Seminal Vesicle Disorders

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Seminal vesicle disorders[i] are hardly ever reported and most are extremely rare.  Since they are often overlooked, men need to know their own bodies and ask the appropriate questions at a healthcare visit if they exhibit multiple signs or symptoms of seminal vesicle disorders.  There are a few different types of disorders. 

 

 

SEMINAL VESICULITIS (SV)

This is an inflammation of the seminal vesicles.  When this occurs, men often have other inflammation or infections of the reproductive tract - prostate (prostatitis), urethra (urethritis), and epididymis (epididymitis).  Diagnosis of this disorder is often based on symptoms as well as a digital rectal exam, since the seminal vesicles can be felt above the prostate. Symptoms of seminal vesiculitis sometimes overlap the symptoms of prostatitis, including:

  • Painful ejaculation

  • Burning or pain after ejaculation (Odynorgasmia)

  • Red/pink/or brown semen (hematospermia)

  • Decreased semen volume

  • Red or orange urine

  • Few sperm in semen (oligospermia)

  • No sperm in semen (azoospermia)

  • Extremely thick semen (seminal hyperviscosity)

  • Pelvic pain

  • Lower back and waist pain (flank pain)

  • Abdominal pain

  • Intraabdominal swelling

  • Constipation

  • Blockage of the bowel (bowel obstruction)

  • Diarrhea

  • Inflammation of the epididymis (epididymitis)

  • Passing out (syncope)

  • Groin pain

  • Feeling of incomplete defecation/pooping (rectal tenesmus)

  • Severe episodes of rectal pain (proctalgia fugax)

  • Gas bubbles in the urine (pneumuria)

  • Gas bubbles in semen (penumospermia)

  • Inguinal hernia

 

Treatment depends on the cause, but oftentimes is treated with antibiotics in conjunction with prostatitis.

 

 

CONGENITAL ABNORMALITIES

It is possible for the seminal vesicles to be absent, be abnormally small, or not produce the correct nutrients and fluids necessary to make semen nourishing the sperm.  Simply being born without one or both seminal vesicles is a condition called Seminal Vesicle Agenesis.  Seminal Vesicle Hypoplasia on the other hand is when one or both seminal vesicles are abnormally small.  These two conditions rarely have symptoms other than lower semen volumes and potential infertility issues.   Neither of these conditions can be treated; however, work arounds for infertility may still be possible.  It isn’t uncommon for men with Cystic Fibrosis (CF) to present with either of these conditions.  In addition, men with CF can also have abnormalities of the seminal vesicles where they don’t produce the prostaglandins and fructose that is vital for sperm transport and nourishment – leading to infertility.  These disorders are usually discovered through a transrectal ultrasound called a TRUS.  During a TRUS an ultrasound is inserted in the rectum next to the prostate and seminal vesicles as seen below:

 

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SEMINAL VESICLE CYSTS

Cysts can form in the seminal vesicles leading to infertility issues as well.  One type of giant cyst called Seminal Megavesicles causes the seminal vesicles to become enlarged.  Other types of rarer cysts can be caused by parasitic infections, these are called Hydatid Cysts.  A final type of cyst can be present at birth where the ureters can connect to these cysts – this is called Zinner Syndrome.  Surgical correction can be performed if warranted, although surgery rarely restores fertility.

SEMINAL VESICLE HEMORRHAGE

This presents itself when bleeding occurs in the seminal vesicles.  The main symptom is hematospermia (blood in the semen) or red to pink semen.

 

DISORDERS ASSOCIATED WITH DIABETES

A disorder called Hypotonic Seminal Vesicles can be caused by diabetes mellitus.  This occurs when high blood sugars over time decrease nerve conduction.  This can affect the nerves that lead to the seminal vesicles.  This can result in less seminal vesicle fluid being produced and ultimately infertility.  Adequate and early treatment of diabetes is vital in preventing this disorder.

DISORDERS ASSOCIATED WITH AGING

One disorder that typically only occurs in older men versus younger men is Seminal Vesicle Amyloidosis.  This occurs when aging seminal vesicles have a buildup of a protein called amyloid.  This too can cause hematosperia (pink/red semen) and can be associated with prostatitis. 

 

SEMINAL VESICLE STONES

Another cause of hematospermia is calcification of the seminal vesicles as well as formation of seminal vesicles stones.  Men with calcification of the seminal vesicles can report flank pain (lower back and waist pain) while men with seminal vesicle stones often report painful ejaculation.

SEMINAL VESICLE INFECTIONS

As stated previously, Seminal Vesiculitis is the most common result of infections of the seminal vesicles.  However, abscesses are possible as are infections of cysts in the seminal vesicles.

TUMORS

A variety of tumors or cancers have been reported although they are very rare.  In addition, cancer of the nearby colon and rectum can cause a fissure or opening into the seminal vesicles called a fistula.

[i] Dagur G et. al., Int J Reprod Biomed (Yazd). Detecting diseases of neglected seminal vesicles using imaging modalities: A review of current literature 2016 May; 14(5): 293–302. (pubmed PMC4910035)

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