Androlog SummaryCopious Pre-Ejaculation: Small
ALEKSANDER CHUDNOVSKY AND
CRAIG S. NIEDERBERGER
From the Division of Andrology, University of Illinois,
Note: Postings to Androlog have been lightly edited
Pre-ejaculate is a clear mucoid fluid produced by
accessory sex glands and expressed on sexual stimula-
tion into the urethra. The organs that produce this fluid
are Cowper glands, the glands of Littre, and possibly the
glands of Morgagni. Pre-ejaculate volume may range in
normal men from a few drops to more than 5 mL. Pre-
ejaculate functions naturally as a chemical neutralizer to
the urine’s residual acidity in the urethra and thus
provides the basic pH of the semen, allowing for safe
passage of sperm (Chughtai et al, 2005).
Investigators have accumulated a significant body of
knowledge about the chemical composition of pre-
ejaculate and have compared sex gland secretions for
different age groups. An abundance of researchers have
studied the presence of human immunodeficiency (HIV)
and other sexually transmitted diseases in the pre-
ejaculate fluid. Reports in the literature also have
discussed the presence or absence of sperm in the pre-
ejaculate and whether or not it is safe to practice
withdrawal (coitus interruptus) as a means of contracep-
tion. However, a relative paucity of research exists
describing normal amounts of pre-ejaculate and the
possible social-sexual consequences that excessive fluid
might render. The majority of reports describing exces-
sive pre-ejaculate include anecdotal evidence, personal
communications, and speculation based on knowledge of
the physiology of the reproductive system. Yet excessive
pre-ejaculate is a documented fact, and several experts in
the field recently discussed this problem.
Dr Jacob Rajfer posed the following question for
discussion on Androlog:
I have a healthy patient in his 40s who complained that
he has copious amounts of ‘‘pre-ejaculation’’ to the point
that he has to wear protection when he goes out on a date
and gets aroused. I know this is a normal phenomenon,
but obviously not to this degree. Any thoughts?
Dr Dana Ohl, citing evidence suggesting 5-a-reductase
inhibition as a rational therapy, responded:
We had a similar case of this exact problem. This young
man would actually soak through his pants during kissing
or other mild erotic stimulation, and this situation was
quite embarrassing for him. We did a literature search
and found some immunohistochemistry data that sug-
gested that the bulbourethral glands were likely re-
sponsive to dihydrotestosterone (DHT) instead of testos-
terone. The man was placed on finasteride, with complete
resolution of his symptoms.
Investigators report immunohistochemical markers,
prostate-specific antigen (PSA) and prostate-specific
acid phosphatase, in the accessory sex glands similar
to those found in the prostate (Elgamal et al, 1994;
Rui et al, 1986). The regulation of the glands’
embryologic and postnatal development as well as
their functions thus may be regulated by DHT
(Chughtai et al, 2005; Raeside et al, 1997). A reason-
able clinical hypothesis is that to attempt to gain control
over the glands’ secretions, clinicians may consider using
5-a-reductase inhibitors, cited here by Dr Ohl success-
Dr Steven Kaplan reported similar results using a 5-a-
There have been similar findings in 2 men in their 20s. Of
interest, both were not sexually active. We used dutaste-
ride for 6 months with resolution.
Dr Ibrahim Fahmy described the different anatomic
sources for abundant pre-ejaculate:
We frequently see this complaint among young un-
married men in our society. The majority have no regular
sexual relations. This clear mucoid secretion is termed
‘‘prosemen’’ and is secreted by Cowper glands and the
small submucosal glands of ‘‘Littre’’ during sexual
excitation. This should be differentiated from another
physiologic secretion called prostatorrhea. Prostatorrhea
is an excess prostatic secretion that is associated with
straining during urination or defecation. Both types do
not require treatment, and the patient should be
reassured. If the situation is embarrassing for him, he
can use a small absorbent towel.
Bulbourethral and other accessory sex glands, while
small in size, deserve special consideration in clinically
assessing sexual function. In addition to mechanically
lubricating the urethra, secretions of these glands
Journal of Andrology, Vol. 28, No. 3, May/June 2007
CopyrightEAmerican Society of Andrology
facilitate the passage of sperm by creating an appropri-
ate chemical environment in the urethra (Chughtai et al,
2005). These secretions also play a fundamental role in
semen coagulation (Beil and Hart, 1973). Glycoproteins
in the fluid serve as lubricant for the glans penis during
intercourse, and they have immunodefensive properties
(Chughtai et al, 2005). These glycoproteins also provide
a neutralizing buffer in the vaginal vault prior to
delivery of the semen into a chemically hostile environ-
ment. While not a particularly abundant source of PSA
production, the glands may play a role in the specificity
and sensitivity of PSA as a clinical assay, as investiga-
tors have demonstrated staining for PSA in Cowper
glands (Elgamal et al, 1994; Rui et al, 1986). While the
concentration of HIV in the pre-ejaculatory fluid is
lower than that in the semen, presence of virus is still
believed to be responsible for HIV transmission (Pudney
et al, 1992).
Sperm is not usually found in any of the accessory sex
glands; however, investigators have long debated the
presence of sperm in pre-ejaculatory fluid. Researchers
have observed the presence of spermatozoa in pre-
ejaculatory fluid and have advocated against the use of
coitus interruptus as a safe means of contraception
(Zukerman et al, 2003). Other authors favoring coitus
interruptus argue against the presence of sperm in the
expressed secretions, citing faulty methodology for fluid
collection and ascribing reported pregnancies to late
withdrawal (Rogow and Sonya, 1995). While infre-
quently reported, copious pre-ejaculation causes a great
deal of social and physical distress. Based on the
literature and reports of physicians on Androlog,
clinicians may attempt a course of 5-a-reductase
inhibitors for symptomatic management.
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Chudnovsky and Niederberger