December 10th, 2015
Semen is the male ejaculate that contains sperms, prostatic and other glandular secretions and some enzymes. Under normal circumstances, blood is not considered a normal constituent of semen; however, in certain cases, broken or abraded blood vessels or traumatic injuries to the inguinal region may lead to extravasation of blood in the semen. Depending upon the nature and intensity of damage to the genital apparatus, urine or pus may also occur in the semen.
Blood in semen (also refers to hematospermia) is a serious and frightening complaint but fortunately in most cases, the cause is benign. It is believed that as many as 15% cases of blood in semen are idiopathic i.e. no cause can be ascertained (1).
Most common causes of blood in semen are:
Physiological causes:
Blood in semen is normal in certain cases; such as:
Other less common causes include:
Pathological causes:
In the absence of a physiological cause/ explanation of blood in semen; your healthcare provider will explore pathological causes; such as:
Other causes include:
In most cases, the symptoms resolves spontaneously. You probably don’t even have to see a healthcare professional if you are young (under 40 years of age) and have recently undergone a medical or surgical procedure that may explain mild/ transient genito-urinary bleeding. However, it is highly recommended to seek medical help to identify the cause and pathophysiology for proper management; if:
The treatment or management of blood in semen is dependent on the primary cause and related pathophysiological factors. For example, antibiotics are usually recommended to address blood in semen due to sexually transmitted diseases. Surgical intervention is needed to address organic lesions or polys after careful evaluation by transrectal ultrasound and other reliable diagnostic tools (3).
1. Li, Y. F., Liang, P. H., Sun, Z. Y., Zhang, Y., Bi, G., Zhou, B., … & Jin, F. S. (2012). Imaging diagnosis, transurethral endoscopic observation, and management of 43 cases of persistent and refractory hematospermia. Journal of andrology, 33(5), 906-916.
2. Han, H., Zhou, X. G., Fan, D. D., Tian, L., & Zhang, X. D. (2015). An Unusual Etiology for Hematospermia and Treatments that were Successful. Urology, 86(4), 740-743.
3. Raviv, G., Laufer, M., & Miki, H. (2013). Hematospermia—the added value of transrectal ultrasound to clinical evaluation: Is transrectal ultrasound necessary for evaluation of hematospermia?. Clinical imaging, 37(5), 913-916.
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