No Cancer

 

Good morning.

I love it when folks bring us follow-up information.

"You may recall that I emailed asking how to clear blood in my ejaculate more quickly following a transperineal biopsy of the prostate, and that the original biopsy was positive for prostate carcinoma with a Gleason score of 3+3=6, but my PSA was high. Thus they wanted to do a repeat biopsy.
 
The repeat biopsy was thankfully done under GA. It came back negative for carcinoma. The blood in my ejaculate took three weeks to clear again at 4 to 5 solo sessions a week.
 
However, the PSA was still high at the 6-week post-surgery mark, but not quite high enough to have a funded PET-scan under the rules in my country. After discussion with my urologist we decided to see if I could push my PSA a little higher so as to qualify. So, after an enjoyable solo session with ass toys knocking on my prostate, I got the blood test done. Exactly the same PSA score!
 
Urologist decided that we could round the number up (it was only 0.2 off the minimum) and he took my case to the appropriate team. The PET-scan provider in my city only does one session a week, so after a three-month wait I had the PET-scan. The results are that there is no avidity anywhere in my body—including the prostate. So, it looks like the biopsy took all the cancer cells. There’s also no prostatic inflammation.
 
The present diagnosis for my PSA levels being high is that I just have a large prostate. The main problem with that is that I sometimes have problems urinating—particularly at night. He doesn’t want to do reduction surgery as that is likely to leave me with permanent retrograde ejaculation. So, I’m on a medication called Tamsulosin to help with urination. It has a side-effect of partial retrograde ejaculation—so I am periodically pausing the medication for a few days to enable a couple of full ejaculations.
 
Thus, I am now on the active surveillance programme ordered by the Urologist (rather than my GP)."

The best news is that there is no cancer present. Surgical reduction of the prostate can cause a myriad of problems. If you recall (from years past) Lord Patrick (a faithful reader until his death) dealt with them. Loss of solid erections, incontinence.... it's good your doctors have opted out of that. Nice to know there is a work-around for the ejaculation side-effects of the Tamsulosin. Retrograde ejaculation (where the semen is sent backward into the bladder) is nowhere near as satisfying as a normal one.

All It Takes Is One

 

A letter demands a response without any further delay.

"We're trying to get pregnant and finally went to get evaluated. She's fine. Evidently, it's my issue. See I cum but not much. I only get a small globule of semen and it doesn't shoot out at all. And it happens only on the first pulse of my cock even thought the orgasm lasts. The fertility doctor says the ejaculatory sphincter is not functioning properly and I'm experiencing a retrograde ejaculation all but the first little bit ends up in my bladder. He says it can't be fixed and we'll have to go In Vitro but he'll have to extract sperm with a needle. Kind of like doing needle biopsy. The thought of a needle in my balls scares the hell out of me."

Whoa, whoa, whoa. First, it would be a needle into your seminal vesicles, not the testicles.. Second, didn't he at least recommend that you try altering your coitus position when you ejaculate?

If you expel even a small amount of semen when you first cum, remember all it takes is one sperm cell. Acrobatics during sex may not be everyone's favorite, but if I was in your shoes and wanted to father a child in the natural way, it's what I would try first.

Put a stack of pillows under her hips - as high as you both can comfortably deal with. When your cock lets go of that first small globule of cum, you will be in a better position. Your semen will flow toward the cervix instead of away from it, helping your little swimmers reach their ultimate goal.

If that doesn't work then, yeah, your only option will be sperm extraction. As painful as that sounds, they should give you some type of anesthesia for the procedure. If a doctor didn't and came at my nether with a biopsy needle, I'd kick him in the balls and run.

You need to discuss this with your wife. Hopefully, she'll be willing to try this method. Not only because of the discomfort on your part but because In Vitro can be very expensive. 

Erections and Ejaculations

From the Mail Bag:

"Our 14 year old has shown no signs of masterbation or even wet dreams. My wife syas she's seen no bed linens, towels, or socks with dried semen. My wife wants me to talk to him to make sure everything is ok because she read an article and thinks maybe he's not able to shoot. All ready she's worried she won't be a grandmother some day. I say he'll ask when he's ready."

The win goes to your wife. Oh, sure, it may be that he's jacking off in the bathroom, in the shower. Or he's cleaning up with tissues or paper towels.

It may also be that he's an extraordinarily late bloomer. But you won't know - and neither will he - if you don't broach the subject of his genital health.

First off, you need to make sure his cock gets hard. Ask if, or how often, he wakes with morning wood. You can slip into his room in the morning to check on that if he can't/won't answer. Does he sprout spontaneous boners? Erections, or the lack thereof, is a critical sign.

No hard-ons? Time to see his doctor.

If the answer is yes, ask if he's ever had an ejaculation. If the answer is yes, then all is well - let him enjoy himself the way he wants. Though, you really should let him know he doesn't need to hide the fact.

If the answer is no, it is time to see his doctor. Retrograde ejaculation isn't life threatening, and there is no treatment for it (that I'm aware of, anyway). But to know the issue is to be better able to deal with it when he's into a serious relationship and wants to sire children. IVF is possible but is expensive, and would be doubly so for guys who can't shoot when they cum. Sperm must be extracted with a syringe. The procedure is done either in an office under local anesthesia, or in an operating room under general.

Your wife may be relieved to have that information. But, your son deserves to know what he's facing - if he indeed is having erection or ejaculation issues.

A Sticky Situation

"It's a sticky situation. I don't produce any pre-cum at all. When I cum I get one tiny spurt of jizz out my dick. I feel the "pulses" and my cock will throb with each one, but nothing shoots out. I want to get it checked out but I live at home and I'm still on my parents insurance. It might be one thing if my father took care of all the bills but it's my mom who does it. I don't want her questioning me. What do you think is causing this? Do I need to see a doctor?"

B

Well, there are a couple of things which could be happening. Some guys just don't produce much semen. You could be one of them. But, it could also be Retrograde Ejaculation. You have all the sensations of cumming but the semen is firing backward into the bladder, instead of out the end of your cock. You might be able to check this one at home. You'll need a clear jar or bottle. Drink lots of water until your urine is clear. Then you'll masturbate to orgasm.

C

When you take that post-cum piss, use the bottle.

2

If this is simple retrograde ejaculation, the urine will be cloudy...that's your semen. It's not dangerous in any way but, at this time, there's nothing anyone can do to change it. The sphincter that closes off the pathway from the bladder is either not there, or not operating efficiently.

3

Two: You don't mention it, but if there is a small bulge, or swelling, in the lower abdomen - beside the base of your cock - right after you orgasm, there could be a blockage of the seminal ducts. The swelling can ache but will usually go away after a while as the body absorbs the semen. Again, you get all the sensations of an orgasm, but no true ejaculation. It's a long-shot but vibration therapy might be able to clear it. Or, micro-surgery could remove the blockage to fix this, but you need a very skilled surgeon.

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5

If you want to sire offspring, your sperm would have to harvested. There are several methods, but your situation would most likely involve a procedure known as  Microsurgical Epididymal Sperm Aspiration (MESA).  There are other methods which you can read about here: How can sperm be retrieved. 

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7

8

In a strict case of retrograde ejaculation, there is a centrifuge system of collecting sperm from urine. It involves jacking off

9

and then pissing into medical-type urinal large enough to capture everything.

Though painless it's difficult to separate the viable sperm from other cells and not very successful. If you determine you need to see a doctor, I suggest you create an opportunity to broach the subject with your father before seeing a doctor. 

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That way, he can inform your mother in a way that won't have her questioning you.