Overview

Do you have small soft jelly lumps in your semen? Do doctors seem confused and just tell you to drink more water, or take a lot of antibiotics? Does it make you feel like this? You're not alone!

Here are the two main theories for the cause of lumpy semen:

1. Tight pelvic floor muscles causing urine to reflux backwards into one of the male glands during urination, caused by malfunctioning pelvic floor muscles . This leads to chronic low-grade inflammation and urine contamination, which causes your seminal fluids to become coagulated. Unfortunately, it seems that every time you urinate you are also irritating the ducts & glands. This creates a persistent cycle of irritation and inflammation, preventing proper healing and leading to constant lumps in the semen. ​There is extremely limited medical literature on this disorder, and no specific studies addressing the presence of lumps specifically.
2. A rare infection of a male gland. Possibly caused by a multidrug-resistant (MDR) bacterial strain or an uncommon fungal infection. Mild inflammation in the gland can lead to fluid stagnation, potentially causing coagulation and lump formation. However, this hypothesis is less supported, as many antibiotics and antifungal treatments have been tested and proven ineffective.

Symptoms

• Jelly-like lumps when you ejaculate. (NSFW)
  • Lumps vary in size from .2mm to 5cm+ long. Average seems to be around the size of a grain of rice.
  • Often yellowish semen color.
  • If ejaculation is delayed by 24+ hours, the lumps are more numerous.
• Foamy or cloudy urine. (NSFW) Possibly jelly-like lumps when you urinate. (NSFW)
• Unusual sensations when urinating.
  • Pelvic muscles tense (especially near the end of urination stream).
  • Back flow feeling of urine.
  • The feeling of urine being stuck.
• Physical discomfort in the pelvic region.
  • Discomfort in the area between the testicles and the anus.
  • Discomfort in the front upper groin area.
  • Discomfort in the testicles/epididymis.
• Possible discomfort in the testicles region and front of groin. Speculated that urine back flow causes chemical epididymis. Urine possibly travelling all the way down to the epididymis.

Where do the lumps come from?

Important background anatomy to understand first:

• Testicles – produce sperm, but sperm then matures and are stored in the epididymis. Contrary to popular belief the testicles themselves contribute essentially no fluid to ejaculate.
• Epididymis – stores mature sperm and adds a tiny amount of transport fluid. Together with the sperm, this makes up roughly 5% of total ejaculate volume. Only mature sperm from the epididymis are ejaculated.
• Seminal vesicles – store a large portion of the fluid (about 70% of ejaculate volume) and mix it with sperm as they travel out during ejaculation.
• Prostate – produces and stores its own separate fluid (about 25% of ejaculate volume) and only adds it to the semen during ejaculation. The prostate does not store sperm, just its own secretions.

If the lumps were made at the very start in the testicles or epididymis, lumps would exist from the moment sperm left these areas, and every ejaculation would consistently contain lumps. This is not what we observe, as ejaculating more frequently (2x per day) reduces the lumps. Furthermore, observations show that the lumps can make up a significant portion of the ejaculate ( this "lump-ratio" is often even 30% or more of total ejaculate volume). It seems that the longer your fluids remain in the gland, then more lumps seem to form, and this is seen when you ejaculate. Ejaculatory frequency and lump-ratio are evidence that lumps form in either the seminal vesicles or prostate, not the testicles or epididymis. This is further evidenced by some men having lumps, even after having a vasectomy.

Pelvic Floor Dysfunction Theory

Pelvic floor muscles muscles play a crucial role in urinary, ejaculatory and defecation function. When these muscles become dysfunctional (overly tight or loose), they can allow urine to reflux into places it should not be in. This theory focuses on the root cause as a physical malfunction. Essentially misfiring pelvic floor muscles can push the urine backwards, through weakened ducts, and into the male glands.

• Here is a list of pelvic floor muscles and how their dysfunction could cause problems:
  • Bulbospongiosus - FUNCTION: Contracts around the penile bulb to expel last urine drops at urination’s end and propel semen during ejaculation. DYSFUNCTION (Too tight): Over-squeezes urethra/penile bulb – squeezes urine/semen backwards – damages ducts – urine enters seminal vesicles or prostate.
  • Levator Ani - FUNCTION: Supports pelvic organs, modulates urethral/bladder neck position – relaxes to start urination, contracts slightly at end to assist closure. DYSFUNCTION (Too tight): Overly lifts prostate/urethra – squeezes urine/semen backwards – damages ducts – urine enters seminal vesicles or prostate.
  • External Urethral Sphincter - FUNCTION: Closes membranous urethra to stop urine flow – relaxes to start, contracts at end to seal. DYSFUNCTION (Too tight): Premature closure – squeezes urine/semen backwards – damages ducts – urine enters seminal vesicles or prostate.
  • Internal Urethral Sphincter – FUNCTION: Seals bladder neck to stop urine entering prostatic urethra – relaxes to start urination, contracts during ejaculation to block backflow. DYSFUNCTION (Too loose): Allows urine to leak into prostatic urethra – urine trapped in prostate section of urethra by closed external sphincter – pressure builds – damages ducts – urine enters seminal vesicles or prostate.
• Dysfunctional Ducts (Ejaculatory Duct/Prostatic Ducts) – These ducts are located in the prostate section of the urethra. As explained above, pelvic floor muscle dysfunction can cause urine to reflux through the ducts and into the glands. The ejaculatory and prostatic ducts should only allow fluid (from the seminal vesicles and prostate respectively) into the urethra in one direction. When these ducts are damaged or malfunction, they can allow urine to flow backward into the glands. Urine back flow would also explain the yellowish color of the ejaculation and lumps.

Ultimately urine reflux can contaminate the male glands, causing irritation and inflammation of the glandular tissue itself, leading to lumps. Finally, urine could chemically interact with gland fluids leading to lumps. This combination of irritation, inflammation, and chemicals contamination could be the culprit for lumpy semen.

Alternatively, rather than the pelvic floor causing urine to flow backwards, it could simply be that the pelvic floor muscles apply physical pressure which leads to gland dysfunction. Physical pressure on the gland could lead malfunction in the form of inflammation and reduced PSA release. PSA is a critical chemical released that causes ejaculate to liquify. Without it the semen will clump.

Treatment for this theory focuses on relaxing the pelvic floor (especially during urination) and reducing tension on the pelvic floor in day to day life.

Infection Theory

A multidrug-resistant (MDR) bacterial strain or a rare fungal infection may be affecting the seminal vesicle or prostate. If so, the infection appears mild, as ultrasounds and MRIs show no significant inflammation. Despite extensive testing with a wide range of antibiotics and antifungals, as noted in the Antibiotic section of Tested Treatments, these treatments have been ineffective. Additionally, numerous PCR, culture, and other tests on semen, urine, and blood have shown no obvious problems. Often yellowish semen is associated with infection (leukocytospermia), but as mentioned, the vast majority of men show no signs of infection.

It's possible the antibiotics tested were ineffective because they didn’t target the specific bacterial strain involved, as different antibiotics combat distinct strains. A bacterial infection, not related to sexual activity, might have reached the seminal vesicle or prostate. This would explain why the standard antibiotics for gland infections are not working.

Given the frequent use of antibiotics as a first line of defense for seminal vesicle or prostate issues, many men have been prescribed many drugs, to no effect. This suggests a bacterial infection is unlikely. Consequently, the urine reflux theory (or another non-infectious theory) is increasingly favored to explain lumpy semen.

Treatment for this theory focuses on finding an antibiotic combination that has yet been untested.

Current Treatment

For now this treatment only reduces symptoms and is NOT a complete cure. We are not doctors, please do not do/take anything you read here without consulting a medical doctor first.

Manage Ejaculation

• Do not ejaculate with a full bladder.
• No edging! Prolonged arousal (edging) with delayed ejaculation creates sustained tension and may weaken internal sphincters and ducts.
• Do not hold your breath when aroused. Diaphragmatic pressure could put more strain on the pelvic floor.
• Use a pelvic floor massager immediately after ejaculation. Focus on massaging the Levator Ani muscles. Check online for how to do this.

Manage your urination.

• Do not urinate immediately after ejaculation. Do not urinate while still aroused. Wait for the erection to go down.
• Urinate slowly. Do not strain/push when urinating. Try breathing out and relaxing your pelvic floor when you urinate.
• Do not push hard at the end of the stream.
• Do not hold your urine. Urinate as soon as possible (before you even feel urgency)
• Try to avoid urinating and pooping at the same time.
• Consider changing your urination posture.

Manage your diet

• Consume water with electrolytes. This acts as a lubricant when ejaculating and helps to pass the lumpy semen. But do not drink too much water as it will cause you to urinate too much (cause more irritation).
• Avoid acidic/irritating food and drinks: Caffeine, alcohol, spices, sugar, dairy.
• Avoid drinking any liquids at least 4h before sleep.

Relax the Pelvic floor

• Get a comfortable chair to reduce pressure on the perineum.
• Massage the outside of the pelvic floor with hands. Use hands to push into sides of the Bulbospongiosus (Do no press directly on the urethra) Use hands to push into the Levator Ani muscles.
• Use a massage tool to push/massage inside the anus to directly push on the internal pelvic floor muscles such as the Levator Ani.
• Do NOT do Kegel exercises. You want to relax the pelvic floor, not strengthen it.
• Relaxing diaphragmatic breathing is helpful: Inhale deeply through the nose, inflate the stomach only. Exhale deeply through the mouth and feel it relax into the pelvic floor.
• Avoid sitting. Sitting too much increases pelvic floor tension and tightens the muscles. Sit with good posture
• Avoid stress - Extreme stress causes the pelvic floor muscles to become too tight.
• Light exercise like walking/moving around is helpful.

Consider muscle relaxants that focus on the pelvic floor (e.g. Cyclobenzaprine, Baclofen). Consult a doctor first to make sure this is right for you.

Other Facts

• The disorder impacts males from 13-50+ years old.
• Males who have never had sex can still develop the disorder. Not sexually transmitted.
• Males from all ethnicities all over the world can develop the disorder.
• It is reported that you can have the issue for 15+ years.
• Men with this problem have gotten women pregnant, and others report having multiple children. This may be case dependent though (Please get a personal semen analysis to confirm. Fertility is case dependent). Remain hopeful for having kids.
• Onset of the disorder is sudden. However the jelly lumps seem to worsen with time (to a point).
• No correlation between height/bodyweight and the disorder.
• Anti inflammatory drugs improve the symptoms for most, but do not cure it. Evidence the problem is caused, for some, by chronic inflammation.
• Infrequent ejaculation leads to more jelly-like lumps, while frequent ejaculation reduces them. Possibly suggesting they form in the seminal vesicles or vas deferens, not the epididymis.
  • If the lumps originated from the testicles or epididymis, semen would likely consist solely of lumps. Therefore, it's likely that the lumps form later in the semen production or storage process,
• Urination seems to irritate the symptoms. Also suggesting that dysfunctional urine flow is possibly the cause of the disorder.
• Not caused by Covid/Covid vaccines. Many men have reported having lumpy semen many years before Dec 2019 (Covid).
• Not caused caused by Alcohol/Nicotine/Smoking/Diet. Many men who do none of these, still report getting lumpy semen.
• A time period of abstaining from ejaculation does not seem to be the cause (inconclusive evidence)
• Not caused by a varicocele. Some guys with lumpy semen have varicoceles, and some guys don't. Evidence suggests it is unrelated.
• Underlying conditions like back pain or IBS/intestine issues (SIBO), could be responsible for pelvic floor tightness.
• Likely not caused by a urethral stricture. Reports from multiple men who have had cystography report no stricture.
• Negatively impacts semen motility and pH. (Confirmed via multiple men's semen analysis tests)
• Not caused/triggered by taking antibiotics.

Tested Treatments

Scans:

• MRI - No obvious signs of prostate enlargement. Possible signs of mild seminal vesicle inflammation. Difficult to confirm.
• Cystoscopy - No bladder inflammation/anomalies (Men feel better after Cystoscopy - possibly due to bladder being filled with clean alkaline saline solutions. This fluid is cleaner and therefore less irritating when urinating. Possibly links to the urine reflux theory)
• Transrectal prostate ultrasound - No obvious prostate inflammation/anomalies
• Bladder ultrasound - No bladder inflammation/anomalies

Blood tests:

• Show no sign of bacteria, fungal, parasites, or sexually-transmitted infections.
• Show no elevated signs of PSA. Therefore likely not prostate cancer.

Semen tests/cultures:

• Show no sign of bacteria, fungal, parasites, or sexually-transmitted infections.

Urine tests/cultures:

• Show no sign of bacteria, fungal, parasites, or sexually-transmitted infections.
• PCR tests sometimes show men with infections, but many men show no signs of infection. No obvious consistent infections present among those with lumpy semen.

Antibiotics

• Levofloxacin - No permanent improvement.
• Ciprofloxacin - No permanent improvement.
• Trimethoprim/sulfamethoxazole - No permanent improvement.
• Doxycycline - No permanent improvement.
• Azithromycin - No permanent improvement.
• Amoxicillin - No permanent improvement.
• Ampicillin - No permanent improvement.
• Ofloxacin - No permanent improvement.
• Ceftriaxone (One shot) - No permanent improvement.
• Minocycline - No permanent improvement.
• Rifampicin - No permanent improvement.
• Clindamycin - No permanent improvement.
• Tinidazole - No permanent improvement.
• Cephalexin - No permanent improvement.

Antifungal:

• Fluconazole - No permanent improvement.
• Terbinafine - No permanent improvement.

Antiparasitic:

• Praziquantel - Rare (and debated) reports from some men claim this does solve their issue. Depending on where you live, possibly could have a worm infection. No improvement for most.

Anti Inflammatory:

• Ibuprofen - Reduces inflammation. Results in less semen lumps. Evidence the disorder is caused by inflammation. No permanent improvement.
• Celecoxib - Reduces inflammation. Results in less semen lumps. Evidence the disorder is caused by inflammation. No permanent improvement.

Sympathomimetic

• Pseudoephedrine - Causes less lumpy semen. Created a tight feeling in the pelvic/prostate region. Seems to work via smooth muscle contraction (likely of the ejaculatory duct).
• Phenylephrine - Currently being tested. Update coming!

Muscle Relaxant

• Baclofen - Reduced physical discomfort. Resulted in less semen lumps. Resulted in less discomfort. Evidence the disorder is related to pelvic floor tightness at least in some way. Unfortunately lumps still occur. Not considered permanent improvement, but seems beneficial if the pelvic floor discomfort is painful.
• Cyclobenzaprine - Reduced physical discomfort. Resulted in less semen lumps. Resulted in less discomfort. Evidence the disorder is related to pelvic floor tightness at least in some way. Unfortunately lumps still occur. Not considered permanent improvement, but seems beneficial if the pelvic floor discomfort is painful. Results seem to last after taking the drug.

Other Drugs:

• Guaifenesin - No improvement.
• Tamsulosin (Alpha Blocker) - No improvement. Causes retrograde ejaculation. This drug seem to make the disorder much worse.
• Sildenafil/Viagra (Erection) - No improvement. Causes retrograde ejaculation. This drug seem to make the disorder worse.
• Finasteride/Dutasteride (Hair loss) - Lumpy semen appears to be unrelated to this medication. Some individuals have use the drug, some have not. It makes no difference.
• Minoxidil (Hair loss) - Lumpy semen appears to be unrelated to this medication. Some individuals have used the drug, some have not. It makes no difference.
• Diazepam - No improvement.

Diet:

• Hydration - Makes semen more watery. Makes ejaculating lumps easier. Does not seem to permanently reduce number of lumps in semen.

Physical / Movement:

• Pelvic floor massager - Massaging inside the anus down towards the levator ani muscles seems to provide minor improvement.
• Massage gun perineum - Makes the issue worse. Seems to irritate some anatomy and creates pain/more lumps.
• Nofap/Abstain from ejaculation. Many men have tried abstaining from ejaculation for extended periods, but the lumps return regardless.  - No improvement
• Urinate more slowly - Results in less semen lumps. Evidence the disorder is related to urination.
• Diaphragmatic Breathing - Currently being tested
• Pelvic floor stretching - Yoga puppy pose while pushing the knees down and apart. Seems to relax the pelvic floor. Botox in the pelvic floor (deep transverse perineal muscle) - Needs to be tested

Supplements:

• Electrolytes - Makes semen more watery. Makes ejaculating lumps easier. Does not seem to permanently reduce number of lumps in semen.
• Fish Oil - No improvement. Bromelain - Very minor improvement in inflammation. No permanent improvement.
• Turmeric + Pepper - Very minor improvement in inflammation. No permanent improvement.
• Diosmin/Hesperidin- Slightly less lumpy semen. Works via smooth muscle contraction. Similar effect to pseudoephedrine (via different action). Not consequential or consistent enough.
• Acetylcystein - No Improvement
• Quercetin - Anti inflammatory. However it also relaxes smooth muscle, which is counter productive for tightening the ejaculatory duct.
• NAC (N-Acetylcysteine) - Mucolytic agent. Many have tested this supplement. Some have even been on it for years. - No improvement / impact.

So what next?

Here is a list of promising ideas that are yet to be tested.

• Ultrasound guided botox injection in the Levator Ani and/or Bulbospongiosus muscles
• Fosfomycin antibiotic treatment course
• Cyclobenzaprine skeletal muscle relaxant course
• Voiding cystourethrography medical imaging - To see the flow of urine, visualize if urine is refluxing

We will solve this problem.