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About Arthur Goldstein, M.D.
Expertise
Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience
I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations
American Medical Association, American Urological Association, American College of Surgeons
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You are here: Experts > Health/Fitness > Urology > Urology > low semen volume
Expert: Arthur Goldstein, M.D.
Date: 9/12/2008
Subject: low semen volume
Question
I'm male,21.Three months back I got a acute pain in my left testicle with swelling,which lasted for a 3-4 hours.The swelling was for 3-4 days. After that till today I experience brief pains in both the testicles.The scary symptom is that I see a decrease in semen volume from nearly a month.Assuming that was a torsion why wasn't the semen volume reduced immediately after the first time pain? If my left testicle is dead is it still possible to experience pain there? I also find a small lump above my left testicle which is developed recently.Is it possible that this lump is the reason for the reduction in the ejaculation volume? The ejaculation volume was normal upto a month after the first pain. I'm optimistic that my left testicle is not dead yet. What do you suggest?
Answer
Kiran, during sexual arousal the prostate gland & seminal vesicles manufactures fluid that account for the majority of the semen. The seminal vesicles are paired structures located behind the prostate gland that are also sensitive to sexual excitement. Sperm from the testicles (which account for only 1-2 % of the semen) travel up a series of tubes (epididymis and vas deferens) on each side to join the seminal vesicles forming the paired ejaculatory ducts. These structures empty into the prostatic portion of the urethra. At the time of ejaculation, fluid is discharged from the prostate gland and ejaculatory ducts into the urethra (urinary canal) forming the semen. As noted above, since the sperm make up only 1-2% of the total semen volume, testicular atrophy will NOT perceptibly decrease the volume. In fact, men who undergo vasectomy notice no change in their semen.
The average semen volume is 2-6 cc. There are several causes for this to be decreased. As you have noted, the most common etiology is too frequent ejaculation. Decreased volume can also occur because of retrograde ejaculation, blockage of the ejaculatory ducts or aging (the semen volume decreases at a rate of only 0.03 ml per year). Retrograde ejaculation (the backward path of semen into the bladder) may be due to certain medications, local surgical procedures and diseases such as diabetes. Ejaculatory duct obstruction is usually due to scarring from local inflammation and infection.
Retrograde ejaculation can be determined by finding large amounts of semen in the urine after orgasm. The diagnosis can be confirmed by catheterization after ejaculation. With an obstructed ejaculatory duct, a swollen seminal vesicle may be palpated on rectal examination and confirmed by ultrasound of the prostate and seminal versicles. This condition can usually be treated successfully by a minor procedure done endoscopically to unroof the obstructed duct. If infertility is an issue due to retrograde ejaculation, drug treatment with medications related to Sudafed may help. One can also use the first voided urine specimen after ejaculation for artificial insemination.
If infertility is an issue, a low semen volume is only one possible factor. A complete semen analysis, among other tests, is required. Generally, the sperm concentration and motility are the most important factors related to fertility.
As far as your testicular problem is concerned, I suspect that it is more likely that you had an episode of epididymitis rather than torsion. The mass you feel is probably scarring in the head of the epididymis. The epididymis is the tubular structure located behind the testicle that drains sperm from
the testis to the vas deferens and eventually out the ejaculatory ducts. Inflammation or infection of the prostate gland (prostatitis) often will spread down the vas and into the epididymis causing inflammation in this area (epididymitis). This is the most common cause of epididymitis although it may also occur without prostatitis. Typical signs of epididymitis are swelling of the scrotal skin with loss of the normal skin folds (rugae), redness of the skin, enlargement of the epididymis and testicle, and local tenderness and pain that is eased by elevation of the testicle. The discomfort associated with prostatitis can sometimes be referred into the epididymis without actually an inflammation being present in the epididymis. In this case, the epididymis and scrotum are normal although slightly tender.
Too frequent or too infrequent ejaculation, sexual arousal without ejaculation, and withdraw at the time of ejaculation are just
some of the factors that may predispose to prostate infections (prostatitis) that can then spread into the epididymis. You recurrent periodic aching in the testes may well be due to prostatitis referring discomfort to this area. The treatment
is antibiotics, warm baths, scrotal supporter and mild pain relievers. Probably the best antibiotics to use are from the fluoroquinolone group, such as Cipro and Levaquin. Usually the pain is gone in a few days but the swelling may persist for several weeks. Treatment should be instituted by a urologist after a proper and prompt evaluation. The urologist should follow the patient until the inflammation has totally resolved and the testicle has returned to normal. The reason for this is that occasionally, a tumor of the testicle may present clinically as epididymitis. In this case, the inflammation and swelling initially obscure the true diagnosis. A lack of response to treatment may be due to bacterial resistant to the antibiotic being used, the formation of a testicular abscess (which may be detected on ultrasound), or a misdiagnosis of torsion of the testicle.
The bottom line is that, in order to make a correct diagnosis, you need to see a urologist in consultation. Only after a diagnosis is made, can an appropriate plan of treatment be instituted. Good luck.
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