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Blood in Semen – Here’s what you need to do

Hematospermia is defined as the presence of blood in the ejaculate / seminal fluid. The blood is sometimes visible to the naked eye or in microscopic amounts occasionally detected during a semen analysis.

The prevalence of hematospermia is estimated at approximately 1: 5000 urological patients. The colour of the ejaculate may depend on how much time has elapsed since the bleeding event. Fresh blood will be light red to brownish in colour, while darker, even dark brown or black clots usually mean that some time has passed since bleeding occurred.

In most cases hematospermia is painless. It may be associated with burning urination, difficulty in passing urine, discharge from penis etc. Hematospermia may occur only once, but may also be recurrent or chronic. It often goes unnoticed and is typically self-limiting. Quantification is also difficult because most men do not often look at their ejaculate.

Should you be worried?

Hematospermia may naturally cause concern for men who experience it and be disturbing for the couples affected, because they are worried about sexually transmitted disease (STD) or malignancy. However, it is not likely to be a sign of a major health problem. Historically, hematospermia was viewed as a consequence of either prolonged sexual abstinence or excessive sexual activity.

Is seeing blood in my semen normal?

No it is not normal. It could be due to various causes like

  1. Leaking of blood from a small blood vessel that bursts during ejaculation the same way that a person gets a nosebleed after blowing their nose.

  2. Infection of the genitourinary system (sexually transmitted diseases, TB)

  3. Trauma from a recently performed urologic procedure, such as a vasectomy or prostate biopsy.

  4. An injury to the male reproductive system (testes, epididymis, vas deferens, seminal vesicle, prostate gland)

  5. Malignancy (prostate, bladder, urethra)

  6. Systemic diseases (e.g. Hypertension, bleeding diathesis, leukaemia, HIVs, liver disease)

  7. Drugs (e.g. anticoagulants)

  8. Deviant sexual practices

In younger men (< 40 years), hematospermia is uniformly benign. Even in older men (>40 years), it is rarely associated with malignancy. However, there is an association between hematospermia and treatment-necessitating disease, e.g., a malignancy, necessitating further investigations

Should you see a doctor?

Although it’s usually not a serious health issue, it’s always wise to seek medical help any time you develop a new symptom, especially one that’s as alarming as blood in your semen. It is advisable to approach an andrologist / urologist for expert opinion.

The treating doctor would obtain complete history, general and focussed examination including rectal examination, certain tests like urine/semen culture to rule out infection, PSA and Ultrasonogram/Transrectal Ultrasound/CT/MRI imaging wherever necessary.

Specific treatment for hematospermia depends on the underlying pathological lesions but often involves only minimal examinations and simple reassurance in most cases. Usually an antibiotic is prescribed for a std. Hematospermia due to malignant disorders including prostate, testis, and seminal vesicle cancers resolves with definitive treatment of the primary lesions.

About the Author – Dr. Srivatsan Ramani

Dr. Ramani is a Consultant Uro-oncology & Robotic Surgery at Apollo Proton Cancer Centre. he has been a Former Doctor at St. Isabel’s Hospital and former Senior Resident Trauma at AIIMS. Dr. Ramani studied General surgery at Maulana Azad Medical College and Medicine at Stanley Medical College, Chennai. He finished his training in Urology at Kilpauk Medical College. His special interest is in treatment of prostate cancer with the help of Robotic Surgery.

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