The Facts About Perceived Ejaculate Volume Reduction

There are a number of reasons your climax feels less forceful on occasion, or why you don't produce as much semen day to day. However, if a one-time fluke turns into a pattern, you may have perceived ejaculate volume reduction (PEVR).

PEVR is exactly what the name suggests: a reduction in the amount of semen produced during ejaculation. With PEVR, you may find yourself sexually stimulated and feel the desire to climax but experience reduced ejaculatory force and volume, making for a less intense orgasm.

Even as one of the most common types of ejaculatory dysfunctions, PEVR can be difficult to address as a medical condition, since you are the only one who knows the look and feel of your normal orgasm.

A look at risk factors

The main cause of weakened ejaculation is aging. Simply put, the body, including the male reproductive center, gets weaker as you get older. However, weak ejaculation can happen for reasons outside of age, some of which are preventable and treatable with the help of a urologist.

Treatment for PEVR largely depends on the cause of the condition in your specific case, so the first step to remedying the issue is identifying a "why." When a patient comes in talking about PEVR, a urologist is going to think about disorders such as premature ejaculation in relation to the issue of lower volume, retrograde ejaculation (another ejaculatory disorder) and psychogenic/partner issues.

PEVR can be induced by many medical factors, such as:

• Cancer treatments, especially in prostate cancer cases
• Issues with male hormone production
• Depression medication
• An enlarged prostate gland
• Diabetes
• High blood pressure

PEVR can also be attributed to an unhealthy lifestyle, such as not drinking enough water. Since semen is composed mostly of water, dehydration reduces the amount produced during ejaculation. Alcohol, drug use, smoking, obesity and medications—Flomax, for example, carries retrograde ejaculation as a side effect—can also contribute, as well as psychological factors, including a history of depression, trauma or stress.

Finally, a urologist will look for anatomical causes of obstruction or blockage of the seminal vesicles, either from seminal vesicle cysts or ejaculatory duct obstruction, which can cause low semen volume. Such obstructions are discovered via a transrectal ultrasound and likely will need surgery to repair, such as a transurethral resection of the ejaculatory duct to unblock the semen.

Psychological effects of PEVR

Like any change in your typical sexual performance, PEVR can potentially affect your self-esteem or overall feelings about sex, and that might make it difficult to reach out to a partner, medical professional or therapist for help with the condition.

If you are in a sexual relationship, PEVR could also lead to a breakdown in communication or a reduced level of intimacy as you avoid situations that can lead to sex with your partner. While PEVR may be difficult to discuss with your partner, communication can help you avoid potential feelings of rejection, dissatisfaction and inferiority.

PEVR and erectile dysfunction

Some scientists have established a link between erectile dysfunction (ED) and PEVR, with many men experiencing both sexual disorders simultaneously. A 2015 study by the International Society for Sexual Medicine focused on a group of 988 men who were being screened for potential testosterone therapy. While many of the men were identified as having at least one ejaculatory disorder, 88 percent reported experiencing PEVR specifically.

Though the connection is still being studied, it's possible that low levels of testosterone can cause both ED and perceived ejaculate volume reduction. Both sexual disorders have psychological symptoms and effects that range beyond limiting physical intimacy.

In fact, a diagnosis of one of these conditions is often followed by a diagnosis of the other.

Make a plan with your doctor

Once you and your healthcare provider, preferably a urologist, have figured out the source of your PEVR, a variety of treatment solutions are available.

Medication

Some medications, such as pseudoephedrine, midodrine and testosterone, can be used to address PEVR, though testosterone may lead to a host of other issues. If you're taking medication for another condition, you should talk to your doctor to see if it is possible to switch to a treatment that does not contribute to PEVR.

Lifestyle changes

Kegel exercises can strengthen the muscles that help with ejaculation, specifically the bulbospongiosus muscle and the bulbocavernosus muscle. To perform a kegel, start by locating the muscle you use to stop urinating midstream. Practice doing it a few times. Once you have the feeling down, isolate and flex this muscle for five seconds at a time, then rest, and repeat this for five to 10 reps.

Aerobic exercise is good for overall health and testosterone production, which can help with PEVR. To encourage healthy sperm production, your doctor may recommend dietary changes, such as drinking more water and eating foods high in zinc and other important amino acids. Lean red meat, oysters, salmon, dark chocolate and nuts are a good place to start.

If you smoke cigarettes, consider quitting. Not only is quitting good for your overall health, but tobacco is also known to cause reductions in semen quality and volume. Additionally, reduce your alcohol intake. Studies show that men who drink heavily have lower semen volume and quality than moderate drinkers.

Therapy

If the cause of your PEVR is psychological, therapy may be the right solution. Some therapists and psychiatrists specialize in sexual health and can help navigate the pressure to perform as well as reduce potential conflicts with a partner due to PEVR.

Therapists can also provide resources for dealing with the anger, frustration and depressive thoughts triggered by sexual disorders. Communication strategies, assistance in planning intimacy and homework in the form of books or videos about sexual wellness may be part of the process. As the field of sex therapy continues to grow—and the scope of this important role becomes better understood—more inclusive treatment options are becoming viable.

Treatment is possible

Though you may be unable to stop your body from aging, you and your doctor can strategize a treatment plan to help you get back to normal ejaculations. Evaluation by a urologist is likely your best bet. A urologist may give you a simple test to see if your urine contains semen. If it does, it could signify retrograde ejaculation, which would lead to further lab tests.

While PEVR may seem like an uncomfortable or embarrassing topic to broach, keep in mind many men face it at some point in their life.