Dear Dr G,
I came across your article recently and I have a few questions to ask.
I am a sexually active man and I found some discharge from the penis especially when I am aroused.
I am worried that I may have caught something from someone, from previous contacts.
I went to see a doctor, who assured me this is natural.
According to him, this is pre-ejaculatory fluid and is normal.
I would like to put Dr G on the spot to find out what is pre-ejaculatory fluid.
What is the risk of pregnancy and what are the risks of sexually transmitted infections with the secretions?
I think I have an excessive "production" of pre-ejaculate, and this is embarrassing.
Is there any way the amount can be reduced?
Hope you can clarify.
Reply: Pre-ejaculate is also known as pre-seminal fluid. In a more crude terminology, it is often referred as pre-cum.
In comparison to semen, this is clear and colourless viscous fluid secreted by the urethra during sexual arousal.
Although the composition is similar to semen, the presence of sperms in the pre-ejaculate is quite variable among normal men.
The source of pre-ejaculatory fluid is from the mucus secreting glands in the urethra, just inside the opening of the penis.
The bulbourethral glands are mainly Cowper's and glands of Littre, which produce secretions that will lubricate the penis during sexual intercourse.
The fluid itself also contains acid phosphatase that neutralises the urethral and cervix of the partner, making the environment less hostile to sperms. Physiological, this can enhance sperm survival.
The amount of pre-ejaculate is hardly noticeable in most men (unless one worries about the discharge related to the naughty past coming back to haunt you).
However, excess secretion might cause some degree of embarrassment in some men.
The confirmation that the discharge is not associated with infections such as chlamydia and gonorrhea can be easily verified with DNA assessment of the fluid.
However, such diagnostic tests are usually unnecessary, as the discharge from pre-ejaculate is not persistent, and not associated with painful urination.
The presence of sperms in the pre-ejaculate is a subject of research, as this will give the answer of the risk of pregnancy when a female partner is in contact with the fluid.
In fact, the studies have been conflicting, as some studies revealed high concentrations of sperms, and others concluded no absence of sperms.
There have been several small-scale studies, with numbers of subjects ranging from 4 to 23, highlighting no sperms present in the pre-ejaculate.
The studies concluded pre-ejaculate is ineffectual in causing pregnancy. On the other hand, two other studies demonstrated viable sperms in pre-ejaculate. Again, the sample size was too small to make definitive conclusions.
One fact that is certain when referring to pre-seminal fluid is the risk of HIV.
Multiple studies have revealed the presence of HIV in most pre-ejaculate samples of the HIV positive individuals.
Therefore, the use of condoms before the emission of pre-ejaculate is crucial for disease prevention!
The excessive production of pre-seminal fluid is well documented, but uncommon.
The production of the fluid can be as much as 5ml. So far, the only medication that has been used to reduce the pre-seminal secretion is 5-alpha-reductase inhibitor.
Although such medication is primarily indicated for enlarged prostate and hair loss, the drug seems to benefit men having issues with excessive pre-ejaculate!
In many ways, nature works in a mysterious way in sexual and reproductive health.
In my experience, the excessive production of pre-ejaculate is a physiological phenomenon that only blesses the young and diminishes in the elderly.
In a modern society, instead of standing proud and embrace the enhanced fertility advantage, some men would rather take medicine to reduce the natural secretion.
When Dr G is put on the spot on pre-cum, his view is: "Enjoy it while it lasts!"
Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men's health. The column "Putting Dr G on the spot" is a forum to help men debunk the myths and taboos on men's issues that may be too "hard" to mention. You can send him questions at firstname.lastname@example.org