madman
Super Moderator
Ejaculation: the Process and Characteristics From Start to Finish (2023)
Matthew M. Mason, Kyle Schuppe, Alexander Weber, Aaron Gurayah, Akhil Muthigi, Ranjith Ramasamy
Abstract
Purpose of Review—Semen analysis serves as the initial step in the evaluation of male infertility. However, given the difficulty in interpreting abnormal findings, physicians and patients often struggle with understanding the results. In this review, we aim to review the normal physiology of ejaculation and create an accessible resource for interpreting abnormal semen volume, viscosity, liquefaction, pH, appearance, and color.
Recent Findings—Emerging evidence has revealed that men with genitourinary tract infections have a greater number of seminal leukocytes, which may result in the clumping of motile sperm and altered morphology. Hence, these patients may have abnormal sperm parameters secondary to their health status. Recent findings have further characterized the semen liquefaction process, suggesting that increased levels of semenogelin and decreased levels of proteases and plasminogen activators (e.g., urokinase and chymotrypsin) may be associated with the failure of semen to convert to a watery consistency.
Summary—This article creates a resource which may be referenced when abnormalities in a semen analysis are encountered. We offer a comprehensive overview of normal ejaculation physiology and abnormal variants in male ejaculate volume—including aspermia, anejaculation, retrograde ejaculation, and hypo- and hyperspermia—and their potential etiologies. Additionally, we discuss several processes (infection, inflammation, and dysfunction of male sex glands) which may affect semen viscosity, liquefaction, and pH. Finally, our discussion of the potential colors of male ejaculate is meant to reduce the anxiety of both patient and provider. Through a better understanding of the process and varying characteristics of ejaculation, physicians may adequately counsel their patients on abnormal findings and concerns regarding infertility.
Introduction
Human male ejaculate, or semen, is an organic mixture composed of spermatozoa and fluid from the seminal vesicles, prostate, and bulbourethral glands. Semen analysis (SA) has long been the first investigative tool used when assessing the male factor in couples with infertility, which is a contributing factor in approximately 50% of cases [1, 2]. This test includes an assessment of macroscopic and microscopic parameters through a series of tests as described by the World Health Organization (WHO) [3••]. Beyond fertility implications, an abnormal SA has been associated with higher rates of testicular cancer and multiple non-malignant chronic diseases [4, 5]. Although SA is considered the gold standard of male fertility assessment, this test has been shown to be a poor indicator of reproductive outcomes. Results are also widely variable depending on sample collection methods, length of abstinence, and other factors [6, 7].
Many components of SA have been thoroughly explored, including a modern review of conventional methods and clinical interpretation of variables [8]. However, a paucity of literature exists regarding abnormal macroscopic features of SA, including semen volume, viscosity, liquefaction, pH, and appearance or color. A better understanding of these variables has important clinical implications for medical providers but would also empower patients with knowledge of normal and abnormal semen variances.
In this article, we will briefly review the normal physiology of semen formation and ejaculation. This will be followed by a detailed literature review exploring the etiologies, significance, and management, when available, of variances in the macroscopic characteristics of SA. In doing so, we aim to create a resource that providers and patients may reference when abnormalities in these characteristics are encountered.
*Physiology of Ejaculation
*Volume
*Viscosity
*Liquefaction
*pH
*Appearance and Color
-Yellow to Orange Coloration
-Pink to Red Coloration
-Brown to Black Coloration
Conclusions
Semen analysis (SA) is the first and most fundamental step in the evaluation of male fertility potential. Variances in the macroscopic characteristics of SA, including semen volume, viscosity, liquefaction, pH, and appearance or color, have wide-ranging etiologies and clinical implications. A better understanding of these variances has the potential to guide counseling for patients with certain variances while also potentially allowing for intervention to improve fertility and additional medical outcomes. Continued robust methodological research on this topic is necessary to better determine the origins of macroscopic abnormalities in SA and guide recommendations regarding clinical significance and management.
Matthew M. Mason, Kyle Schuppe, Alexander Weber, Aaron Gurayah, Akhil Muthigi, Ranjith Ramasamy
Abstract
Purpose of Review—Semen analysis serves as the initial step in the evaluation of male infertility. However, given the difficulty in interpreting abnormal findings, physicians and patients often struggle with understanding the results. In this review, we aim to review the normal physiology of ejaculation and create an accessible resource for interpreting abnormal semen volume, viscosity, liquefaction, pH, appearance, and color.
Recent Findings—Emerging evidence has revealed that men with genitourinary tract infections have a greater number of seminal leukocytes, which may result in the clumping of motile sperm and altered morphology. Hence, these patients may have abnormal sperm parameters secondary to their health status. Recent findings have further characterized the semen liquefaction process, suggesting that increased levels of semenogelin and decreased levels of proteases and plasminogen activators (e.g., urokinase and chymotrypsin) may be associated with the failure of semen to convert to a watery consistency.
Summary—This article creates a resource which may be referenced when abnormalities in a semen analysis are encountered. We offer a comprehensive overview of normal ejaculation physiology and abnormal variants in male ejaculate volume—including aspermia, anejaculation, retrograde ejaculation, and hypo- and hyperspermia—and their potential etiologies. Additionally, we discuss several processes (infection, inflammation, and dysfunction of male sex glands) which may affect semen viscosity, liquefaction, and pH. Finally, our discussion of the potential colors of male ejaculate is meant to reduce the anxiety of both patient and provider. Through a better understanding of the process and varying characteristics of ejaculation, physicians may adequately counsel their patients on abnormal findings and concerns regarding infertility.
Introduction
Human male ejaculate, or semen, is an organic mixture composed of spermatozoa and fluid from the seminal vesicles, prostate, and bulbourethral glands. Semen analysis (SA) has long been the first investigative tool used when assessing the male factor in couples with infertility, which is a contributing factor in approximately 50% of cases [1, 2]. This test includes an assessment of macroscopic and microscopic parameters through a series of tests as described by the World Health Organization (WHO) [3••]. Beyond fertility implications, an abnormal SA has been associated with higher rates of testicular cancer and multiple non-malignant chronic diseases [4, 5]. Although SA is considered the gold standard of male fertility assessment, this test has been shown to be a poor indicator of reproductive outcomes. Results are also widely variable depending on sample collection methods, length of abstinence, and other factors [6, 7].
Many components of SA have been thoroughly explored, including a modern review of conventional methods and clinical interpretation of variables [8]. However, a paucity of literature exists regarding abnormal macroscopic features of SA, including semen volume, viscosity, liquefaction, pH, and appearance or color. A better understanding of these variables has important clinical implications for medical providers but would also empower patients with knowledge of normal and abnormal semen variances.
In this article, we will briefly review the normal physiology of semen formation and ejaculation. This will be followed by a detailed literature review exploring the etiologies, significance, and management, when available, of variances in the macroscopic characteristics of SA. In doing so, we aim to create a resource that providers and patients may reference when abnormalities in these characteristics are encountered.
*Physiology of Ejaculation
*Volume
*Viscosity
*Liquefaction
*pH
*Appearance and Color
-Yellow to Orange Coloration
-Pink to Red Coloration
-Brown to Black Coloration
Conclusions
Semen analysis (SA) is the first and most fundamental step in the evaluation of male fertility potential. Variances in the macroscopic characteristics of SA, including semen volume, viscosity, liquefaction, pH, and appearance or color, have wide-ranging etiologies and clinical implications. A better understanding of these variances has the potential to guide counseling for patients with certain variances while also potentially allowing for intervention to improve fertility and additional medical outcomes. Continued robust methodological research on this topic is necessary to better determine the origins of macroscopic abnormalities in SA and guide recommendations regarding clinical significance and management.
