Comprehensive Review on Semen Production, Premature Ejaculation, Contributing Factors, and Related Health Conditions: Understanding the Biological, Psychological, and Lifestyle Influences on Male Sexual Health

Abstract

This review explores the formation, composition, and various factors influencing semen production, as well as its relationship with sexual health conditions, including premature ejaculation (PE). Semen, primarily composed of spermatozoa and fluids from various male reproductive organs, plays a crucial role in fertilization. Hormonal and biological factors regulate its production, while lifestyle choices and health conditions can significantly impact semen quality and sexual performance. The review also addresses how semen quality and premature ejaculation are influenced by biological, psychological, and environmental factors. Strategies to improve semen production and sexual stamina, including diet, exercise, and psychological interventions, are discussed. Furthermore, the article highlights conditions in which sexual activity should be approached with caution, such as cardiovascular disease, infectious diseases, and post-surgery recovery. It emphasizes the importance of understanding the complex interplay of factors affecting sexual health and provides evidence-based recommendations for managing premature ejaculation and enhancing overall sexual well-being.

Keywords

Introduction

       
           
       
   Figure 1. Parts of male reproductive system which help in production of semen (https://kidshealth.org/en/parents/male-reproductive.html)

1. Formation, Composition, and Characteristics of Sperm

Sperm cells, which contribute to only 2–5% of the total semen volume, are produced in the testes. As sperm travel through the reproductive tract, they are enriched with fluids from the epididymis, prostate, seminal vesicles, and other glands. The maturation process occurs in the epididymis, where sperm acquire energy sources like glycerylphosphorylcholine. The ductus deferens, seminal vesicles, and prostate gland add fluids, such as fructose and amino acids, that support sperm motility and function (KidsHealth). The breakdown of the fluid contributions is as follows:

• Seminal vesicles: 46–80%
• Prostate gland: 13–33%
• Testes and epididymis: ~5%
• Bulbourethral and urethral glands:2-5%

Trace elements, including calcium, magnesium, zinc, and selenium, play crucial roles in sperm function, particularly in motility, capacitation, and sperm maturation (Mirnamniha et al., 2019). Additionally, the characteristics of semen, such as slightly alkaline pH and presence of fructose, ensure sperm viability and efficient function during ejaculation.

2. Enhancing Semen Production

Various strategies can enhance semen production, including diet, supplements, exercise, and ejaculation timing. Nutrient-rich foods like fruits, vegetables, and seafood, along with supplements such as zinc, D-aspartic acid, and maca root, have been shown to improve testosterone and semen quality. Physical activity, particularly pelvic exercises, can also enhance semen volume and ejaculation strength (Wu et al., 2010). Additionally, reducing tobacco and alcohol consumption helps preserve seminal zinc levels and testosterone production (Cooper et al., 2010).

3. Factors Affecting Semen Formation

Semen formation is influenced by several hormones such as testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin, which regulate spermatogenesis and overall reproductive health (Columbia Health). Conditions like diabetes, cardiovascular disease, or obesity, as well as psychological factors like stress or anxiety, can impair sexual function and semen quality (Corona et al., 2013). Moreover, misconceptions about semen and vitality, often emphasizing its role in energy conservation, are not supported by modern medical research (Shafiq & Haider, 2011).

4. Relationship between Sexual Intercourse and Body Weakness

Sexual activity involves various muscle groups and can lead to temporary fatigue or soreness, especially in individuals with pre-existing musculoskeletal conditions (McGill, 2007). Lower back and knee pain are common complaints, particularly in individuals with chronic conditions such as osteoarthritis (Peat et al., 2001). Sexual activity can also cause temporary hormonal changes, including the release of endorphins, prolactin, and oxytocin, which promote relaxation and may contribute to feelings of mild fatigue (Exton et al., 2001).

5. Relationship between Premature Ejaculation and Semen

Premature ejaculation (PE) is characterized by early ejaculation, often due to psychological factors like anxiety or stress, rather than the quantity or composition of semen. However, various biological, psychological, and lifestyle factors contribute to PE. Biological factors such as neurobiological dysregulation and hormonal imbalances, including low testosterone or serotonin receptor dysfunction, can exacerbate PE (Giuliano & Clement, 2005; McMahon et al., 2012). Psychological factors, including performance anxiety and depression, may heighten arousal, leading to early ejaculation (Symonds et al., 2003; Waldinger, 2007).

6. Factors Affecting Premature Ejaculation (PE)

PE is influenced by several factors, including biological, psychological, and lifestyle components. Genetic predisposition, urological conditions, and hormonal imbalances contribute to PE's occurrence (Zhang et al., 2013). Additionally, lifestyle habits such as rapid masturbation, substance use, and stress play significant roles (Rowland et al., 2000; Waldinger et al., 2004).

7. Vaginal Dryness and Premature Ejaculation

Vaginal dryness is a condition that can exacerbate PE, although it is not a direct cause. Low estrogen levels, aging, and hormonal contraceptives contribute to vaginal dryness (Kingsberg et al., 2013). This dryness increases friction, stimulating the penis excessively and reducing ejaculatory control. Psychological factors like anxiety about partner discomfort and inadequate arousal may further worsen PE (Symonds et al., 2003). Additionally, relational tensions stemming from vaginal dryness may contribute to performance anxiety and exacerbate PE (Basson et al., 2001).

7. Erectile Dysfunction (ED) and Premature Ejaculation (PE)

Erectile dysfunction (ED) and premature ejaculation (PE) are prevalent male sexual health concerns in India. Prevalence rates can vary based on factors such as age, geography, and study methodology. Below is a summary of available data on the prevalence of ED and PE in India, along with references to key studies.

Erectile Dysfunction (ED) Prevalence in India:

• Kumar et al. (2015) in their observational study found that 6% of men aged 20–29 years and 50–70% of men aged 40–79 years experienced erectile dysfunction.
• Gupta et al. (2015) reported a 26% prevalence of ED among men aged 40–70 years in a tertiary care hospital in North India.
• Chaudhary et al. (2015) found that 15.77% of elderly males (aged 40–70 years) suffered from ED.
• Sharma et al. (2015) observed a similar prevalence of 15.77% for ED in a rural South Indian population.

 Premature Ejaculation (PE) Prevalence in India:

• Agarwal et al. (2007) reported a broad prevalence range of 4–39% for premature ejaculation in the general community.
• Grover et al. (2021) found an 8.76% prevalence of PE in men aged 40–70 years in their study on sexual dysfunction.
• Chaudhary et al. (2015) also observed an 8.76% prevalence of PE among elderly males in a similar age group.

8. Improving Sexual Stamina

Improving sexual stamina and performance in men involves a holistic approach that includes lifestyle changes, medical consultation, and psychological well-being. Below is a detailed explanation with references to scientific studies and credible sources.

1. Lifestyle Modifications

• Dietary Changes (Esposito et al., 2006): A diet rich in fruits, vegetables, whole grains, and lean proteins can improve blood circulation and heart health, essential for sexual performance.
• Specific Foods:

Nuts and seeds: Contain arginine, which supports nitric oxide production and improves blood flow.

Dark chocolate: Rich in flavonoids, it can enhance circulation.

Oysters: High in zinc, which supports testosterone production.

• Exercise (Dubin et al., 2016): Regular cardio improves blood flow and stamina. Strength training increases testosterone levels, while pelvic floor exercises (e.g., Kegels) can help improve erectile function and ejaculation control.
• Avoid Smoking and Alcohol (Feldman et al., 2000): Smoking damages blood vessels, reducing blood flow, while excessive alcohol consumption can impair sexual function.

2. Psychological Interventions (Bancroft, 2009)

• Stress Management: Chronic stress releases cortisol, which inhibits testosterone. Practices like mindfulness and yoga can help reduce stress.
• Addressing Anxiety: Performance anxiety can lead to premature ejaculation or erectile dysfunction. Therapy or counseling may help.
• Cognitive Behavioral Therapy (CBT): CBT is useful for addressing underlying psychological barriers.

3. Medical Interventions (Carson & Gunn, 2006)

• Medications: Sildenafil (Viagra) or tadalafil (Cialis) may be prescribed for erectile dysfunction.
• Testosterone Replacement Therapy: For men with clinically low testosterone levels.
• Delay Spray or Creams: Local anesthetics can help manage premature ejaculation.

4. Natural Supplements (Shin et al., 2010)

• L-arginine: Boosts nitric oxide levels, improving blood flow.
• Ginseng: Traditional aphrodisiac with evidence of enhancing sexual function.
• Maca Root: May improve libido and stamina.

5. Regular Check-ups (Grover et al., 2006)

Underlying conditions like diabetes, hypertension, or hormonal imbalances can affect sexual health. Routine medical check-ups are crucial.

9. Conditions in Which Sexual Activity Should Be Avoided

Sexual activity is generally considered safe for healthy individuals, but it can be risky or inadvisable under certain medical or situational conditions. The following review outlines various conditions in which sexual activity should either be avoided or approached with caution, based on available medical literature.

1. Cardiovascular Conditions

Cardiovascular conditions can present significant risks when engaging in sexual activity, as physical exertion may exacerbate symptoms and lead to complications.

• Heart Attack (Recent Myocardial Infarction): Sexual activity can place additional strain on the heart, especially immediately following a heart attack. Medical guidelines recommend waiting until a doctor clears the individual for resumption of sexual activity. This precaution helps avoid the risk of re-injury or worsening cardiac conditions (Feldman et al., 2000).
• Unstable Angina or Severe Hypertension: Engaging in strenuous activity, including sexual intercourse, can worsen symptoms of unstable angina or high blood pressure. High-stress levels associated with sexual activity may further elevate the risk of cardiovascular complications (Bancroft, 2009).

2. Infectious Diseases

Certain infectious diseases can complicate sexual activity and increase the risk of spreading infections or worsening health conditions.

• Active Sexually Transmitted Infections (STIs): Sexual activity should be avoided during active STI outbreaks (e.g., herpes, syphilis, gonorrhea) as it can exacerbate symptoms and increase transmission risks to both partners (Grover et al., 2021).
• Severe Flu or COVID-19: Individuals suffering from severe viral infections like the flu or COVID-19 should refrain from sexual activity, as physical exertion may worsen symptoms and prolong recovery. Additionally, close contact increases the risk of spreading these contagious viruses (Dubin et al., 2016).

3. Post-Surgery Recovery

Following surgical procedures, sexual activity may interfere with healing processes or put stress on surgical sites, which can lead to complications.

• Pelvic or Abdominal Surgery: After surgeries involving the pelvic or abdominal area, sexual activity may strain surgical wounds and delay recovery. Health professionals often recommend abstaining from sexual activity until the body has adequately healed (Sharma et al., 2015).

4. High-Risk Pregnancy or Postpartum Recovery

Certain pregnancy-related conditions or postpartum recovery may require individuals to avoid sexual activity to prevent harm to themselves or the baby.

• Complications during Pregnancy: Conditions like placenta previa, preterm labor, or cervical insufficiency may necessitate abstinence from sexual activity. These conditions can complicate pregnancy, and sexual activity may increase the risk of preterm labor or miscarriage (Carson & Gunn, 2006).
• Immediate Postpartum Period: Following childbirth, especially after cesarean delivery or perineal tears, the body requires significant time to heal. Sexual activity during this recovery period can interfere with the healing process (Esposito et al., 2006).

5. Chronic Pain or Illness Flare-Ups

Certain chronic pain conditions or illness flare-ups can make sexual activity uncomfortable or exacerbate existing symptoms.

• Severe Arthritis or Fibromyalgia: Physical strain during sex may worsen symptoms of arthritis or fibromyalgia, leading to increased pain, discomfort, or fatigue. Individuals with these conditions may need to adjust sexual activity to manage their symptoms more effectively (Shin et al., 2010).
• Migraine or Severe Headaches: For some individuals, sexual activity may trigger or intensify migraines or severe headaches. Avoiding physical exertion during migraine episodes is generally recommended (Feldman et al., 2000).

6. Mental Health Conditions

Mental health conditions can significantly impact the ability to engage in and enjoy sexual activity.

• Severe Depression or Anxiety: Emotional distress related to severe depression or anxiety can make consensual and enjoyable sexual activity difficult. It is important for individuals experiencing such mental health challenges to seek professional help and guidance before resuming sexual activity (Bancroft et al., 2009).

7. Substance Abuse or Intoxication

Substance abuse can impair judgment, which can make sexual activity risky or inadvisable.

• Drug or Alcohol Intoxication: Intoxication from drugs or alcohol can lead to impaired judgment, reduced inhibition, and possible consent issues. This makes sexual activity particularly risky, as it may lead to unsafe behaviors or unintended harm (Grover et al., 2021).

8. Genital Injuries or Conditions

Genital trauma or certain medical conditions affecting the genital area should be fully healed before resuming sexual activity.

• Genital Trauma or Infections: Conditions such as vaginitis, urethritis, or penile injuries should be healed before engaging in sexual intercourse. Continuing sexual activity while these conditions are unresolved may lead to further injury or complications (Agarwal et al., 2007).

9. Severe Fatigue or Physical Weakness

Physical weakness or severe fatigue can interfere with sexual activity, particularly when dealing with chronic conditions.

10. Chronic Fatigue Syndrome (CFS):

Individuals with CFS may find that sexual activity exacerbates fatigue and requires significant recovery time. In such cases, it is important to prioritize rest and limit strenuous activity, including sex, until the condition stabilizes (Kumar et al., 2015).

10. Relationship Between Semen Quality and Impotence:

Semen quality and impotence (erectile dysfunction, ED) are two critical aspects of male sexual health that have significant implications for both reproductive and sexual wellbeing. While these conditions are often studied independently, they are intrinsically linked through various biological, physiological, and psychological mechanisms. Erectile dysfunction is typically characterized by the inability to achieve or maintain an erection sufficient for sexual intercourse, whereas semen quality encompasses the characteristics of semen, including sperm count, motility, morphology, and volume, which are essential for fertility. This review explores the relationship between these two factors, emphasizing the overlapping systems that govern both erectile function and semen production.

1. Biological Interplay between Semen Quality and Impotence

The relationship between semen quality and erectile dysfunction is complex and multifactorial. Numerous factors contribute to both conditions, and the presence of one condition may increase the likelihood of the other. Understanding how sexual function and semen production are governed by overlapping systems within the body provides insight into the intricate connection between these two health issues.

a. Hormonal Regulation

Testosterone is a key hormone involved in both semen production and erectile function. It is primarily produced in the testes and plays a crucial role in spermatogenesis (sperm production) and maintaining erectile function. Low levels of testosterone have been shown to adversely affect both semen quality and erectile function (Corona et al., 2013). A reduction in testosterone can lead to a decrease in sperm count, motility, and morphology, while simultaneously impairing the ability to achieve or maintain an erection. This highlights a clear relationship between low testosterone levels, poor semen quality, and erectile dysfunction (Giuliano & Clement, 2005).

b. Vascular Health and Circulation

Both erectile function and semen quality rely heavily on proper blood circulation. Erectile dysfunction is frequently linked to impaired vascular health, as adequate blood flow to the penis is essential for achieving and maintaining an erection. Conditions such as diabetes, hypertension, and atherosclerosis, which compromise vascular health, are known to negatively impact both erectile function and semen quality (Agarwal et al., 2007). Endothelial dysfunction, a hallmark of vascular disease, has been associated with both poor erectile function and reduced sperm quality (Sharma et al., 2015). Furthermore, inadequate circulation may hinder sperm motility and their ability to reach and fertilize the egg, thus impairing semen quality.

c. Psychological Factors

Psychological factors such as stress, anxiety, and depression have profound effects on both erectile function and semen quality. Mental health disorders often lead to reduced libido and sexual arousal, contributing to erectile dysfunction. Chronic stress and anxiety can also alter hormone levels, particularly cortisol, which may, in turn, affect testosterone production and sperm quality (Feldman et al., 2000). Moreover, performance anxiety and relationship issues can exacerbate erectile dysfunction, creating a vicious cycle that negatively impacts semen quality. Psychological stress is frequently associated with increased oxidative stress, which has been shown to compromise sperm DNA integrity and overall semen quality (Waldinger, 2007).

2. Comorbid Conditions: Diabetes, Obesity, and Cardiovascular Disease

A number of comorbid conditions—such as diabetes, obesity, and cardiovascular disease—can negatively influence both erectile function and semen quality. These conditions affect vascular health, hormone levels, and sperm production, creating a vicious cycle of deteriorating sexual and reproductive health.

a. Diabetes

Diabetes has been strongly linked to both erectile dysfunction and poor semen quality. Chronic high blood sugar levels can damage blood vessels and nerves, impairing circulation to the penis, which contributes to ED (Grover et al., 2021). Moreover, elevated glucose levels generate oxidative stress, which negatively affects sperm function and motility (Zhang et al., 2013). These factors contribute to reduced semen quality, further compounding the impact on erectile function.

b. Obesity

Obesity, particularly visceral fat, is associated with lower testosterone levels and reduced semen quality (McMahon et al., 2012). Fat cells produce estrogen, and an imbalance in sex hormones may lead to reduced sperm production and motility. Additionally, the increased risk of metabolic disorders such as insulin resistance and hypertension in obese individuals further exacerbates both erectile dysfunction and poor semen quality.

c. Cardiovascular Disease

Cardiovascular diseases, such as hypertension and atherosclerosis, impair blood flow and damage blood vessels, significantly affecting erectile function. These conditions also hinder the delivery of essential nutrients and oxygen to the testes, thereby impairing spermatogenesis and semen quality (Sharma et al., 2015). Poor cardiovascular health, therefore, contributes to both ED and reduced semen quality, reinforcing the interdependence of these two conditions.

3. Treatment and Impact on Both Conditions

Various treatments for erectile dysfunction, such as phosphodiesterase type 5 inhibitors (e.g., sildenafil); focus on improving erectile function by enhancing blood flow to the penis. However, these treatments do not directly affect semen quality. On the other hand, testosterone replacement therapy, commonly used to treat low testosterone levels and ED, has been shown to improve both erectile function and semen production (Bancroft, 2009). Lifestyle modifications such as regular physical activity, a balanced diet, and weight management have also demonstrated positive effects on both sexual function and semen quality (Wu et al., 2010). Such holistic approaches can address the underlying factors contributing to both erectile dysfunction and poor semen quality.

Relationship between Semen Quality and Milk from Various Animals (Cow, Buffalo, Camel, Goat)

Milk is a rich source of nutrients that can have direct and indirect effects on human health, including reproductive health and semen quality. The consumption of milk from different animal sources—cow, buffalo, camel, and goat—varies in nutrient content, which can influence male fertility through hormonal modulation, oxidative stress reduction, and overall improvement in sperm parameters.

1. Cow Milk and Semen Quality

Cow milk is widely consumed and contains essential nutrients such as calcium, vitamin D, zinc, and high-quality proteins. These nutrients can positively influence semen quality by enhancing sperm motility, count, and morphology.

• Zinc: Plays a crucial role in spermatogenesis and sperm membrane stabilization. (Prasad, 2013)
• Potential Concern: Excessive intake of commercial cow milk may lead to exposure to exogenous hormones, such as estrogen from treated cows, which could potentially interfere with male hormonal balance and reduce testosterone levels. (Afeiche et al., 2013)

2. Buffalo Milk and Semen Quality

Buffalo milk is higher in fat, protein, and certain minerals compared to cow milk. These nutrients can support reproductive health by providing energy and structural components for sperm production.

• Protein and Fat: Help sustain energy metabolism, which is crucial for sperm motility.
• Bioactive Compounds: Buffalo milk contains immunoglobulins and other bioactive molecules that may reduce oxidative stress, a key factor in poor semen quality. (Jirillo et al., 2010)

3. Camel Milk and Semen Quality

Camel milk is rich in antioxidants, vitamins, and minerals, which can significantly benefit male reproductive health. Its unique composition includes high levels of vitamin C and unsaturated fatty acids.

• Antioxidants: Camel milk helps reduce oxidative stress, which is one of the primary causes of sperm DNA damage and infertility. (Kaskous, 2016)
• Immune-Modulatory Effects: Camel milk has anti-inflammatory properties that may improve overall sperm health by creating a favorable systemic environment.

4. Goat Milk and Semen Quality

Goat milk is highly digestible and nutrient-dense, making it a beneficial dietary option for improving reproductive health.

• Rich in Medium-Chain Fatty Acids: These compounds provide quick energy and are less likely to be stored as fat, aiding in hormonal regulation. (Park et al., 2007)
• Bioavailability of Nutrients: Goat milk is rich in selenium and vitamin A, which are essential for improving sperm motility and reducing oxidative stress. (Toghyani et al., 2016)

General Considerations:

While milk from different sources can positively influence semen quality, the following factors are worth considering:

1. Hormonal Additives in Milk: Consumption of milk with added hormones may negatively impact testosterone levels.
2. Lactose Tolerance: Individual tolerance to lactose may affect nutrient absorption.
3. Organic vs. Commercial Sources: Organic milk is preferable to avoid exposure to antibiotics and artificial hormones.

ACKNOWLEDGMENT:

The authors are grateful to Dr. Amit kumar (Principal) of JIT Faculty of Pharmacy Jahangirabaad for his constant encouragement, valuable insight and facilities at all stages of this work.

CONCLUSION

In sex-related research, the detailed understanding of semen formation, composition, and its relationship with sexual function can be invaluable. Semen is central to male fertility and sexual health, as it contains sperm cells that, when combined with seminal plasma ensures sperm viability and facilitates fertilization. The hormonal and environmental factors influencing semen production, including testosterone, FSH, LH, and prolactin, plays significant roles in understanding conditions such as erectile dysfunction, premature ejaculation (PE), and infertility. Trace elements like calcium, zinc, and selenium are vital for sperm motility and capacitating, making them crucial in fertility studies. Factors affecting semen quality, including diet, exercise, and substance use, offer insight into potential interventions for improving male sexual health. Furthermore, the intricate dynamics between psychological factors, physical health, and hormonal balance also shed light on common dysfunctions such as PE and conditions like vaginal dryness, which can contribute to or exacerbate male sexual dysfunctions. This comprehensive understanding aids in developing effective diagnostic tools and treatments for sexual health disorders, as well as offering insights into improving sexual well-being. These areas will shape the future of sexological research by focusing on culturally relevant data, developing comprehensive treatment models that combine medical, psychological, and lifestyle interventions, and ensuring the safety and well-being of individuals with underlying health conditions. Integrating these findings into practice will improve sexual health outcomes, increase awareness, and create more personalized care for individuals experiencing ED, PE, or other sexual health concerns. As a result, men with poor semen quality may also experience erectile dysfunction, and vice versa. Effective treatment of one condition may often improve the other, making a holistic approach to male sexual and reproductive health essential.

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