We Have Questions: Semen Volume and Its Importance
If something is off during a man's orgasms, it's undoubtedly going to raise some red flags. Though the volume of ejaculate can vary from day to day, based on a number of factors, if you're constantly feeling as though it's less than normal, you could be experiencing perceived ejaculate volume reduction (PEVR).
For some men, a dwindling ejaculate volume could be caused by medication, diabetes or possible prostate trouble. For others, external comparisons could cause a faulty perception, resulting in worries over nothing.
"If I see a 20-year-old guy who comes concerned about ejaculate, I ask them what they're comparing it to—porn or their 16-year-old self," said Jesse Mills, M.D., associate professor of urology and director of the Men's Clinic at UCLA.
To better understand semen volume and the perceptions and medical issues that could lead to PEVR, we spoke with Mills about the condition and how he approaches these concerns when talking to patients.
How often do men come to you with concerns about PEVR. Is it common?
Well, it's uncommon in that there are only a few papers in the scientific literature that have tried to measure it. It's common in men with low testosterone and men with diabetes. And it tends to be younger men who notice their ejaculate is less than normal, and that can be super-bothersome for them.
There are so many reasons that can cause it: medication use, clinical disorders and also surgeries, specifically in the pelvic region, and those could cause men to lose the ability to ejaculate entirely. It's mostly self-reported. They'll tell me they're noticing something off and then we have to figure out why; whether it's diabetic, medicine or something else. The most common drug that dries up ejaculate is Flomax, which is common for men with a lower [urine] stream. It makes them urinate within hours, but they can lose their ejaculate entirely.
There is also a subset of men who are much more attuned with it and concerned with it, but there's nothing wrong with them. They don't have chronic medical conditions, surgery or are on any medicine, so part of this is, unfortunately, a selective perception thanks to the porn industry.
What are the initial steps to getting a diagnosis and what are the steps immediately after?
It largely revolves around learning their history. What are you comparing this to? Are there changes in your medical history, do I need to screen, and are you actively trying to initiate a pregnancy and can't because the volume is too low? There are parts of the physical exam that could be enlightening, such as checking if their testicles are healthy and checking the prostate, because 99 percent of ejaculate comes from the prostate. You can feel a blockage from a prostate exam, and that would lead me to order an imaging or ultrasound, or even a CT [computed tomography] scan.
So the goal really is to make sure you find the diagnosis if you can and manage the expectations.
A lot depends on the age of the men. The younger men are having issues because they're told by a partner their ejaculation isn't enough or they're seeing things on porn. But as men age, those men will have more clinical diagnoses to find. For the 50-year-old guy who says they aren't ejaculating like they were at 30, I can usually find something.
Should guys care about PEVR? What could it indicate if diagnosed?
The normal range for ejaculate volume is about 1 milliliter to 5 milliliters, or about a teaspoon. Now, 20 percent of a teaspoon to a full teaspoon is a pretty big range, and if a guy is in that range, there's nothing to be worried about. Now, if a guy normally had 5 milliliters and is now at 1, then they should maybe get it looked at. It makes a difference in fertility and performance, as well. For me, it's all about asking the right questions at the beginning of the interview. The "P" is the most important part of it: I have to understand why they're having that perception. Is it internal loss or comparative?
What are the downsides to PEVR? Are they largely emotional or can they be physical, too?
Yeah, there really are no health implications for low ejaculate volume once you rule out the bad stuff like diabetes or prostate problems. For example, men who lost their prostate to cancer won't have any ejaculate, but they'll be fine. The act of ejaculation, if it's not happening, is not intrinsically dangerous. For the guys who are bothered by it, the emotional [aspect] can be huge.
There are some studies that indicate 1,000 milligrams of fish oil can help increase by half a milliliter, so that could make a difference. That's one thing I can recommend if there's nothing medical or surgical I can do to ease an obstruction. Men can orgasm without having fluid come out, so as long as that's possible, I don't get worried about the amount from a medical standpoint. But that release being absent can cause problems emotionally.
Can a guy have low semen volume and an adequate sperm count for fertilization? Is there a correlation either way or are they largely separate?
Well, there's a significant correlation. You can have a good number of healthy sperm, but without the fluid to deposit that sperm into the cervix and beyond, you'll have a significant fertility problem. For men born with an undeveloped prostate or other conditions, I'd have to harvest their sperm and inject it into their partner to initiate a pregnancy. But that being said, you have options. Low volume ejaculation with healthy sperm is better than the opposite.
Can a man do anything in his day-to-day life to boost the volume? If day-to-day lifestyle changes aren't helping, what are the options from there?
Semen is like saliva—it's a liquid produced by glands in your body. If you're not drinking enough water, you're probably dried up. Water and hydration will help and that's probably most important. There are a lot of supplements out there that say they'll boost volume, but there's not much to those, other than maybe fish oil. So just living a healthy lifestyle and keeping blood sugar under control is key. The most common reason in this country for PEVR is diabetes.
We do tend to underplay how big diabetes is, and PEVR can be an indicator of that.
How do you talk to men for whom low semen volume is a worry?
I think it's very much like, let's see if there's a medical problem, and then we manage expectations and try to get them comfortable with where their volume is. A lot of men just need reassurance. If you spend time on Google, you find scary things. I enjoy that part of being a doctor: giving people peace of mind and letting them know everything they read isn't relevant to them.