What Are The Causes and Treatment of Blood in the Semen?

Hematospermia is a condition whereby small to large amount of blood is seen in semen after ejaculation. It is not well known how common this condition is because most men do not observe their semen. However, in the clinical setting it is thought to be seen most in men younger than 40 years of age.

Should I be worried?

In the past hematospermia was thought to be due to prolonged sexual abstinence, excessive masturbation, and rigorous sexual intercourse. However, with advancement in imaging and testing it is thought to be a result of one or more of the following causes too:

  1. Benign and malignant tumours of the bladder, urethra, prostate, seminal vesicles, spermatic cord, epididymis, and testes
  2. Systemic illnesses, for instance
    • High blood pressure
    • Bleeding disorders
    • Liver disease
    • Lymphoma
  3. Cysts in the seminal vesicles
  4. Varicoceles (the enlargement of scrotum veins)
  5. Trauma
    • After prostate biopsy
    • Injuries to the pelvis or genitals
  6. Sexually-Transmitted Diseases (STD):
    • Chalmydia
    • HIV
    • Herpes
  7. Other infections
    • Tuberculosis
  8. Prostate disorders
    • Prostate cancer
    • Prostate infections (leads to inflammation of the prostate gland)
    • Prostate stones

What are the next steps if I have hematospermia?

Most of the time it is due to benign causes. Patients who developed this infection should seek immediate professional medical help for further advice.

When doing so, doctors will take a detailed account of your medical history. This includes notable illnesses in your family’s history as well as any previous injuries, medications, surgeries or other symptoms.

Next, doctors will perform an in-depth physical examination. They will check your blood pressure, see if your lymph nodes are swollen, and inspect your scrotum. In addition to that, the doctor may even need check your prostate and will then carry out a Digital Rectal Examination.

What are some of the tests that needs to be done?

Further tests are dependent on the results of the physical examination. If the cause of your hematospermia is still undetermined, the doctor may follow through with more tests, such as:

  • Urine tests (to screen for any STDs)
  • Blood tests (in order to check for any bleeding disorders, infections or any other diseases)
  • Ultrasound of the scrotum (To exclude testicular lesions)
  • CT scan or MRI depending on the results of the above tests.

Will hematospermia go away by itself? Do I need treatment?

The treatment for hematospermia varies depending on the specific cause. In about half the cases, there is no identifiable cause due to the tests’ results showing no abnormalities. In this situation the semen will probably be free of blood after 10 ejaculations.

If the blood is still present after this, please seek help from your doctor again, in which they will likely recommend more tests.
The patients are usually followed up every 3 to 6 months and in uncommon situations, a referral to a urologist will be done.

What is pseudo-hematospermia?

It is when other conditions are misinterpreted as hematospermia. This can happen when the patient has hematuria (Blood in the urine) or the blood may have been from the patient’s sexual partner.

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