Involuntary loss of semen

Specialty: Nephrology and urology.

• spermatorrhea
• loss of seminal fluid outside of intercourse or masturbation

Why it occurs

• Chronic prostatic congestion (due to prolonged sexual abstinence or chronic abacterial prostatitis with stasis of seminal secretion)
• Neuropathy of the sympathetic autonomic nervous system (associated with diabetes mellitus with dysfunction in the tone of the seminal vesicles and ejaculatory ducts)
• Hypertonia or dysfunction of the pelvic floor muscles (which exerts mechanical pressure on the accessory glands during efforts such as defecation or lifting heavy weight)
• Incomplete spinal cord lesions (causing urinary and genital sympathetic dysautonomia)
• Side effect of certain psychotropic or anxiolytic drugs (which alter local adrenergic tone)

Initial workup

Detailed physical examination and rectal examination (to evaluate prostate size and pain); sperm culture and urine culture after prostate massage to rule out underlying bacterial infection; transrectal ultrasound (to assess the anatomy of the prostate and seminal vesicles); electromyographic study of the pelvic floor.

Standard management

• Ciprofloxacin — 500 mg every 12 hours PO for 4 weeks if secondary to chronic bacterial prostatitis
• Tamsulosin — 0.4 mg daily orally to reduce the tone of prostate and bladder smooth muscle, reducing congestion and facilitating controlled emptying
• Pregabalin (75 mg daily orally as a modulator of neuropathic and associated dysautonomic pain).