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Seeing bloody semen can cause anxiety for men.
Fortunately, this does not necessarily indicate a serious health problem - and is common in men of all ages, especially after puberty. In younger men (less than 40 years), the condition of bloody semen that is not followed by other symptoms can be categorized as benign. Even in men aged 40 years and over, this condition is also rarely associated with malignancy.
The condition of bleeding semen in the medical world is called hematospermia or hemospermia. When men ejaculate, they usually don't check their semen for blood - making it hard to know how common this condition is.
The main cause of bleeding semen
In order to understand the causes of hematospermia, it is worthwhile to first arm yourself about the relevant anatomy of the ejaculatory system.
The male reproductive system consists of the testes, a system of ducts (tubes), and glands that open into these ducts. Sperm are produced in the testes. During orgasm, contraction of the penile muscles releases sperm, which are accompanied by a small amount of fluid, from the testes through the vas deferens. The seminal vesicles and prostate contribute to releasing additional fluid to protect sperm. The mixture of sperm and ejaculatory fluid (semen) travels along the urethra to the tip of the penis, where the fluid comes out. Bleeding can occur anywhere during this process.
Blood in semen can be caused by inflammation, viral or bacterial infection - including venereal infections such as genital herpes, trichomoniasis, gonorrhea or chlamydia - blockage, or injury somewhere along the male reproductive system. The seminal vesiculas (two pairs of glandular like sacs located on either side of the bladder) and the prostate are the two main organs that contribute to the production of the sperm-protective fluid (semen). An infection, inflammation, or trauma to any of these organs can cause blood to appear in the semen. Infection and inflammation are the main culprits behind nearly four out of every ten reported cases of bloody semen.
In addition, blood in semen is a common side effect after certain medical procedures. For example, as many as four in five men, quoted from WebMD, may have temporary bleeding in their semen after having a prostate biopsy. The procedures performed to treat problems with the bladder system can also cause minor trauma that causes temporary bleeding. This condition will usually disappear a few weeks after the procedure. Radiation therapy, vasectomy, and injection of hemorrhoids can also cause blood to appear in the semen.
These causes are generally not serious and most cases will resolve on their own without special treatment, or after taking antibiotics or painkillers / anti-inflammatory drugs.
Other causes of bloody semen are rarer
Physical trauma to the sex organs after a broken hip, injury to the testicles, or other injuries can cause semen to bleed. Blood in the ejaculatory fluid can be seen during / after rough sex or excessive masturbation, but this is not the cause of bleeding. Severe trauma to the bladder can cause bleeding from the urethra, but this is different from hematospermia.
Other less common causes of bloody semen include:
- Severe hypertension
- Blood clotting disorders, or problems with blood vessels - All of the fine structures involved in the ejaculation process, from the prostate to the tubes that transport the sperm, contain blood vessels. This blood vessel complex can be damaged, causing blood to appear in the semen.
- Cancer - including prostate cancer, testicular cancer, and bladder cancer; however, most men with prostate cancer will not show these symptoms unless they have had a prostate biopsy that causes bleeding.
- Seminal vesicle calculi - deposition of small rocks in the seminal vesicles
- Other medical conditions - HIV, liver disorders, leukemia, tuberculosis, parasitic infections, hemophilia, and other medical conditions associated with bleeding in the semen.
Some of the conditions above are more serious and may require specialist treatment.
When to see a doctor?
Your doctor will try to determine if the cause of your bleeding semen is likely to be serious or not.
To diagnose blood in your semen, your doctor will take a complete medical history. This log will cover any of your recent sexual activity.
Apart from taking a medical history, the doctor will also need to consider several things, such as:
- How often do you have bleeding in the semen
- Do you have any other symptoms
- Your age
They may also need to run several tests, including:
- Check your blood pressure
- Urine and blood tests
- Physical examination, which includes examining lumps or swelling of the genitals; and manual / digital rectal examination to detect prostate swelling, pain, thickening, and other symptoms.
If you are less than 40 years old, have only had 1-2 bloody semen, and the test results do not show you have a serious underlying medical condition, you do not need a hospital referral.
However, if you are 40 years of age or older, experience recurring symptoms of bloody semen that do not go away, or if the test results suggest another potential medical cause underlying your current condition, your doctor will refer you to a urologist, a specialist who deals with urinary system problems. Follow-up with the urologist may include performing a biopsy of the prostate gland or a digital scan using an ultrasound scan.
