Urology/'Semen incontinence' after antibiotics treatment for chronic prostatitis
Bit of a long story but, as a background, I'm a 44yo man with a long history of chronic prostatitis symptoms since my mid to late teens. I first saw a doctor about clumpy semen when I was about 21yo. Urine dipstick showed evidence of an infection, treated with Ampicillin for 5 days and I had about 3 months of normal semen, before symptoms returned and I've never known a normal prostate since.
I've never really had much medical treatment since owing to varying degrees of disinterest from doctors I've attended, though I haven't sought help too often either. Basically I've learned to live with the condition.
11 years ago I also had an episode of acute prostatitis (blood in the semen, totally numb orgasm; no fever or systemic upset) and chose to attend a sexual health clinic for treatment. It was treated effectively with Doxycycline (4 week I think), but the chronic prostatitis continued and has since slowly progressed to, I suspect, being quite advanced. Then last month I did get treated again with antibiotics for my chronic prostatitis.
My symptoms over the last 25 years or more have NOT been anything like the classic symptoms of chronic prostatitis. I suspect this is because the ducts in my prostate must have been getting very blocked up and my prostatic secretions are kept walled in until I ejaculate. My semen ALWAYS contained some stringy casts of the ducts, measuring up to 4cm long and practically never smaller than 2cm long. I usually refer to these cast as lumps as these strings come out folded up into oval balls. The semen otherwise has been quite viscous and mucus like (sticky), but yellowish in color, although it has also been greenish in color in the past.
My main symptom as a result of this had been consistently poor force to my ejaculations, resulting nearly always in very unsatisfying orgasms, often needing to milk out every blob of semen. I had also towards the end of last year become aware of a vague muscular ache from my prostate that was permanently there but mild enough to generally ignore and forget about.
Six weeks ago, after a disappointing consultation with my now ex-doctor, I attended a sexual health clinic and was given a good prostate check by a doctor who fortunately had recent experience working in Urology. Digital examination per se was comfortable, but examination of the prostate itself was quite painful. I did wonder at the time if I was being given a prostate massage and the pain was the same as the constant discomfort I'd been having, just much much stronger. Still I did find it bearable in a therapeutic muscle massage kind of way, and could actually have tolerated an even longer exam. Of note and consistent with my opinion of a blocked up prostate, the examination didn't express any prostate secretions.
I was still 'feeling it' more than 15 minutes after the digital exam, the pain being similar in nature to an achy tired shoulder muscle being pressed hard on. The doctor did tell me that he had pressed quite hard on my prostate and also that it was smaller than normal, I presume due to contraction of the prostate muscle.
My inkling is that the muscle component of my prostate had become tired, achy and dysfunctional. My only real urinary symptom had been frequency. This was not due to any urgency but due to convenience, as the weight on my prostate of sometimes even a small amount of urine just felt naggingly unwelcome, including in bed if I was struggling to get to sleep.
The doctor at the sexual health centre treated me with 2 weeks of Doxycycline plus 4 weeks of Ciprofloxacin. It was a day before I started the antibiotics, and by then I had noticed a slight but definitely improved ejaculation which I presumed to be thanks to the digital exam having a therapeutic effect.
By the end of the second week of antibiotics, there was a dramatic improvement in the prostatitis and my semen on a couple of occasions was virtually liquid - unheard of for me. However, the more liquid semen was now giving me the more classic symptoms of chronic prostatitis:
- acidic burning sensation in the urethra (at prostate level, perineum and head of penis)
- starting 25 minutes after ejaculation, a gradual 'muscle tightening' pain from the prostate, plateauing 5 minutes later and persisting for some hours. This felt different to and more annoying than the persistent muscular ache I'd had prior to antibiotics
- occasional brief darts of a colic-like pain that felt like it originated from one side of the prostate.
There was a definite disimprovement again when the course of Doxycycline finished at 2 weeks, but with some recovery of the original improvement before finishing Ciprofloxacin.
Since then I've continued with far more liquid semen than usual (though still containing somewhat smaller 'lumps') and I've also an improvement in pleasure from orgasms and in libido.
Suddenly in the past week, for whatever reason, the semen became fully liquid for the first time since my youth and I've begun experiencing proper orgasms again, with the prostate properly spurting out semen. My semen is now white in color too.
This sudden change might be due to me this week becoming sexually aroused more frequently and to a greater degree than usual. I have in the past noticed my semen gets more liquid when I'm aroused for longer periods. I have also once a day this week been drinking a strong Colombian filter coffee - usually I drink only instant coffee. I've read that coffee can affect prostatitis.
With the more liquid semen, sometimes even when partially aroused, I became aware of a 'filling up' sensation in the perineal part of the penis, at times even a gurgling sensation (no actual sound!). The sensation was accompanied by an acid burning element too, so I immediately thought it was 'my' prostatic secretions rather than precum which I have always produced very little of. Due to my long prostate history, I've become ignorant as to what is normal. While masturbating this sensation would get stronger and I did actually find that the sensation made me even more aroused.
On one occasion I noticed that I was slowly leaking a fairly clear fluid from the tip of my penis while masturbating and this continued for several minutes until I ejaculated. I'm still not sure if this was precum or not.
When I next masturbated a couple of days later, I still had this 'filling up sensation' and made a sudden change in body posture from sitting to standing... and saw 2 spurts of fluid shoot out of my penis. I hadn't ejaculated so I started to wonder if it was a form of stress incontinence of semen/prostatic secretions. (I did ejaculate liquid semen about 2 minutes later.)
I am at this stage well able to distinguish a prostate pain from a non-prostate pain, and I have been getting some prostate pain too this week, plus for a few days I had a sickly pelvic feeling that I found hard to characterise. No urinary symptoms, but I have had a MSU sent off, after seeing my new doctor who I saw just before I started 'leaking'.
The leaking seems to have been temporary, as I've had 4 days without a recurrence. I did do some Kegel exercises before and since the improvement started. I have also continued drinking the filter coffee, as I feel the effects it may have had have been mostly beneficial (more liquid semen, which I crave), though it maybe made my semen more acidic.
However in the past 2 days, the acid burning sensation has gone, the prostate pain has virtually gone and the semen has again got strings casts (smaller than before).
I would hope to finally get a Urology referral when I next visit my new doctor later this week.
In the meantime, some questions I'd like to ask:
- Is it possible to get semen incontinence?
- Is it reasonable to assume that 2 weeks of Doxycycline wasn't long enough as my symptoms were starting to improve significantly as I finished the course and got worse again after stopping Doxycycline?
- Can coffee have a beneficial effect on prostatitis, or at least have made my semen more liquid?
- I remember I had a pustular acne spot prior to my acute prostatitis. I also had a burst of acne a week ago, though nothing too dramatic. I do sometimes get a few spots but this was an unusually high number of spots. Can prostatitis can cause acne spots, and vice versa, due to bacteria spreading in the blood stream?
- I've also been passing some mucus from my rectum during the last week. In the past I have at times, though not regularly, passed mucus without noticing any pattern. Could this be in any way related to prostatitis?
Thanks in advance.
No, semen incontinence is not a known or reported entity.
It's possible that 2 weeks of doxycycline were not sufficient in your case.
Coffee almost never has any beneficial effect on prostatitis due to the caffeine.
It is remotely possible but unlikely that the prostatitis and your acne were related. Prostatitis does not routinely cause acne spots or vice versa but it's theoretically possible.
The rectal issue is probably unrelated.