Low Semen Volume: Causes and Solutions After Surgery

Decreased semen volume?

Hello Doctor: My husband underwent surgery for a hernia last year, during which part of his intestine and testicle were removed.
Since then, he has been unable to achieve normal erections and relies on erectile dysfunction medication for sexual activity.
As a result, his interest in sex has diminished, and he engages in sexual activity only once every month or two.
Recently, during intercourse, he noticed that the amount of semen he ejaculated was almost negligible.
Could this be a warning sign from his body? What methods are available to improve this situation (can medication help, or is it purely a psychological issue)? Thank you for your response!

rince, 30~39 year old female. Ask Date: 2006/02/27

Dr. Xu Weikai reply Urology

Hello, generally speaking, under normal circumstances, even with only one testicle, endocrine function should remain normal and not significantly affect sexual function.
Most factors contributing to postoperative sexual dysfunction are primarily psychological, with some being related to pain from the surgical site (scarring).
If medication allows for normal sexual activity, it suggests that the issue may not be too severe.
Recommendations include checking male hormone levels and conducting a semen analysis.
If necessary, you can visit a urology department for a detailed sexual function assessment.

Sincerely,
Dr.
Hsu Wei-Kai
Director, Urology Department
Taitung Hospital, Department of Health, Executive Yuan

Reply Date: 2006/02/27

More Info

Low semen volume can be a concerning issue for many men, especially after undergoing surgical procedures such as hernia repair or orchiectomy (removal of the testicle). In your husband's case, the surgery he underwent may have had several implications for his sexual health, including erectile dysfunction and reduced semen volume. Let's explore the potential causes and solutions for these issues.

Causes of Low Semen Volume
1. Surgical Impact: The surgical removal of part of the intestine and testicle can affect hormone levels, particularly testosterone, which is crucial for sperm production and sexual function. If the testicle was removed or damaged, this could lead to lower testosterone levels, resulting in decreased libido and erectile dysfunction.

2. Hormonal Changes: After surgery, the body may experience hormonal imbalances. Testosterone is produced in the testes, and its deficiency can lead to reduced sexual desire and lower semen production. Additionally, other hormones such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH) play roles in regulating sperm production.

3. Psychological Factors: The psychological impact of surgery and the subsequent changes in sexual function can lead to anxiety and depression, which can further exacerbate erectile dysfunction and affect sexual performance. The stress of not being able to perform sexually can create a cycle of anxiety that affects libido and semen volume.

4. Medications: If your husband is taking medications, such as those for erectile dysfunction, they may have side effects that impact semen volume. Some medications can affect the smooth muscle contractions necessary for ejaculation, leading to reduced semen output.

5. Underlying Health Issues: Other health conditions, such as diabetes, hypertension, or vascular issues, can also contribute to erectile dysfunction and low semen volume. It’s essential to consider these factors in the overall assessment of his health.

Solutions and Recommendations
1. Consult a Urologist: The first step is to consult a urologist who specializes in male reproductive health. They can conduct a thorough evaluation, including hormone level tests, to determine if there are any underlying issues that need to be addressed.

2. Hormone Replacement Therapy: If low testosterone levels are identified, hormone replacement therapy may be an option. This can help restore libido, improve erectile function, and potentially increase semen volume.

3. Psychological Counseling: If psychological factors are contributing to the issue, therapy or counseling may be beneficial. A mental health professional can help address anxiety or depression related to sexual performance.

4. Lifestyle Changes: Encouraging a healthy lifestyle can also help improve sexual health. This includes regular exercise, a balanced diet, adequate sleep, and stress management techniques. Avoiding smoking and excessive alcohol consumption is also crucial.

5. Medication Review: If your husband is taking medications for erectile dysfunction, it may be worth discussing with his doctor whether these are the best options for him or if alternatives exist that might not affect semen volume as much.

6. Regular Follow-ups: Regular follow-ups with healthcare providers are essential to monitor any changes in sexual health and make adjustments to treatment as necessary.

Conclusion
Low semen volume and erectile dysfunction after surgery can be multifactorial, involving hormonal, psychological, and physical aspects. It is crucial to approach this issue holistically, addressing both the physical and emotional components. With the right medical guidance and support, there are effective strategies to improve your husband's sexual health and overall well-being. Encourage him to seek professional help to explore these options further.

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