Chat

Semen Analysis and Sexual Performance: Unraveling the Myths
September 19, 2023

Many patients are still very confused about the relationship between their semen analysis and their sexual performance in bed. Men who feel their sexual ability is lacking, either because they can’t satisfy their wife, or because they compare themselves with the studs in blue films) will go to the doctor and ask for help. They often request the doctor to do a semen analysis (sperm test ) to check their libido, because they think the two go hand in hand, and that their semen test is a good index of their sexual capability.

Many doctors are happy to oblige them, even though they know that there is no connection between the two. They are happy to take advantage of the patient's gullibility and ignorance, and they know that patients expect them to do some tests, and they are happy to oblige them!

Now this ends up opening a new can of worms because sperm tests can often be abnormal and a lot of these abnormalities are of no clinical importance at all! For example, there may be a few pus cells, or the sample may be viscous, or it may take a long time to liquefy. None of these affect the man’s fertility potential, but patients don't know any better and anytime they see an abnormality in the lab report, they start freaking out and dutifully go back to the doctor and ask for treatment. The doctor is quite happy to “ treat “ the abnormality because it helps them make more money.

Doctors are of two types. Many who do these tests unnecessarily are quacks and are happy to exploit a patient’s anxiety. Now that they have found a patient to treat ( aka “bakra” in medical parlance) they will keep on advising additional tests and more treatments because they treat the patient as a source of revenue. They know the patient is vulnerable and will do everything they are ordered to. They order additional tests like a Doppler ultrasound, and blood tests for testosterone levels – and even recommend varicocele surgery. Others will put the patient on antibiotics, and will keep on repeating the test again and again to document the “ treatment “ has worked! Now the test result is not going to improve, but they have successfully trapped the patient for life!

There is another group of doctors who will take advantage of the fact that the patient doesn't know any better. Even though they have a medical degree, once they have found a patient, they will continue exploiting that patient by referring him to a urologist, or giving him medications such as anti-oxidants and “fertility supplements”!

There will be a small minority of doctors who will tell the patient that there's no need for them to do any tests and that if they have a sexual performance issue, they need counseling, and not a semen analysis because there's no connection between the two. Unfortunately, patients are not willing to listen to sensible doctors, because they want the doctor to do something – anything and everything!

They start doctor-shopping, and doing one test after another, because they become so obsessed with these results! They end up wasting a lot of time, money, and energy, and the underlying problem doesn't go away!

The root cause for this problem is that sexual issues are still taboo topics, that carry so much stigma and shame. Even though the patient's problem may have nothing to do with his fertility, he doesn’t want to use words like premature ejaculation or erectile dysfunction, because he's worried that this will reflect on his manliness. His wife becomes an unwitting accomplice in this charade because she does not want to hurt his fragile ego.

Many men cover up their embarrassment by using a proxy complaint. For example, they say – I am worried about my semen because it's too thin or too thick or comes out too early. Sadly, because the problem is not with the semen but with the man’s psyche, it is very hard to treat these patients, and many quacks make tons of money by exploiting these patients for years on end.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.