Sperm leakage in the urine – Why does it happen?

Namaste and Welcome to Dr. Shahs Clinic, My name is doctor Shah and I am a Consultant Andrologist in ChennaiCheck the video on sperm leakage in the urine if you feel lazy to read up the article, this is a very common problem I routinely see in my clinical practice with my patients. 

In this, post, we are going to discuss sperm leakage in the urine or also called semen leakage problem in the urine. 

A large proportion of my patients who come to see me in my private practice complain that ‘dear doctor, I am losing sperm in my urine because of that I feel tired and exhausted, my erection is gone and my penis size has become small. Moreover, I feel weak, sometimes I feel I have lost my fertility. 

Some patients also complain of fatigue and body pain. For such patients, it is important to rule out a clinical condition called Dhat syndrome. Now come to the clinic with the complaint of sperm leakage in the urine along with physical tiredness and fatigue Dhat syndrome has to be ruled out.

For these patients, behavioral therapy along with medication and counseling can be of tremendous benefit. 

Now, what are the commonest causes of seminal fluid leakage in the urine?

The most common cause of semen leakage in the urine is usually voiding urine after a session of masturbation or a session of sexual intercourse. 

This is because they penile urethra is coated with sperm or seminal fluid during ejaculation and what happens during urination is that sperm and urine tend to mix together and come out through the same common tract.

So it is not surprising to note semen or sperm mixing with the urine especially while passing urine after a session of sexual intercourse or masturbation.

A simple reassurance of the patient is usually all that is necessary (at least in most cases). 

There was a very interesting study done on over 5005 men in Tokyo, in which the researchers actually looked for sperm in the urine and its Association with certain clinical conditions.

The researchers found that over 5% of men actually had sperm in the urine (that’s roughly 300-400 men) when their urine was put through a urine element analysis. 

In the study, they found 3 clinical conditions in which these men had sperm mixing with the urine or semen leakage the urine. 

The first condition was Diabetes mellitus.

This is not surprising because in patients with diabetes mellitus the internal urinary sphincter becomes weak and what happens is that, and this internal urinary sphincter (check out the image below) does not close at the time of ejaculation what basically happens if that the sperm or semen goes into the urinary bladder in retrograde fashion (backward) instead of coming antegrade (forward) out of the penis as is normally expected. 

The second condition in which semen leakage occurred in the urine is the condition called dyslipidemia (also referred to as high cholesterol problem).

The exact link between high cholesterol issues and semen leakage in the urine is unknown. However, what we do know is that patients with high cholesterol (dyslipidemia) tend to develop diabetes in the long run or at an increased risk of developing Diabetes mellitus. 

The third common cause of sperm leakage in the urine came with patients who used a certain class of medications called antidepressants.

Semen leakage in the urine was also seen in patients who used drugs for improving urine flow namely drugs like tamsulosin. 

Now that we have discussed the common causes of semen leakage in the urine or sperm leakage in urine in the clinic,  what we try to assess in our sexology clinic is a medical condition called retrograde ejaculation.

Retrograde ejaculation can definitely lead to sperm leakage in the urine

Retrograde ejaculation is commonly seen in patients who are diabetic and also in patients who have had prostate surgery for urinary flow problems.

For this class,  of patients, a simple non-surgical procedure called sperm retrieval from the bladder can be done to overcome the severe male factor infertility issues stemming from a lack of antegrade ejaculation. 

Here is another interesting fact, an average man produces 2500 sperm per minute the produced sperm are usually stored in three structures the testis the epididymis as well as the long tube-like structure called the vasa, the storage capacity of this three structures put together seldom exceeds 5 to 7 days.

Check out the image below, it highlights the sites of sperm storage. 

sperm leakage in urine | semen leakage in the urine | what causes semen leakage in urine

So normally what happens if that once this storage capacity is exceeded most men have automatic ejaculations during sleep. This is referred to as nightfall.

Moreover, this is more commonly seen in men who are sexually inactive and who do not masturbate. Such men, also report seeing sperm in urine the day following nightfall.

As a result, these men get psychologically distressed and think they are losing their fertility on account of the nightfall problem.

Therefore the importance of proper counseling and behavioral therapy cannot be stressed enough and only a small proportion of patients truly require treatment for a sperm leakage problem for semen leakage problems in the urine. 

Retrograde ejaculation is a definite cause of sperm leakage or semen mixing in the urine and definitely requires treatment once a diagnosis has been established. 

I hope you enjoyed reading this blog post on sperm leakage in the urine, please do share this with all your friends and loved ones.

Feel free to reach out to me in case of difficulties. 

Wishing you a very healthy and peace-filled and fun-filled living

References

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136844

https://onlinelibrary.wiley.com/doi/full/10.1002/rmb2.12289

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