Problems with semen? Let's learn about Ejaculatory Duct Obstruction!

Do you sometimes feel like your semen volume is low during sex? Or are you having trouble conceiving? Maybe the reason for this is something you don't think about. Today, let's talk about a problem that affects men, but isn't talked about much - ejaculatory duct obstruction, or EDO.

What is Ejaculatory Duct Obstruction?

Simply put, Ejaculatory Duct Obstruction (EDO) is a blockage in a man's sperm duct. It's like a clogged water pipe. This can be a cause of infertility , but in most cases, doctors can treat it.

What is a vas deferens? How does it work?

Okay, now let's look at what an ejaculatory duct is. You have two tubes (the vas deferens) that carry sperm from your testicles. These two tubes join with the seminal vesicle ducts (the ducts from two other glands that make semen) to form the ejaculatory ducts (EDs). As these tubes pass through the prostate gland, the fluid produced by the prostate gland is added to the semen. Finally, the complete semen is released from the body through the urethra during sexual stimulation. Do you understand? This fluid carries the sperm out.

How common is this condition?

To give you an idea of ​​how common this blockage is, it is estimated that about 5% of men with azoospermia, a condition in which there are no sperm in the semen, have this blockage. Azoospermia itself affects about 1% of men.

Are there types of vas deferens obstruction?

Yes, there are several main types of vas deferens obstruction (EDO). Let's take a look at what they are:

• Complete or classic EDO: This is when both tubes are completely blocked. Imagine that both water pipes are completely blocked.
• Incomplete or partial EDO: In this, one duct may be completely blocked, or both ducts may be partially blocked. It's like a pipe getting stuck halfway.
• Functional EDO: This is similar to full EDO, but there is no physical blockage in the duct. This means that there is nothing blocked inside the duct, but there is a problem with the duct's functionality.

Do you also have these symptoms?

If you have vas deferens obstruction (EDO), you may experience some of these symptoms:

• Decreased amount of ejaculated semen (less than 1.5 ml).
• Reduced ejaculation and/or low sperm count.
• Feeling pain during or after sex.
• Pain related to the prostate gland.
• The presence of blood in the semen (in medicine we call this `(hematospermia)`).
• Blood in the urine (this is called `hematuria`).
• Infertility.

Some symptoms may be more common in one type than another, so it's best to see a doctor if you have any of these symptoms.

What causes this?

Okay, now let's see what causes this vas deferens obstruction (EDO). There can be several reasons:

• Genetic causes: Sometimes, genetic conditions such as cystic fibrosis can cause structural changes that are present at birth. For example, the vas deferens may be absent (`atresia`) or may be shrunken (`atrophic`).
• Scar tissue from previous pelvic surgery or damage to the urethra. This scarring can block the tubes.
• Stones (calculi): Just like kidney stones, small stone-like objects can form and become blocked in these seminal ducts.
• Cysts: Cysts can form in or around the tubes, causing them to become tight.
• Frequent urinary tract infections (UTIs).
• Chronic prostatitis.
• Epididymitis is an inflammation of the epididymis, the tube that carries sperm behind the testicles.

Also, problems with the seminal vesicles can sometimes cause symptoms similar to a blocked vas deferens.

What tests are being done to find out exactly this?

A doctor may perform one or more of the following tests to confirm the diagnosis of vas deferens obstruction (EDO):

• Semen analysis: This is the most basic test. It looks at many things like the number of sperm, their movement, and their shape.
• Semen fructose analysis: Fructose is a type of sugar found in semen. It is produced by the seminal vesicles. If it is low, it could be a problem with those ducts.
• Transrectal ultrasound (TRUS): This allows you to see things like the prostate, seminal vesicles, and vas deferens clearly. This can help find any blockages.
• An X-ray examination of the vas deferens.
• A test that involves injecting a dye into the vas deferens. This is called a vasogram. This can check for blockages in the tubes.

What are you doing as treatment?

There are two main medical methods used to treat this condition (EDO). These are usually surgical:

• Transurethral resection of the ejaculatory ducts (TURED): This involves passing a small instrument through the urethra and cutting out the tissue (such as a cyst or scar) that is blocking the ejaculatory ducts.
• Seminal vesiculoscopy: This is also a procedure in which a very small camera (an endoscope or telescope) is passed through the urethra into the prostate, into the seminal vesicles, and the cause of the blockage is found and removed. This is a slightly more delicate procedure than TURED.

Sometimes surgeons may use both methods together. However, you will need to take antibiotics to prevent infection after the surgery.

Doctors often recommend freezing your semen (or sperm banking) before undergoing these procedures. Since these treatments are not always 100% successful, it's a good idea to do so with the future in mind.

How long does it take to recover after treatment?

These surgeries are usually performed without a hospital stay and allow you to go home the same day (`outpatient procedures`).

• A Foley catheter will be placed through your penis to help you urinate for two to three days after surgery. It may be a little uncomfortable until it is removed.
• You may have blood in your urine and semen for a while after surgery. This is normal, but if there is a lot of bleeding, you should tell your doctor.
• You should avoid sexual intercourse until you see your doctor and have the catheter removed, and until your doctor advises you otherwise.
• Don't lift more than 10 pounds (about 4.5 kilograms) for about two weeks. Stay away from strenuous activities.
• Take painkillers and antibiotics exactly as prescribed by your doctor.
• Once the doctor gives you permission, you can return to your normal activities.

Are there any side effects of TURED surgery?

These are some of the side effects or complications that can sometimes occur after `TURED` surgery. They don't happen to everyone, but they're good to know:

• When you are in a state of ecstasy , a liquid like water may come out.
• Epididymitis (inflammation of the tube that carries sperm behind the testicle) may occur.
• The blockage may recur.
• Very rarely, there may be some damage to the rectum.
• Urinary incontinence may occur (this is also very rare).

What happens if you have a Seminal Vesiculoscopy?

Side effects from this ``Seminal vesiculoscopy`` surgery are very rare. Most of them are short-term, such as pain. However, some people who have had this surgery have reported things like:

• Feeling like the amount of semen coming out is low.
• Feeling like sexual function or performance has changed.

No matter what surgery you have, it's important to discuss everything thoroughly with your doctor before having it done.

Is there a way to prevent this from happening?

In fact, there is currently no clear way to prevent these blocked vas deferens. Because some causes are congenital. However, if you have frequent urinary tract infections (UTIs), you can reduce your risk to some extent by getting proper treatment for them and protecting yourself from sexually transmitted diseases.

If you have any concerns about genetic problems, you can meet with a genetic counselor to talk about it.

There are some medications that can affect ejaculation, but they don't directly cause erectile dysfunction. Avoiding these medications may help improve ejaculation to some extent (only under medical advice):

• Medicines called `(Alpha blockers)` (for example, medicines for enlarged prostate such as `(tamsulosin)`).
• Some high blood pressure medications, such as thiazides, prazosin, and phentolamine.
• Medications for some mental illnesses, such as `(thioridazine - Mellaril®)`, `(haloperidol - Haldol®)` and `(chlordiazepoxide - Librium®)`.
• Some antidepressants, such as imipramine and amitriptyline.

The most important thing is, do not stop taking any of these medications or change the dosage without talking to your doctor.

What happens if I have this condition?

Most of the time, you find out you have EDO when you have trouble conceiving. Or it could be because of ongoing pain. Although EDO can be uncomfortable, it is not life-threatening or contagious. That's a relief, isn't it? In most cases, doctors can successfully treat this condition and restore fertility.

When should I see a doctor?

If you have any of these problems that are causing you concern, see or talk to a doctor immediately:

• If there is new or excessive bleeding (in semen or urine).
• If you have new or increased pain (in the lower abdomen, around the testicles, during sexual intercourse).
• If you have a fever of more than 102 degrees Fahrenheit (about 38.9 Celsius).
• If you feel cold and shivering.
• If you have had surgery on your legs and there is swelling or pain around the wound.
• If you have an allergic reaction to a medicine you are taking (e.g. skin rash, difficulty breathing).

If you are trying to have a baby but are having trouble, ask your doctor to help you figure out what the problem is. If you have a blocked fallopian tube, your doctor may recommend surgery to correct the blockage. These surgeries can be very successful. Talking honestly with your doctor is the best way to make the best decisions about your health.

Some of the most important messages to take home

Ejaculatory Duct Obstruction is a treatable condition that affects men. It is important to be aware of this.

• Be aware of symptoms: If you have low semen volume, pain, or blood in your semen or urine, be sure to seek medical advice. Don't be shy.
• This could be a reason for not having children: If you and your partner are expecting a baby but are delaying it, it would be wise to check this as well.
• Accurate diagnosis is important: Avoid self-diagnosing based on what you read online. Get tested by a qualified doctor to find the exact cause.
• There are treatments: Surgeries like `(TURED)` and `(Seminal vesiculoscopy)` can successfully treat this condition. Don't worry.
• Talk openly with your doctor: It is very important to talk openly with your doctor about your problems, fears, and expectations. Only then can you choose the treatment that is best for you.

Remember, there's no need to be ashamed or afraid to talk about these issues. Your health and happiness are the most important thing!

` Ejaculatory Duct Obstruction, Male Infertility, Sperm, Semen, TURED, Prostate