Blood in Semen: Causes, Tests, and What to Watch For

Q: Blood in Semen: Causes, Tests, and What to Watch For

Hello： In response to your question, what is hematospermia? Hematospermia is the presence of blood in the semen, which may appear as spots or clots, giving the semen a brown or red color. <br>According to statistics, more than half of patients may experience recurrent episodes of

Hematospermia

Hello Doctor: During intercourse with my wife, I noticed that the semen had a dark red color, close to brown.
I underwent a urinalysis, and the result showed a trace of blood (+1).
What could this condition indicate? What further tests are needed? What should I be aware of? Thank you.

Ruiwen, 40~49 year old female. Ask Date: 2007/04/12

Dr. Cai Zongyou reply Urology

Hello: In response to your question, what is hematospermia? Hematospermia is the presence of blood in the semen, which may appear as spots or clots, giving the semen a brown or red color.
According to statistics, more than half of patients may experience recurrent episodes of hematospermia weeks to years after the initial occurrence.
Hematospermia can cause significant anxiety for men and their sexual partners, as it may indicate infections, tumors, or other issues affecting the urethra, prostate, or seminal vesicles.
It typically occurs in men who are sexually active, with a peak incidence between the ages of 20 and 40.
Often, patients are unaware of the condition until it is noticed by their wives or sexual partners, with an incidence rate of approximately 1% based on our hospital's statistics.
What diseases can cause hematospermia?
1.
Trauma - such as urethral injury
2.
Inflammatory conditions - such as urethritis, prostatitis, seminal vesiculitis, and urinary tuberculosis
3.
Tumors - such as benign prostatic hyperplasia, prostate cancer, and seminal vesicle tumors
4.
Congenital issues - such as ectopic ureters, where the ureter opens into the urethra, which can lead to hematospermia
5.
Vascular factors - such as mucosal hyperplasia of the seminal vesicles, abnormal or engorged blood vessels in the posterior urethra
6.
Other factors - such as liver cirrhosis, schistosomiasis, and leukemia
If blood is present in the initial portion of the ejaculate, it usually indicates a urethral issue.
If blood appears in the later portion of the ejaculate, prostate and seminal vesicle problems should be considered.
The presence of blood in the semen often shocks patients, leading them to believe they have a terminal illness; however, statistics show that most causes of hematospermia are due to benign conditions.
The likelihood of hematospermia being a manifestation of cancer in the prostate, urethra, or seminal vesicles is relatively rare.
Nevertheless, if hematospermia occurs, it is essential to consult a urologist for a thorough examination and appropriate treatment.
Diagnostic evaluations may include:
1.
Urinalysis - to check for urinary tract inflammation
2.
Semen analysis - to confirm the presence of blood and assess sperm count, motility, morphology, and any signs of inflammation
3.
Digital rectal examination - to assess the size of the prostate and check for pain, swelling, or tumors
4.
X-ray examinations - such as intravenous pyelography to check for ectopic ureters or urethral injuries
5.
Ultrasound - to evaluate for tumors in the prostate or seminal vesicles
6.
Cystoscopy - to assess prostate size, vascular congestion, and the normalcy of the urethra
7.
Other tests - such as urine cultures to identify bacteria causing inflammation in the urethra, prostate, or seminal vesicles, and cytological examinations of urine to detect suspicious malignant cells.
Additionally, imaging studies like CT scans or MRIs can help identify lesions in the prostate or seminal vesicles.

Reply Date: 2007/04/12

More Info

The presence of blood in semen, known as hematospermia, can be alarming and may indicate various underlying conditions. The dark red or coffee-colored appearance of the semen suggests that the blood may be older, which can be due to several reasons. It is essential to approach this situation with a thorough understanding of potential causes, necessary tests, and what to monitor moving forward.

Possible Causes of Hematospermia
1. Infection or Inflammation: Conditions such as prostatitis (inflammation of the prostate), epididymitis (inflammation of the epididymis), or urethritis (inflammation of the urethra) can lead to blood in the semen. These infections may also present with other symptoms like pain during ejaculation or urination.

2. Trauma: Any recent trauma to the pelvic area, including vigorous sexual activity or injury, can result in bleeding.

3. Benign Prostatic Hyperplasia (BPH): An enlarged prostate can lead to bleeding, especially in older men.

4. Prostate or Testicular Cancer: Although less common, hematospermia can be a sign of malignancy. It is crucial to rule this out, especially if there are other concerning symptoms or risk factors.

5. Vascular Issues: Abnormal blood vessels or varicoceles (enlarged veins in the scrotum) can also cause bleeding.

6. Systemic Conditions: Conditions affecting blood clotting, such as hemophilia or the use of anticoagulant medications, can lead to hematospermia.

Recommended Tests
Given the presence of blood in your semen and the positive urine test for hematuria (blood in urine), it is advisable to undergo further evaluation. Here are some recommended tests:
1. Physical Examination: A thorough examination by a urologist to check for any abnormalities in the genital area.

2. Transrectal Ultrasound: This imaging test can help visualize the prostate and surrounding structures to identify any abnormalities.

3. Prostate-Specific Antigen (PSA) Test: This blood test can help assess prostate health and screen for prostate cancer.

4. Urinalysis and Urine Culture: To check for infections or other abnormalities in the urinary tract.

5. Cystoscopy: In some cases, a urologist may recommend this procedure to directly visualize the inside of the bladder and urethra.

What to Watch For
While awaiting further evaluation, it is essential to monitor any additional symptoms that may arise, including:
- Pain: Any persistent pain in the lower abdomen, pelvis, or during urination or ejaculation.

- Changes in Urination: Increased frequency, urgency, or difficulty urinating.

- Fever or Chills: These could indicate an infection.

- Changes in Semen: Any further changes in color, consistency, or volume.

Conclusion
In summary, the presence of blood in your semen warrants a thorough evaluation to determine the underlying cause. While it can be benign in many cases, it is essential to rule out more serious conditions. Consulting with a urologist will provide you with the necessary guidance and testing to address your concerns effectively. In the meantime, keep track of any additional symptoms and do not hesitate to seek immediate medical attention if you experience severe pain or other alarming symptoms.

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