men out there who are doing the self cathing, reach out for the catheter before sex.
Hank
Meds can cause RE. They think it is due to the alpha blocker inhibiting smooth muscle contraction
Hi charlton, I saw it also in an article by the ncbi. In the same article, I found this :
"In a long-term, open-label extension study, 30% of patients treated with tamsulosin reported abnormal ejaculation. In contrast, incidences of abnormal ejaculation related to the use of nonselective α-blockers, such as doxazosin, terazosin, or alfuzosin, generally were lower than 1.5%."
I guess I am lucky to be taking doxazosin instead of tamsulosin. Are you taking any now ? Hank
Hi Hank,
All I know, is this:
I am on Tamsulosin... I get RE about 90% of the time (sometimes I do ejaculate normally)... however, whenver I stop the medication, the RE stops and my ejaculation returns to normal
The alpha blocker least likely to cause RE is Alfusozin. You should try that one - but if you're self cathing all the time, why take any meds?
Also, you should know that TURP is an outdated procedure. There are other, far less invasive ones that require no anesthesia with a low incidence of RE, a much shorter recovery and very low risk of permanent side effects. YOu might want to get a full diagnosis, find out how much (could well be all, but isn't always) or your issues are a result of prostate size and whether one of the new procedures might fix your problem with much less risk than TURP.
Hank, I did one of the new procedures that Old Buzzered is talking about and I had very good results. I did the Focal Laser Abalation of my prostate. I have no RE and no other side effects. Was back to great in 4 weeks of letting the swelling go down. This is a very precise and focused procedure done only by the Interventional Radiologist using real time MRI guided laser technology. They only remove the tissue causing the issue. (Hey, that rhymes!) In my case I was 65 with very bad BPH symptoms . My prostate was 125cc in volume with a large median lobe that caused retention. All my symptoms have improved greatly and I got my life back. If you want more close up detail you are welcome to personal message me and I will give you direct contact imformation so we can discuss. I think FLA is the best thing going right now. But remember all of these are symptom cures and nothing cures the actual condition of BPH. The gland continues to grow. I am trying to combat that with herbal things and slow the process of tissue growth. I hope to get 10 years out of the FLA and by then maybe we will have even better solutions.
John
Have thought if trying daily calls instead of doxazosin? I know insurance may not pay for it though
The alpha blocker relaxes prostate muscle. It can also relax the ejaculatory blocking sphincter at top of prostate causing RE.
I used to take Flomax and did not get RE. When that stopped working, I moved on to Rapaflo and learned what RE was all about. I was on Terazosin for about 4 years, and never got RE with it, plus it worked better than the others. It also seemed to give me better and more frequent erections, kind of like cialis, which I also tried.
I just got off the Terazosin last week, and the erections don't seem to be a frequent, but don't have any of the other side effects now either.
Hi Hank,
Smooth muscle relaxants like doxazosin, Tamsulosin, etc., cause retro ejaculation in men who previously had normal antegrade ejaculation. It can be dose dependent and can vary with the individual but it's more the rule than the exception. Normal ejaculation returns after you stop taking the drugs although it may take a little time.
Surgical procedures like TURP, GL, HOLEP, etc, also have a very high incidence of retro ejaculation, but for different reasons.
If you want to know the technical reasons why, you can do some online research, but those are the facts. Neither the meds or the named procedures have been "falsely accused" as you suggest. That doesn't mean everyone who takes a smooth muscle relaxant or has a TURP will have retro, but a significant per cent will.
As to CIC helping with your retro, sounds like in your case the doxazosin puts you into borderline retro which I also experienced on a certain dose of a smooth muscle relaxant. Sometimes I had it, sometimes I didn't. And, yes, it's very possible that performing CIC right before ejaculation helps in that it pushes you over the border to the non-retro side, probably because an empty bladder will be exerting less pressure. That still doesn't mean CIC is a solution to retro, just that it could make the difference in someone with borderline retro from drugs. If you had retro from TURP, for example, CIC would not make any difference.
Glad though that you have taken up CIC instead of rushing to a TURP. That is the choice I made over three years ago and through CIC my bladder has gotten better to the point where now where I am able to stop CIC for long periods of time.
How many times a day do you self cath? Are you able to have a natural void first? If so, how much comes out of the catheter after a natural void?
Jim
Hi Hank,
Your case seems atypical.
I'm on an alpha-blocker which definitely causes RE (I was previously on finasteride which did also). All docs I've talked to say this is the case and that it will go away almost immediately when the drug is discontinued. As a matter of fact if I have sex 2--23 hours after I take the alpha-blocker (before taking the next one) I very often DO NOT have RE. Timing is everything!
Good luck!
That is very good to know. Yes most meds cause retro. Take care Ken
Eventually you will have to undergo some procedure. Some who comment on this forum constantly promote a number of procedures but not all are for everyone.
The med you are taking is known to have some bothersome side effects but it does little for the prostate. Herbals are unregulated and does nothing. You can take it for years and your problem remains the same
Lester said; Eventually you will have to undergo some procedure.
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Self cathing (CIC) is a viable long term option for some. It has worked well for me for over 3 years now and hopefully I will never need a procedure.
Jim
Hi John, I'm on and off this and don't take the time to read everything. I have seen FLA mentioned but didn't understand too much about it. Your results sound good. I've considered Urolift and rezum.How long ago did you have it done? Did a urologist recommend the procedure? Thanks, Kenny from MN
If you are over 80 CIC will do. For others it is an inconvenient crutch.
Lester,
While I certainly understand CIC looks like that from the outside, for many who have chosen that path it is anything but an "inconvenient crutch". Given the imperfect results of all current procedures, one could argue that it has the least risks with the most rewards.
In my case, not only did CIC get me by the TURP hurdle and losing my ejaculate -- the newer procedures were not very available back then -- but it has rehabbed my bladder to the extent that today I only have to cath maybe once every month. As far as symptons go, my IPSS score of 7-8 (mild) is about as good as I could expect from any surgery or procedure. Prior to CIC it was in the 30's (severe).
Jim
Jimjames,
Thanks for posting. At the beginning of CIC 3 years ago, how often were you doing this - every 4,5or 6 hours. Am self-cathing every 4-5 hours with a slow, thin stream in-between and not always. Approx 200-300 ml each time. Reason I asked is you mentioned that after 3 years all looks much better, no procedure needed to date w/CIC once a month. Just curious Brother. Thanks
Thanks Clive, your case did prove that tamsulosin causes RE. Hank
Hi oldbuzz, I am still taking doxazosin to give my bladder more exercises and also to keep my retention lower between caths. I am looking into alternatives from TURP. Thanks. Hank