Hemospermia (Blood in Semen / Sperm Ejaculate)

Hemospermia (blood in semen / sperm ejaculate)

Hemospermia (also known as hematospermia) is the presence of blood in ejaculation.

It is usually a benign symptom and nothing to worry about. In men age 40 or older, hemospermia is a slight predictor of cancer, and may need to investigate for prostate and bladder neck cancers.

Hemospermia usually causes a lot of distress and anxiety in males. Hemospermia, once occurs, usually last for a few weeks.

Causes

The commonest cause of hemospermia is a seminal tract infection or inflammation.

Other less common causes include:

Sexually transmitted infections (STI), such as gonorrhea, chlamydia, or a viral or bacterial infection
Blood disorders, such as clotting disorders or sickle cell disease
Recent medical procedures, such as vasectomy, prostate biopsy, or cystoscopy
Tumors (cancerous) and polyps (non-cancerous or benign growths)
Testicular or prostate cancer
Other medical problems, such as high blood pressure, human immunodeficiency virus (HIV), liver diseases, and leukemia (blood cancer)

Evaluation

The management of a case of hemospermia depends on the following factors:

The extent and duration of the hemospermia
Your age
Any accompanying symptoms.

Most importantly you should first be reassured that in most cases of hemospermia, particularly under 40 years of age, there is no serious underlying disease.

Patients under 40 years of age with a single instance of hemospermia are investigated by history taking, physical examination (external genitals and prostate), urinalysis, ultrasonography of the scrotal contents and the prostate, and blood test if necessary.

If you are under the age of 40, have no urinary tract symptoms, and no risk factors for other medical conditions, the blood in your semen will disappear on its own.

Any unusual findings on examination will require an exhaustive urological work-up.

Risk Factors

Risk factors that require further evaluation include:

If you are over the age of 45
Repeatedly have blood in the semen
Have other urinary/ejaculation related symptoms
Have blood in the urine
Have a bleeding disorder or other medical condition
Have a family history of prostate cancer
Have elevated PSA

If you have these risk factors, i.e., age over 40 years, repetitive or persisting hemospermia, family history of prostate cancer, elevated PSA, or hematuria (blood in the urine), you will have to undergo detailed and exhaustive investigations.

Treatment

Although treatment depends on determining the causes of hemospermia, it may include taking:

Antibiotics if you have an infection
Anti-inflammatory drugs
Medicines to treat other medical conditions, such as high blood pressure, liver disease, or sexually transmitted disease/infection

In general, hemospermia in healthy young men goes away by itself.

When to see a urologist

When you have blood in the ejaculate (semen) for the first evaluation

When you continue to have persistent or recurrent hemospermia

Hemospermia (Blood in Semen / Sperm Ejaculate)