Reduced Libido and Ejaculate Volume: Causes and Solutions

Q: Reduced Libido and Ejaculate Volume: Causes and Solutions

Hello： 1) Psychological factors are more likely, but the influence of medication cannot be ruled out. <br>2) Lyrica (Pregabalin) does have this side effect, but you should consult the physician who prescribed it to you, as they may not have personal experience with this medicatio

Decreased libido and reduced ejaculate volume issues?

Hello Doctor: Since early February, I have noticed a lack of morning erections.
At that time, I was undergoing treatment for gastrointestinal issues (taking PPI), so I didn't pay much attention to this problem.
On February 13, during a DIY ejaculation, I found that the semen was very minimal and just flowed out.
On February 16, I experienced some discomfort in my bladder and began to have frequent urination.
I initially thought it might be a kidney issue due to the increased bubbles in my urine, so I underwent urine and kidney function tests, both of which came back normal.
Two days later (February 18), the frequent urination and bladder discomfort disappeared, but I still had no morning erections.
I started to worry that there might be an issue with my urinary function.
On the night of February 21, I tried watching adult films for DIY (I could still achieve an erection, but the hardness was noticeably reduced.
After ejaculation, the semen amount was the same as on February 13, very minimal and just flowed out).
In the past, after abstaining for two or three days, I would start to feel desire, but this time it remained the same.
Due to some panic, I began to confront this issue.
At the end of January, before the Lunar New Year, my sexual function was completely normal (hardness and semen volume were the same as before).
I would like to ask the doctor: 1.
Could this situation be caused by psychological stress? (Since I was focused on my stomach issues in February, taking a lot of stomach medications, and feeling anxious about possibly having a serious illness, I lived in anxiety throughout February.) 2.
I have been taking "Finasteride" for three years, and during this time, I have not experienced the erectile dysfunction or decreased semen volume side effects mentioned in the leaflet.
I did some research, and it seems that if there are side effects from this medication, they usually appear within the first three months.
So, I would like to ask the doctor, is it possible for side effects to appear only after three years of taking the medication? (I am also hesitant to stop the medication for a week to test if it is the cause of these side effects.) 3.
Current symptoms: no desire, no morning erections (not sensitive when manually stimulated, no erection), but I can still achieve an erection when watching adult films (though the hardness is noticeably reduced).
After ejaculation, the semen volume is very low (just a little flows out).
P.S.
In the past, when I had a girlfriend, I experienced premature ejaculation (but both hardness and semen volume were normal).
I am worried about potential infertility in the future.
I kindly ask the doctor for advice.
Thank you!

Niming, 30~39 year old female. Ask Date: 2020/02/22

Dr. Du Shixi reply Urology

Hello: 1) Psychological factors are more likely, but the influence of medication cannot be ruled out.
2) Lyrica (Pregabalin) does have this side effect, but you should consult the physician who prescribed it to you, as they may not have personal experience with this medication.
3) Sexual function is different from infertility; testing a semen sample can determine infertility in about 90% of cases.
Sexual function is very complex and can be affected by physical condition, medication, stress, sleep, and other factors.
You can try to get good sleep, engage in moderate exercise, and observe the situation.

Reply Date: 2020/02/22

More Info

Understanding reduced libido and ejaculate volume can be a complex issue influenced by various factors, including psychological stress, medication side effects, and underlying health conditions. Let's break down your concerns and explore potential causes and solutions.

1. Psychological Factors: It's entirely possible that psychological stress and anxiety can significantly impact sexual function. The mind plays a crucial role in sexual arousal and performance. If you've been experiencing anxiety related to your gastrointestinal issues and concerns about your health, this could lead to decreased libido and changes in sexual function. Stress can inhibit the body's ability to respond sexually, leading to issues like reduced morning erections and lower ejaculate volume. Techniques such as mindfulness, relaxation exercises, or counseling may help alleviate some of this stress and improve your sexual health.

2. Medication Side Effects: You mentioned taking finasteride (柔沛) for three years without experiencing the common side effects of erectile dysfunction or reduced ejaculate volume. While it is true that many side effects of medications like finasteride manifest early in treatment, there are cases where side effects can develop later. This phenomenon is sometimes referred to as "delayed onset" side effects. However, it is essential to consider that the relationship between medication and sexual function can be multifaceted. If you suspect that finasteride may be contributing to your symptoms, it is crucial to consult your healthcare provider before making any changes to your medication regimen. They can help assess whether a trial discontinuation or a switch to another medication is appropriate.

3. Physical Health: The absence of morning erections and reduced ejaculate volume can also indicate underlying physical health issues. Hormonal imbalances, particularly low testosterone levels, can lead to decreased libido and changes in sexual function. It may be worthwhile to have your hormone levels checked, including testosterone and other relevant markers. Additionally, conditions such as diabetes, cardiovascular issues, or neurological disorders can also impact sexual health. A thorough evaluation by a healthcare provider can help rule out these potential causes.

4. Ejaculate Volume: The volume of ejaculate can vary significantly from person to person and can be influenced by factors such as hydration status, frequency of ejaculation, and overall health. If you are experiencing a significant decrease in ejaculate volume, it may be worth discussing with your doctor. They can help determine if this is a normal variation for you or if it indicates a more significant issue.

5. Future Fertility Concerns: Your concern about potential infertility is understandable. However, it's important to note that reduced ejaculate volume does not necessarily equate to infertility. Many men with lower ejaculate volumes can still conceive. If you are considering starting a family in the future, it may be beneficial to consult a fertility specialist who can provide guidance and possibly conduct tests to assess your reproductive health.

In summary, your symptoms could be influenced by psychological stress, medication side effects, or underlying health conditions. It is crucial to have an open dialogue with your healthcare provider about your concerns. They can help you navigate these issues, explore potential treatments, and ensure that you receive the appropriate care tailored to your needs. Remember, sexual health is an essential aspect of overall well-being, and addressing these concerns can lead to improved quality of life.

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