What your semen says about your health

By Dr. Jamin Brahmbhatt, CNN

(CNN) — Just like urine and stool, semen can provide important clues about a man’s health. Variations in its color, texture, smell and volume can signal underlying health conditions. Understanding these signs can help men maintain their overall well-being and address potential issues early on.

What is normal for semen?

It is normal for semen to have minor changes in color, texture or smell. The quality may also vary from day to day or ejaculate to ejaculate — no two are exactly the same. Semen, or seminal fluid, is a mixture of fluid from the prostate, seminal vesicles and testicles.

Normal semen parameters include a sperm concentration of at least 15 million sperm per milliliter, with at least 40% of the sperm showing motility and 4% having normal morphology or appearance, according to the World Health Organization. It typically has a slightly thick, gel-like consistency. It has a faint, bleach-like smell due to its alkaline pH. The volume of ejaculate typically ranges from 1.5 to 5 milliliters per ejaculation. Semen liquifies within minutes after exiting the body, going from thick gel to smooth liquid to support the movement of sperm.

Simply said, each ejaculate has millions of sperm; not all of them have to be gold medal swimmers, and not all of them have to look normal. Also, it’s important to note that abnormal swimmers or appearance does not equal abnormal genetics or higher risk of congenital anaomolies.

Color changes

Semen is usually whitish-gray in color. The color may change as it mixes with urine, blood or other fluids in the urinary or reproductive tracts. Semen can change color from starting a B vitamin or medications. Just like there may be changes in the color of your urine when starting supplements and medications, the same can happen with the semen.

Medical conditions like liver failure or jaundice, where the entire body appears more yellow, can also discolor the semen. Even smoking can alter semen parameters with not just changes in color but a decline in fertility. Yellow or green semen might suggest an infection, such as a sexually transmitted infection (STI), urinary tract infection or prostate inflammation (prostatitis). Red or brown semen, known as hematospermia, can be alarming but is often benign, typically caused by inflammation, enlarged prostate infection or even riding a bike for too long.

Texture and consistency

Normal semen is slightly thick and gelatinous, so thick and clumpy semen might be a sign of dehydration or infection. Men with chronic dehydration often have altered semen parameters, which include texture, which can lead to a decrease in fertility. Watery semen, on the other hand, can indicate a low sperm count or frequent ejaculation, which may temporarily reduce sperm quality.

Smell

Typically, semen has a light bleach or ammonia-like smell due to its slightly alkaline pH. A strong or foul odor can be a red flag for infections such as bacterial prostatitis or STIs. A sweet smell may signal abnormal glucose levels concerning for diabetes.

Volume

The average volume of ejaculate ranges from 1.5 to 5 milliliters—about 1/3 to 1.5 teaspoons—or roughly what you would find in a small packet of ketchup. Low volume can result from frequent ejaculation, low testosterone levels or blockages in the reproductive tract. A high volume of semen may be due to prolonged abstinence or in rare cases, an infection or inflammation.

Frequency of Ejaculation

While regular ejaculation is generally healthy, very frequent ejaculation can affect semen quality. It is well known that men who ejaculate multiple times daily may experience temporary reductions in sperm count and motility, though this typically normalizes with less frequent ejaculation.

Pain during ejaculation

Painful ejaculation can be a symptom of prostatitis, urethritis and conditions like Peyronie’s disease (abnormal penile curvature) or post-vasectomy pain syndrome. A recent guideline review found that 15% to 55% of men with chronic prostatitis may experience sexual dysfunction and/or pain during ejaculation, which can significantly impact their quality of life and virality.

Lifestyle factors

Diet, hydration and overall health profoundly impact semen quality. Poor diet, lack of exercise, and smoking can negatively affect semen health, while a healthy lifestyle can improve it.

Medications and supplements

Certain medications and supplements can alter semen’s appearance and quality. For example, testosterone replacement therapy can reduce sperm production, while supplements like zinc and folic acid can enhance semen quality.

When to see a doctor

Occasional changes in semen are usually not cause for concern. However, persistent changes should be evaluated by a healthcare professional. Regular check-ups and open communication with your doctor are crucial for maintaining sexual health and addressing any issues early. It’s important to remind your doctor of any medication or over-the-counter supplements you’re taking.

Semen can provide valuable insights into a man’s health. By paying attention to its color, texture, smell and volume, men can detect potential health issues early. If you notice persistent changes, consulting with a healthcare provider can help ensure your sexual health remains in top shape.

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