low ejaculation volume, prostatitis?

[tman4244]

roughly 2 years ago I noticed a decrease in the volume of my ejaculations.  It happenned all of a sudden but was not painful for about 2 months.  after about 2 months of these symptoms, my prostate area began to feel sore and I had burning sensations during urination.  I went to a urologist and he said I had prostatitis.  He gave me antibiotics and I went back to him in 8 weeks.  The burning and aching subsided, but the level of ejaculation remained low.  It got better, but never 100%.  I took antibiotics for about 14 months and it never totally went away.  I then just went on with life and dealt with the problem of having very little semen.  I still have some soreness in the prostate area from time to time, and it ussually occurs after ejaculation.  I have been to a different urologist recently and he said it is a comon problem, and that there is not a lot he can do.  He gave me some things to try such as sitting in a warm bath, and said to stop drinking alcohol, consuming caffiene, and nicotine, as these things can irritate the prostate.  Personally I think that his diagnosis is silly.  It feels to me like there is a physical problem.  My orgasms are intense and it simply feels like there is no semen to ejaculate, or like there is blockage.  I can feel the orgasm come on and feel it ready to ejaculate, then it's like im shooting blanks, not much comes out.  Im not sure if it's getting blocked or just not there.  I used to be able to ejaculate 4 or 5 times a day, sometmes more, with no problem, now I can do it just as many times, but by the 3 or 4th time I have no ejaculate at all, and the first couple are small.  Also my semen looks like it is seperated.  I can see clear liquid, and globular white parts.  I have been back and forth to the urologist and he is no help.  He gives me things to try and they don't work.  I asked him about testing my semen and he said that is not necessary.  What would you recommend that I do, and do you happen to know of a good urologist or urology clinic in the Twin Cities area of Minnesota? Bye the way I am 24 years old and in good health.  I also notice that my precum seems to ooze out in mass quanities at times, and sometimes it seems very liquidy, almost like there is urine in it.  I have had ejaculations where normal looking semen comes out, and then i'll have a spurt or two of clear liquid.  I am almost positive that there is something going on that can be fixed, and I just want to know what direction I should go with this.  Thank you very much for your help.

[Kevin Pho, MD]

If there is concern about the appearance and texture of the ejaculate, you may want to consider semen testing.  The standard semen analysis consists of the following:
   Measurement of semen volume and pH
   Microscopy for debris and agglutination
   Assessment of sperm concentration, motility, and morphology
   Sperm leukocyte count
   Search for immature germ cells.

The semen sample should be collected after two to seven days of sexual abstinence, preferably at the doctor's office by masturbation.

I would also test the urine for infection as well as gonorrhea and chlamydia.  If the semen test is negative and there continues to be concern, a urologist may consider a cystoscopy for further evaluation.

This site can help to find a urologist near you:
http://www.urologyhealth.org/find_urologist/

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Swerdloff, et al.  Evaluation of male infertility.  UptoDate, 2004.

[lulututree]

A related discussion, semen amount was started.