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Expert: Arthur Goldstein, M.D. - 11/12/2009

Question QUESTION: I am 34 year unmarried male living in Pakistan and doing business In past I had problem that I had excessive secretion of precum (during arousal as well in routine) which made me irritate. Immediately, after secretion, I felt problem in urination, pain in lower body region and mentally upset. I took some medicine but it had no effect. However with the passage of time the secretion went on minimizing but it was not normal and mild stimulation (Mental thoughts & romantic programmes) were enough to start it. Now the same problem has started again and this time it is much more severe. My routine life is greatly disturbed and I experience this secretion many times a day. The quantity of secretion varies and started in no time with mild stimulation (Mental thoughts & romantic programmes). After secretion, I felt weakness, backache, pain in penis and lower region, burning in eyes, urge of frequent urination but difficulty in urination. I consulted a local Urologist who did my Ultrasonography and laboratory test of urine. Both reports were normal. Please advise me on this issue.

ANSWER: Ali, pre-ejaculate ("precum") is a normal secretion of a mucous like material from the paired Cowper glands that empty into a man's proximal urethra. The glands are analogous to the Bartholin glands located at vaginal introitus. The discharge they produce is in response to sexual arousal. The amount of pre-ejaculate varies with each individual but will be greater if one has not been sexually stimulated for a while. The function of a man's pre-ejaculate is to lubricate the urethra & to neutralize any residual acid urine. These actions allowing the semen to be discharged more easily & improve sperm viability. This discharge theoretically does not contain sperm although small amounts could possible leak into it. The Cowper glands gradually become smaller with age and the secretion, likewise, lessens over time.

However, Cowper gland secretion in itself will not cause any symptom other than the discharge of pre-cum. Therefore, I believe your other symptoms are originating in the prostate gland. Congestion of the prostate gland will also cause discharge of a similar fluid. To follow is a "macro" I have written on this problem.

I suspect that your symptoms are due to a very common condition with the medical name congestive prostatitis. During sexual arousal the prostate gland & seminal vesicles manufacture fluid that accounts for the majority of the semen. The seminal vesicles are paired structures located behind the prostate gland that are also sensitive to sexual excitement. Sperm from the testicles (which account for only 1-2 % of the semen) travel up a series of tubes (epididymis and vas deferens) on each side to join the seminal vesicles forming the paired ejaculatory ducts. These structures empty into the prostatic portion of the urethra. At the time of ejaculation, fluid is discharged from the prostate gland and ejaculatory ducts into the urethra (urinary canal) forming the semen. The average semen volume is 2-6 cc. With the inception of ejaculation, the bladder neck closes and the semen is forced forward out the urethra by contraction of the pelvic muscles. Arousal without ejaculation causes the prostate to swell with fluid producing tension on the prostates capsule. This may occur with prolonged foreplay, with coitus interruptus, or by holding back ejaculation during intercourse or masturbation. It may also occur if a man rarely ejaculates. In this case, the prostate is still stimulated to secrete fluid in response to sexual. dreams, fantasies and thoughts.

There are a variety of symptoms that may occur with this condition. Often the urinary stream may be split, spraying or manifest a decreased caliber or force. Stool passing through the rectum may push on the distended prostate producing a penile discharge. Prolonged sitting (you sit on the prostate) can cause the discharge to be noted before voiding. At the end of urination, as the bladder is emptying out the last few drops of urine, it actually squeezes the prostate. If the prostate is congested, one may note fluid at the end of urination. A man may notice this more with sitting to void as there is more pressure exerted on the prostate in this position. With congestive prostatitis one may experience discomfort which is often referred to the penis, testicle(s), groin, low back or rectal area. This pain in the testicles is denoted by the slang terms: blue balls or lovers nuts. Irritating urinary symptoms such as frequency or urgency may also occur. Symptoms are typically immediately relieved by ejaculation and prevented by avoiding sexual arousal without ejaculation. Sitting in a warm bathtub for 10-15 minutes daily will also provide some relief. Congestion of the prostate can also predispose to infection of this gland. This requires a course of antibiotic therapy. Therefore, if the condition persists, consultation with a urologist is recommended. Good luck.

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QUESTION: Thanks a lot and sorry to bother you again. Would you please explain that is there any link between food and my stated problem. Should I avoid certain food or take some ones more. I again discuss my problem with doctor and he is advising me for Cystoscopy. Do you recommend this. Thanks again.

Answer Ali, for the present, I see no need for you to have a cystoscopy. I suggest that you follow the suggestions in my initial note to you and defer further evaluation unless you do not get better by following my advise. As far as diet is concerned, highly seasoned (spicy) foods and excessive alcohol intake may inflame the prostate and during your treatment period it is best to limit these. There are no other dietary restrictions. Good luck.

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