Dear Dr. G,

I am a 40-year-old divorcee facing a bit of a problem, and hope Dr. G can help me resolve my conundrum.

Since I remember from my early days of engaging in sex, I have been troubled by excessive pre-cum.

I just get this secretion from the tip of my penis, when I am aroused. In fact, on occasions when I'm not particularly aroused, I also get this troubling discharge.

Initially, I got worried as I thought I might have caught some sexually-transmitted infections. But the doctor confirmed it was all pre-cum.

Although the condition is a nuisance, I have not been particularly troubled by it.

I have recently started a relationship with someone 10 years younger than myself, one year after my divorce.

Although it has been going well, I am not too sure I want to commit myself so soon after the divorce.

I am shocked to learn my girlfriend said her period is late and she may be pregnant. The fact is, I do not recall having ejaculated in her at all. How can this be the case? Can one really get pregnant with pre-cum?

I am desperate to put Dr. G on the spot to resolve the mystery of pre-cum.

What exactly is pre-cum? Why am I getting such excessive pre-cum? Can it be treated? Lastly, is there even a remote possibility someone can get pregnant with pre-cum?

Troubled Thomas

The clear and colourless viscous fluid emitted at the tip of the penis is called pre-ejaculatory fluid, or colloquially known as pre-cum. The secretion is recognised to be pre-seminal fluid excreted by Cowper's gland, which is a pea-sized gland located near the tip of the penis.

The composition of the pre-ejaculatory fluid is similar to the semen, acting as the lubricant for penetrative intercourse and neutraliser for the hostile acidity of the vagina.

Although pre-cum is emitted during arousal, foreplay and early stages during sexual intercourse, the secretion is variable between individuals. On one hand, some men may emit as much as 5ml of the pre-seminal fluid before climax, and others do not produce any pre-ejaculate fluid at all.

The key composite of the pre-ejaculatory fluid is acid phosphatase, which neutralises the acidity of the urine in urethra, creating a favourable environment for the passage of sperms. The delivery of pre-cum into the vagina also alters the acidity of the vaginal environment promoting sperm survival. Lastly, pre-ejaculate is also believed to play a role in semen coagulation and lubrication for intercourse. The big question is whether the pre-cum contains sperms.

The detection of sperms in pre-cum, having the potential resulting in pregnancy dates back more than five decades by the famous Masters and Johnson in 1966.

A more recent study on the presence of sperm in pre-ejaculatory fluid revealed a significant number of men had motile sperm in the samples they provided for analysis. A total of 11 of the 27 participants had sperms in pre-cum, and most of the samples demonstrated motile active sperms. Another similar study demonstrated 16.7% of healthy men had motile sperms in the pre-ejaculates.

Pre-cum is never voluntary and obviously its amount and frequency cannot be stopped or controlled. Many clinicians have investigated the overproduction of pre-cum, and in rare cases the excessive production can be a source of embarrassment and mistaken to be premature ejaculation. Some experts advocate the use of prostate shrinking agents such as finasteride or dutasteride as the mean of reducing the emission. However the outcome has been unpredictable.

Leonardo da Vinci famously said: "I love those who can smile in trouble, who can gather strength from distress and grow brave by reflection. It's the business of little minds to shrink, but those whose heart is firm and conscience approves their conduct will pursue their principles unto death!"

In reality, even with the best form of protection, it is always possible for sexual intercourse (in this case, pre-sexual intercourse) to result in unwanted pregnancy.

Although some men may be completely oblivious of the existence of pre-cum, for others the minor nuisance in pre-sex may land in the big trouble of unplanned fatherhood!

When Dr. G is put on the spot by the troubled men with the fear of "accidental" fatherhood induced by pre-ejaculatory fluid, his response is "Smile in trouble, gather strength from distress and grow brave with reflection!" as upon reflection the small nuisance of pre-ejaculatory fluid "emitted in those whose hard is firm, whose sub-conscience of their conduct, that will pursue the troubled consequences of pre-cum unto death!" I guess the last thing to do is to congratulate Troubled Thomas on his new cumming of fatherhood!