What is Hematospermia?
Hematospermia is defined as blood in semen. This could be frightening for a man when we notice blood in semen. Usually, the cause of blood in semen is benign and the blood will go away on its own. It is usually not likely to be a sign of a major health problem.
Causes of blood in the semen
The most common causes of blood in semen are:
- Trauma: could be due to some procedure (eg: prostate biopsy, vasectomy and so on)
- Treatment of prostate cancer with radiation or brachytherapy
- Leaking of blood from small blood vessels that burst during ejaculation
- Infection: prostate, seminal tract, testicular or epididymal infection
- Sexually transmitted infection (STI/STD)
Other potential causes:
- Blood disorder: clotting disorder
- Cancer: (eg: prostate cancer, bladder cancer, testicular cancer and so on)
- Other medical problems: uncontrolled blood pressure, HIV, liver disease, leukemia, tuberculosis
When to see a doctor?
Usually, blood in the semen will resolve by itself without treatment for someone under the age of 40. However, is it still better to see a doctor to make sure that the condition is harmless.
Those who have the risk and symptoms below need to see a doctor for further investigation:
- Age 40 and above
- Persistently having blood in semen for more than 4 weeks
- Have repeatedly recurring blood in semen
- Painful urination
- Risk of sexually transmitted disease
- Underlying blood disorder or cancer
- Palpable lesion/mass in scrotum region
What to expect when you see a doctor?
A detailed history will be taken. Usually, your doctor will need to know about your medical background for example any underlying disease, history of trauma/procedure, any medications, duration of symptoms and so on.
Besides history, doctors will perform physical examinations which include blood pressure monitoring, looking for signs of a bleeding disorder, examination of testis/scrotum and digital rectal examination to check on the prostate.
What test will be done?
The decision on what test should be done will be based on the findings from the physical examination.
The common tests that will be ordered are:
- Blood test to check on bleeding disorder: full blood count, coagulation profile, liver function test
- Urine test: to screen for urinary tract infection or sexually transmitted disease
- Prostate specific antigen (PSA) to rule out the prostate problem
Further test:
- Semen analysis
- Ultrasound of scrotum: to look for testicular lesion
- Transrectal ultrasound: to look for prostate problem
- CT scan and MRI of the urinary system
How is blood in semen treated?
Treatment is based on the cause identified from physical examination and result of blood/urine test. If there are no urinary tract symptoms and other medical conditions with normal test results, likely no treatment is needed. The symptoms most likely will resolve on their own.
If the cause for blood in semen is identified, the treatment will be given based on the causes.
For example:
- Antibiotics if there is an infection
- Finasteride if due to enlarged prostate
- Stop taking blood thinner if someone on blood thinner with an abnormal coagulation profile
- Surgical excision of lesion or cyst
- Endoscopic treatment
