Spermatorrhea

SPERMATORRHEA, spermatorrhoea (from Greek sperma--seed and rheo - flow), seminal emission. True, continuous seminal emission is extremely rare--in severe traumatic spinal cord injury, and also as a transient symptom in severe myelitis. Clinically, S. refers to seminal loss occurring without erection and characteristic ejaculatory thrusts and without orgasm. This constitutes the difference between S. and nocturnal emission. By Ulzmann's apt observation, nocturnal emission can be compared to a bladder spasm, while S. is comparable to its paralysis. In most cases, S. occurs during defecation (s. defaecationis), less often during micturition (s. mictionis). S. appearing during defecation, especially during constipation and during straining diarrhea and during accompanying defecation micturition, as well as during strong physical exertion, is not a pathological process; S. during micturition without defecation is close to pathology, except in cases of dysuria, where C, as during defecation, is caused by strong straining of the abdominal press and simultaneous contraction of the rectum and seminal vesicles. One cannot deny the possibility of isolated emptying of the seminal vesicles due to nervous irritability of the vesicle walls independently of abdominal press spasm. Sometimes in S. only a few drops of semen are secreted; in other cases a large amount is secreted, so that clots of semen appear in the urine, sometimes in the form of entire casts of the seminal vesicles. The difference in the amount of secreted semen depends on the mechanical cause producing it. The accidental discharge of single spermatozoa with urine does not give grounds to speak of spermatorrhea. The presence of spermatozoa in the urine in most cases is the result of gonorrheal vesiculitis. Spermatozoa are observed in the urine, according to Fübringer, in approximately 20% of persons suffering from gonorrheal vesiculitis; this condition is more correctly called spermaturia (spermaturia) than false spermatorrhea (pseudospermatorrhoea). In these cases the inflammatory gonorrheal process extends from the seminal tubercle to the walls of the ejaculatory ducts and causes their dilation and insufficiency; the presence of an inflammatory process is proved by the simultaneous presence in the urine of leukocytes and bacteria. In diagnosing spermaturia one must remember the possibility of the presence of spermatozoa in the urine due to a voluntary ejaculation or nocturnal emission having taken place after the last micturition; remnants of semen may have remained in the urethra. Insufficiency of the ejaculatory ducts can be caused not only by a gonorrheal process, but also by a purely nervous paresis of the ejaculatory ducts in a normal, otherwise healthy sexual apparatus. At first S. manifests most often during defecation in constipation, especially in subjects abstinent in a sexual sense; then it may occur during normal defecations and even during diarrhea, as well as during micturition without defecation. The age of S. patients is usually from 20 to 40 years. General accompanying phenomena are usually completely absent or very weakly expressed. Finally, in a very small group of cases a series of general subjective phenomena is observed, such as: physical fatigue and listlessness, mental depression and sleep disturbance, headache, dyspeptic phenomena, hypochondriacal mood, etc. It must be borne in mind that S. is not a precursor of sexual impotence, but can play a psychogenic role in the origin of such. - Prognosis of S. is good, especially in defecational S, which in weakly expressed cases often passes without treatment in connection with regulation of sexual life. S. after micturition without defecation requires elimination of the cause. - Prevention of S. consists in regular emptying of the intestines and prevention of all etiological factors leading to chronic prostatitis. - Treatment of S. is divided into local and general. Local treatment consists in treating vesiculitis and posterior urethritis. General treatment consists in hydrotherapy (simple and pine baths, ascending shower, sea bathing) and electrotherapy in the form of general d'arsonvalization (cell) and galvanization of the spine. Internally, general strengthening agents are given (arsenic, iron, phosphorus).