Adult Edition: Will the semen run out? Red spots on the glans and smegma.

**52. Will the semen all flow out?**

Semen consists of sperm and seminal plasma, with sperm comprising a small portion (approximately 5%) and the remainder being seminal plasma. Seminal plasma contains water, fructose, proteins, fats, various enzymes, and inorganic salts. Sperm are produced by the testes, while seminal plasma is secreted by the prostate gland, seminal vesicles, and bulbourethral glands. Seminal plasma serves as a nutrient for sperm. Normal semen is milky white, pale yellow, or colorless. The sperm count per milliliter of semen is generally between 60 million and 200 million. More than 60% of sperm are motile, while less than 10% are abnormal. Sperm motility lasts for 3–4 hours at room temperature.

Semen quality is easily affected by various factors, the most common of which are:

(1) Unhealthy lifestyle habits and reproductive tract infections primarily affect sperm production and transport, leading to oligospermia and decreased fertility. Reproductive tract infections can also cause changes in sperm motility, inhibit the secretion of accessory glands, and severely reduce sperm motility and quantity, resulting in infertility.

(2) Smoking and Alcohol Abuse: Men are particularly sensitive to the toxins in tobacco and alcohol, especially their reproductive cells. Nicotine in tobacco can reduce the secretion of sex hormones and kill sperm. Long-term alcohol abuse can damage the spermatogenic cells of the testes and affect sperm production.

(3) Damage to the testes from a warm environment The testes are the organs that produce sperm. When the scrotum is in a high-temperature state, it will affect the spermatogenic function of the testes.

(4) Improper diet and nutritional deficiencies, such as vitamin A deficiency, can lead to failure of seminiferous epithelium growth; vitamin B deficiency can affect pituitary function and reduce fertility; and deficiencies in trace elements such as zinc and magnesium can also affect sperm production and motility.

The prostate, seminal vesicles, and bulbourethral glands, like our salivary glands, can produce seminal fluid with proper stimulation, so semen doesn't always leak out. However, sperm production in the testes follows a specific cycle. It's currently estimated that human sperm development to maturity requires four cycles, taking approximately 64 days. Therefore, not every semen sample contains a large number of sperm. This is why sexual activity must be stopped for 2-7 days before semen collection, and masturbation and nocturnal emissions should be avoided.

**53. What causes recurring red spots on the glans penis?**

We often encounter patients who develop red spots on their glans penis and become very anxious, constantly worrying that they might have contracted a sexually transmitted disease. Actually, this isn't the case; red spots on the glans penis are most commonly caused by balanitis.

Balanitis is an inflammation of the glans penis mucosa, which can be caused by various pathogens, local irritation, and other factors. Symptoms include local erythema, swelling, itching, and sometimes erosion and exudation. The most common causes include:

(1) Phimosis or redundant foreskin: In cases of phimosis or redundant foreskin, the glans penis is covered by the foreskin for a long time and can only be exposed by manually retracting it during daily cleaning. In particular, patients with phimosis cannot retract the foreskin and suffer from balanitis in the long term.

(2) Neglecting local hygiene: If men do not pay attention to local hygiene, the secretions from the sebaceous glands of the foreskin can easily accumulate under the foreskin and form smegma, which can easily induce balanitis.

(3) Frequent masturbation: Overly rough masturbation can damage the foreskin. These damages are easily contaminated by bacteria, which can lead to balanitis in the long term.

Recurrent balanitis can not only lead to secondary infections of the urinary system but also harm the reproductive system, potentially causing infertility. Therefore, we must take effective measures to prevent and actively treat balanitis. First, we must eliminate irritants, such as circumcision for patients with phimosis, and pay attention to local hygiene. Second, we must abstain from the bad habit of masturbation. When inflammation, erosion, and exudation occur on the glans, we can use a 3% boric acid solution for wet compresses. Finally, we must adopt effective anti-infective treatments targeting different pathogens.

54. What causes the white smegma on the glans and inside the foreskin?

Many men with phimosis are troubled by the presence of white smegma on the inside of their foreskin. It reappears after 1-2 days even after washing, without causing pain or itching, but they always feel unclean. This white smegma is actually "smegma."

Just as the skin in other parts of the body secretes sebum, the sebaceous glands of the foreskin also secrete sebum. Because phimosis or redundant foreskin prevents it from being retracted, this sebum accumulates in the space between the inner surface of the foreskin and the glans penis. At the same time, urine seeps into this space, reacting chemically with the sebum to form smegma, which produces a foul odor. Long-term accumulation of smegma can harden into lumps, leading people to mistakenly believe that some kind of "tumor" has developed.

Smegma does pose certain risks. It can cause frequent inflammation of the foreskin and glans penis. Long-term inflammation can lead to degeneration and deterioration of local penile tissue cells, creating a poor environment for the glans penis, which can lead to precancerous lesions and easily transform into penile cancer.

How to deal with smegma? Pay attention to personal hygiene and clean the foreskin frequently. Generally, washing with water is sufficient; it's best to avoid using detergents as they can irritate the foreskin. If the foreskin is too long, seek treatment promptly, and circumcision may be necessary. Long-term irritation from smegma can cause redness, swelling, pain, and itching of the glans and foreskin. If these symptoms occur, consult a urologist for examination and treatment.