Differential Diagnosis for Leakage of Semen

Single most likely diagnosis

• Retrograde ejaculation: This condition occurs when semen enters the bladder instead of exiting through the penis during ejaculation, but it can also cause leakage of semen in the absence of ejaculation due to the abnormal flow of semen. It's a common issue in diabetic patients or those with certain medications or neurological conditions affecting the bladder neck.

Other Likely diagnoses

• Urethral stricture or injury: Any damage or narrowing of the urethra can lead to abnormal semen leakage due to obstruction of the normal flow of semen.
• Prostatitis or prostate infection: Inflammation of the prostate gland can cause semen to leak due to the increased pressure and irritation in the prostate area.
• Bladder neck dysfunction: Issues with the bladder neck, such as weakness or incompetence, can lead to semen leakage as the bladder neck fails to close properly.

Do Not Miss (ddxs that may not be likely, but would be deadly if missed)

• Testicular or epididymal cancer: Although rare, testicular cancer can cause changes in ejaculation or semen leakage. Early detection is crucial for effective treatment.
• Spinal cord injury or disease: Certain spinal conditions can disrupt the normal nerve control over ejaculation, leading to semen leakage.

Rare diagnoses

• Cowper's gland dysfunction: The Cowper's glands produce pre-ejaculate fluid, and their dysfunction can lead to abnormal leakage, though this is less common.
• Epididymal cyst or spermatocele: These are benign cysts that can cause discomfort and potentially lead to semen leakage, though they are not typically associated with significant leakage in the absence of other symptoms.