Keywords
retrograde ejaculation
risperidone
male infertility
How to Cite
Abstract
Introduction :
Aspermia is the apparent absence of ejaculate. It may result from anejaculation, retrograde ejaculation, an emission disorder, or obstruction of the seminal tract. Atypical antipsychotics are among the medications associated with sexual and ejaculatory dysfunction.
Case presentation :
We report the case of a patient with primary infertility and aspermia while receiving risperidone. The evaluation included a clinical examination, hormonal assessment, testicular ultrasonography, and a search for spermatozoa in post-orgasmic urine. Rare spermatozoa, some of which were motile, were identified in the post-orgasmic urine pellet. This finding was compatible with, but did not conclusively establish, retrograde ejaculation. Bilateral testicular atrophy, low total testosterone, and elevated prolactin were also observed.
Limitations :
The sexual, reproductive, and treatment history was incomplete; hormone assays were not repeated, and LH, FSH, SHBG, and TSH were not measured; transrectal imaging was not performed ; and the patient was lost to follow-up. These limitations reduced diagnostic certainty and precluded a firm assessment of risperidone causality.
Conclusion :
In this case, rare spermatozoa in post-orgasmic urine were compatible with retrograde ejaculation, but a causal relationship with risperidone was not formally established. Multidisciplinary management involving psychiatry, urology-andrology, endocrinology, and reproductive biology was indicated.
References
1. Mehta A, Sigman M. Management of the dry ejaculate: a systematic review of aspermia and retrograde ejaculation. Fertil Steril. 2015;104(5):1074-81.
2. Xie D, Klopukh B, Nehrenz GM, Gheiler E. Aspermia: a review of etiology and treatment. Int Arch Urol Complic. 2017;3(1):023.
3. Revenig L, Leung A, Hsiao W. Ejaculatory physiology and pathophysiology: assessment and treatment in male infertility. Transl Androl Urol. 2014;3(1):41-9.
4. Schneider-Thoma J, Dong S, Kim DD, Efthimiou O, Siafis S, Hansen WP, et al. Sexual dysfunction and other prolactin-related side effects of antipsychotic drugs in schizophrenia: protocol for a systematic review with single-arm, pairwise, and network meta-analyses of randomized controlled trials and non-randomized studies. F1000Res. 2025;13:973.
5. BIOFORMA. Exploration de la fonction de reproduction : versant masculin. Cahier de formation Bioforma n° 42. Paris: Bioforma; 2009. 220 p.
6. Otani T. Clinical review of ejaculatory dysfunction. Reprod Med Biol. 2019;18(4):331-43.
7. Trinchieri M, Trinchieri M, Perletti G, Magri V, Stamatiou K, Cai T, et al. Erectile and ejaculatory dysfunction associated with use of psychotropic drugs: a systematic review. J Sex Med. 2021;18(8):1354-63.
8. Wei L, Zheng L, Jiang T. A novel method: identifying anejaculation or retrograde ejaculation by transrectal dynamic ultrasound (report of 11 cases). J Sex Med. 2024;21(Suppl 2):qdae002.066.
9. Shanmugasundaram N, Nivedhya J, Karthik MS, Ramanathan S. Risperidone-induced retrograde ejaculation and lurasidone may be the alternative. Ind Psychiatry J. 2019;28(1):152-4.
10. Roke Y, Buitelaar JK, Boot AM, Tenback D, van Harten PN. Risk of hyperprolactinemia and sexual side effects in males 10-20 years old diagnosed with autism spectrum disorders or disruptive behavior disorder and treated with risperidone. J Child Adolesc Psychopharmacol. 2012;22(6):432-9.
11. Holtmann M, Gerstner S, Schmidt MH. Risperidone-associated ejaculatory and urinary dysfunction in male adolescents. J Child Adolesc Psychopharmacol. 2003;13(1):107-9.
12. Cichon GJ, Qadri SF. Risperidone-induced sexual dysfunction case report. Cureus. 2023;15(2):e35357.
13. Domiaty DMM, Hasab Allah SSH, Al-Nahary HY. Histological, ultrastructural and molecular studies on the effect of Costus speciosus extract on raising the efficiency of fertility in the testes of male rats treated with risperidone (antipsychotic drug). Med Sci. 2021;25(108):300-11.
14. Partin M, Clark R, Newman R, Silverberg B. Male sexual disorders: ejaculatory disorders. FP Essent. 2025;552:21-8.
15. Konstantinidis C, Zachariou A, Evgeni E, Çayan S, Boeri L, Agarwal A. Recent advances in the diagnosis and management of retrograde ejaculation: a narrative review. Diagnostics (Basel). 2025;15(6):726.
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Copyright (c) 2026 AA Aoue, H Ouedraogo, SN Diessongo, AB Aweh, RA Ouedraogo