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Urology/ejaculation obstruction + ED

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QUESTION: Hello Doctor, I'm a 29 yo male

From mid 2006 I started to notice a decrease on the ejaculation, sometimes i didnt ejaculate at all, which i found strange, and consulted a urologist.The urologist made me a prostate transrectal utrasound and found a cyst that was compressing the ejaculatory duct and was causing the obstruction of the ejaculation. He said that I could be like this and do not have any more problems or I could perform a surgery to drain the cyst and hopefully improve the ejaculation again.

In june 2007 I decided to improve the situation and the urologist performed the surgery, the cyst was drainned. For the next weeks I ejaculated a few times in small quatities, and then I stopped ejaculate for good. No more sperm was coming out. But when I urinated I see the sperm come out with the urine. My urologist said the sperm was moving into the bladder when the orgasm oucours but I would not have any other problem... I was heartbroken about this situation but i got over it, because my sex life was not that affected.

Over the next years I did another prostate transrectal utrasound to see if everything was ok, and the cyst was gone.
Also I stopped seeing the sperm coming out with the urine, just some quantitie group of small boubles. Where is the sperm going?

5 years have passed

I had never had erections problems before, I was always very sexualy active, specially on masturbation, I normaly used to masturbate at least 2times p/ day

Until the Main problem:

Since June 2012 I started to notice that my erections were going away quickly (erectile dysfunction). To keep the erection I had to constantly stimulate / masturbate my penis, so i can get a strong erection, when I stopped stimulating the penis, i rapidly loose the erection. It is a bit easier to keep the erections sitting on a chair or laying on the bed. If stand still on foot I rapidly loose erection, but in the firsts I need to stimulate the penis with my hand.

Also I started to experience pain in the perineum, pelvic congestion, lower back pain too.

I went to my 1st urologist he said it was all psycological and not related with the previous event, he prescribed me daily cialis 5mg.
Cialis help me in the first times and there were weeks i was ok, but then i started to get worse again with pelvic pain too on the perineum and anus.
During this year I masturbate daily and orgams to keep my penis active.
I went to other urologists I did a bunch of exams, they all say it is psycological but I am not convienced of that. I think they dont know what else to say...
Exams i did:prostate transrectal utrasound, scrotal ultrasound, penile color doppler ultrasound (i could not get erection with carveject 5mg), hormones testosterone estradiol psa levels, pelvic MRI

All exams were considered normal by the urologists, expect for the prostate that it is a bit enlarged for my age group, slight varicose on the peri-prostatic venous plex, one urologist suggest some sort of prostatitis. There is NO trauma on the perineum or pelvic area.
The urologists told me to use daily Cialis 5mg and that was all psycological again.

Since the ED problem started two veins on the left and right started to be more proeminent and darker blue, almost looking like varicose veins. Urologist didnt worried on that..

On May 2013 I decided to have another approach I started to do exercise every day (running mostly) to improve the blood flow. Do a rigurous diet. Also I stopped struggling with masturbation i decided not to masturbate the next 2 weeks.
Results: My Erections started to come back normally and expontaniously on the waking up and sometimes during the day all this without Cialis. But still i decided not to orgasm. I dont have perineum/pelvic/lowerback pain anymore.

Then I dediced to Masturbate and to orgam, i orgams 4 times after the pause period, the 1st time i ejaculated a bit of prostate seminal liquid and a bit of white sperm that was not diluded like normally should be. the next times i didnt ejaculate anything.

When I orgasmed I felt the cum being trapped inside and feeling disconfort and compressing of  the perineum like the liquid was moving inside of me and also pelvic congestion.
My erections got worse again after the orgasm. I quitted masturbation for the next days, and the erections got better again and stronger always if i avoid the orgasm.

I've been repeating the same process, and having good results and bad results after orgasm.

In my opinion i think the seminal fluids are being trapped inside the prostate and causing some sort of blood blockage? Or are the ejaculatory ducts are so obstuct that are killing my erections? the urologists say that it is not related...

Where is the sperm going? Is there ruputure on the prostate that cannot be found on the exams? is the sperm going into my blood flow and affecting my veins or obstructing/compressing the corpora cavernosa veins? Or did my body stopped producing Sperm at all?

Please doctor what should I do to cure my problem?

Regards,
Antonio

ANSWER: Antonio:

You have a long and complicated history.  I'll try to answer some of your questions.

The sperm is still probably going into the bladder.  The fact that you don't see it as clearly doesn't mean they are going elsewhere.  The sperm is not going into the blood.  While almost anything in medicine is possible at some point, there have not been any reports anywhere of sperm in the blood.

The prostate does not rupture.  It's not a membrane or a hollow structure; it's a gland.  There has not been a reported case of a prostate rupture in the medical literature.

As long as the testicles are normal, sperm is still being made.  The semen is mostly other stuff including prostatic and seminal vesicle secretions that contribute to the color of the semen and nurturing of the sperm.

I can't tell you what to do to cure your problem.  A tertiary care Urology University Medical Center Department may be able to give you some answers.  Good luck.


---------- FOLLOW-UP ----------

QUESTION: Hello Doctor,

Thanks for your reply, but what about my Erectile Dysfunctions problem? I am more concerned about this than the ejaculation problem. I am like this for over a year, do you think it is related with the ejaculation issue?

Please let me have your insight

Regards,
Antonio

Answer
Antonio:

Any superficial veins you can see on the surface of the penis have nothing to do with erections.

Its impossible to say from the given information why you are having ED, but the ejaculation problem may be related.

Treatments specific for ED include Viagra, MUSE, External Vacuum Devices, penile injection therapy, and combination therapy.  Most likely, one of these options will be sufficient to restore your sexual function.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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