Definition and Overview

Hematospermia is a general term that refers to the presence of blood in the semen, or the fluid ejaculated from the male genitalia.

Contrary to popular belief, hematospermia can be a benign symptom and not an automatic indicator of a serious condition (like prostate cancer). This is especially true for healthy young men, particularly those who do not have risk factors for serious urological diseases. In most cases, the symptom will go away on its own, without the need for medication, management, or intervention.

However, patients over forty years old, who have experienced the symptom along with blood in urine and who are at risk of serious conditions such as blood disorders or cancer, are highly encouraged to consult a urologist.

Causes of Condition

There are many factors and conditions that can cause hematospermia, and most of them are related to the male reproductive system. Unlike the female reproductive system, the male reproductive system is closely linked with the urinary system that deals with waste disposal. The organs in a male individual’s pelvic area are collectively known as the urogenital system. The bladder, rectum, prostate, urethra, and testis are not only close to each other, but they also share common pathways. Thus, the presence of blood in the semen, which passes through the urethra (which also serves as the passage for urine), can point to a wide variety of conditions affecting the urogenital system.

Below are the common causes of hematospermia:

  • Broken blood vessel in the urethra. Like urine, sperm and seminal fluid pass through the urethra, and if the blood vessels in this passage are broken, they will leak blood. During an initial consultation with a doctor or a urologist, the patient will be asked if he has recently undergone a procedure for the prostate, such as surgery, external beam radiation for cancer treatment, or a biopsy, since this could be a cause for broken blood vessels. In this case, the blood in the semen will eventually disappear after a couple of weeks.

  • Infection. Many medical professionals believe that infection, as well as the subsequent inflammation that occurs as the body tries to fight the infection, is the most common cause of blood in the semen. The infection can affect various parts of the urogenital system, especially the ones responsible for the production and passage of sperm and seminal fluid.

  • Sexually transmitted infection such as chlamydia or gonorrhoea. The urogenital system is also susceptible to a wide variety of bacterial and viral infections, which are the main cause of four out to ten cases of hematospermia.

  • Trauma to the blood vessels. Blood is circulated in the body through the blood vessels, and the male reproductive organ has a complicated network of them. Any form of trauma or injury to the blood vessels inside the penile shaft, and other structures of the urogenital system, can result in the presence of blood in the semen.

Other possible causes include excessive masturbation or sexual activity, herpes of the genitals, haemophilia (a condition that involves the body’s lack of ability to clot the blood), coitus interruptus, a long period of sexual abstinence, a swelling of the prostate gland, or a vasectomy. In very rare cases, tuberculosis can also result in the development of the condition.

Key Symptoms

Hematospermia is a symptom that can be experienced with other signs and symptoms such as haematuria (or blood in the urine), painful urination or ejaculation, painful bladder, swollen genitals, fever, and high blood pressure. On its own, it manifests as the appearance of very light to very dark red in the semen.

Who to See and Types of Treatment Available

A urologist is the best medical professional to see in the event of hematospermia. Depending on the causes of the condition, the urologist can prescribe or recommend several forms of treatment. In the case of inflammation and infection, anti-inflammatory medication and antibiotics are typically used. Meanwhile, if hematospermia is caused by other medical conditions, such as prostate cancer, treating the underlying condition will resolve the problem.

References:

  • Barry MJ, Collins MM. Benign prostate disease and prostatitis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 131.

  • Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and the urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 3.

Small EJ. Prostate cancer. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 207.

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