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Symptoms of inflammation, infection, damage of prostate by sex.

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Hello, I am a 25 year old male, 5'11" and 155 lbs.
Diet is almost vegetarian (no beef, no red meat, no pork. Chicken and turkey are eaten and no soda) I drink coffee daily, use nicotine (primarily electonic cigarette), and take amphetamine during the week for work. I'm usually pretty physically active, though for the last six months I've been largely sedentary to gain weight.

I am bisexual, from 2010 to to 2014 I was in a committed relationship with a female. Then we broke up. During our relationship we had abundant sex and there were times where a pregnancy scare would have been appropriate, but never happened (which I'm grateful for). But one month after we broke up, my ex gets pregnant with another man on accident. This leads me to question my fertility and functionality of my reproductive organs.

Since having broken up I've had a multitude of male sexual partners doing everything like oral (giving/receiving) and anal (giving/receiving). I've had a tear in my rectum that caused minor bleeding and pain during bowel movements. I treated that with medicated wipes and preparation H along with vitamin A and D ointment.

That went away, now I have another problem. I can become arouswd and achieve erection perfectly fine (though I've noticed erection quality has diminished lately likey due to lack of exercise and amphetamine use). There is a good amount of preseminal fluid during stimulation, some of which may even be semen due to cloudy appearance.

But, during orgasm/climax I've had extremely low volume of semen for the last week or two. My climax feels different machanically. I do not get the "squirting sensation" with propulsion of semen, but feels more like the muscles in my prostate aren't working hard/properly enough to propel semen properly through the urethra. What I feel is my ejaculatory system working really hard and struggling to push semen up through the urethra and what is usually a series of six to twelve "squirts" is now one drawn out forced attempt to force semen up through the urethra with limited success.

Now, lately I've been bottoming more often than not (anal sex - receiving). And using toys to stimulate my prostate. My first inclination is to say that there is inflammation, infection, or damage to the prostate that is causing this. Moreover, I briefly examined my ejaculate today and it seemed slightly brown. This could have been my eyes, or the lighting in the room, but it seemed to have a slight brown tint to it.

What are my potential diagnoses? I've got bloodwork within the last month and the only issue was vitamin D deficiency.

I also take:
High EPA fish oil

Please help!! I am scheduling a doctors appointment alongside this.
Thank you so much!

Category: Urologist

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Category: Sexually Transmitted Diseases(STD)Specialist
 22 Doctors Online

Dear sir,
Thank you for your query at
You are mostly having some infection in the prostate and that is lowering the amount of ejaculate and hence no longer squirts. It is a very common manifestation of prostatitis.

You need to be examined, started on antibiotics if required. Nothing much needs to be done and you shall be fine. After the examination, the doctor may suggest a course of Doxycycline 100 mg twice daily for 2 weeks. But clinical examination is mandatory before that.
Feel free to discuss further,
Take care
Rajiv Goel

Patient replied :

Okay, this makes sense as a potential diagnosis. Now are there steps I can take (at home otc treatment?), pending standard medical diagnosis, to assist the resolution of this issue? Are there things I should avoid? For example, I take probiotics in the morning. Will this make the issue worse? Also, how can I prevent this from happening in the future?
Thank you!

There is nothing much that can be done from the house.
You need to start the treatment soon, because prostatitis can become a recurrent issue.
Once it is adequately treated, ( whole antibiotic course is taken ), it should not recur.
You can practice safe sex as far as possible, and keep the genital area clean.

Patient replied :

I was reading about prostatitis and many of the symptoms are significantly more severe than what I am experiencing. I am not in any pain right now (the pain I had mentioned passed almost two months ago. I am no longer in any pain). There was also a mention of flu-like symptoms, of which I have none. The only symptoms present are low ejaculate volume and mechanical changes during ejaculation and a slight possibility of hematospermia (wouod this be obvious?). I understand that these could still be a manifestation of infection/inflammation of the prostate, but will I have a hard time with a doctor if my symptoms arent severe enough? Or do doctors typically conduct bloodwork and take a prostatic sample, testing for bacterial cultures/antibodies as well as IL-6, C-reactive protein, TNF-alpha? Is an MRI a good idea?
Since I am not in pain. I have to ask if there are any (potentially more rare) other potential diagnoses that would fit? Can one damage or bruise the prostate during anal intercourse? Can semininal vesicles/vas deferens become constricted the same way veins do? Can I walk into a doctors office and request a hormonal assay?
Thank you!

Yes any damage during bottoming or using toys to stimulate prostate can cause prostatitis causing similar symptoms.
You can get a CT KUB, that will give an idea or the extent of damage to the prostate.
You can go to a doctor, explain the symptoms are request for hormonal assay, however, I insist please start the treatment soon,

Patient replied :

I've called my doctor to schedule an apointment with my doctor. I still have to get a referral to see a urologist (HMO insurance; do you know of a way to see a urologist directly?) You seem urgent about seeking treatment. Is my condition progressive? Is there anything I can do in the meantime to mitigate symptoms or causes? Can you direct me to some journals, articles, or studies about my potential condition so I can learn more?
Thanks again!

No, I am sorry I practise in India, I am not aware of the HMO insurance or the other direct ways of approaching an urologist.
I seemed urgent because prostatitis if not treated carefully and adequately tends to become a recurrent issue. So, it is better to start the treatment as soon as possible.
I would rather advise you to get a course of Doxycycline on request from your family physician. You need to take 100 mg twice daily for 2 weeks, and you will feel a lot better.
If you want to read up more, you can refer PubMed or British Medical Journal ( BMJ ) and search for prostatitis. They have good peer reviewed articles there.

Dr. Rajiv Goel
Category: Sexually Transmitted Diseases(STD)Specialist
MCh(urology) Medical Council of India
Fellow, Laparoscopic urology, Germany
Fellow, Urooncology and Robotic urology, Australia
Felloship - MCH, Urology/Genito-Urinary Surgery, AIIMS, 2004
Residency - MS, Master of Surgery, AIIMS, 2001
Medical School - MBBS, Bachelor of Medicine and Bachelor of Surgery, AIIMS, 1998
Dr. Rajiv Goel and 4 other Medical Specialists are ready to help you

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