Blood in Semen (Hematospermia)
What is Hematospermia?
Hematospermia is the presence of blood in the semen. The semen is composed of secretions from the testes, epididymis, urethral glands, prostate gland, and seminal vesicles. The clear secretion from the urethral glands accounts for 0.1-0.2 ml, the milky white prostate gland secretions account for 0.5 ml, and the viscous secretions from the seminal vesicles for 1.5-2.0 ml. Hematospermia may cause blood in the initial, middle, or terminal portion of the ejaculate. The color of the semen can vary from bright red, indicative of recent or active bleeding, to a rust or brown color, indicative of old bleeding. Hematospermia is not uncommonly encountered in men and usually results from prostate or seminal vesicle inflammation. It is almost always benign and self-limited (goes away on its own), resolving in several weeks. In a very small minority of individuals, hematospermia may become recurrent or chronic, causing great concern and anxiety.
ALTHOUGH BLOOD IN THE SEMEN MAY BE FRIGHTENING, IT IS ONLY RARELY A SIGN OF AN UNDERLYING PROBLEM!
Evaluation for hematospermia usually involves a digital rectal examination of the prostate to check the size and consistency, a urinalysis to check for urinary infection and blood in the urine, and a PSA (prostate specific antigen) blood test. If infection is suspected, hematospermia can managed with oral antibiotics. Only if the bloody ejaculations fail to respond is further workup required. This may involve prostate ultrasound with possible prostate biopsy and cystoscopy. Prostate ultrasound, done via the trans-rectal route, will commonly show dilated seminal vesicles, ejaculatory duct cysts, and ejaculatory duct or seminal vesicle stones. Cystoscopy, a visual inspection of the lower urinary tract with a small-caliber, flexible instrument will enable inspection of the inner aspect of the prostate and urinary bladder. Please inform your urologist if you develop new urinary symptoms (such as pain, blood in the urine, urinary frequency) or if the hematospermia doesn’t go away after a few weeks.