Hematospermia – What Should You Know About It?

Hematospermia refers to appearance of blood in the male ejaculate (or semen). This condition is more common in young to middle-aged males (especially between 30-40 years of age), but any man can develop it after puberty. As grave as it may sound, hematospermia does not always signals a major medical concern. Depending upon the etiology and severity of symptoms, your doctor may advise a variety of treatment options.

Typically when men eject semen, they don’t examine it for blood, which is why experts believes that the actual prevalence of hematospermia is not exactly known in the general population.

What Are Some Notable Causes Of Hematospermia?

The reproductive system of a male comprises of testes (the primary male organ) as well as an intricate system of ducts and glands that produces and release sperms into the female genital tract during the act of intercourse.

Sperms are produced in the male testes (which also serves as the storage site of sperms). During orgasm, the testicular muscles are contracted which moves the sperms to vas deferens along with a small quantity of fluid. The prostate and seminal vesicles are key reproductive glands which donates additional fluid (semen) to protect and nourish the sperms. This composition of semen and sperm passes through urethra towards the tip of penis for ejaculation. Bleeding occurring anywhere in the male genital tract can seep into the ejaculate; thereby causing this condition. Some common sources of hematospermia include:

• Infection of male tubes and ducts: According to different researches, STIs –sexually transmitted infections are also responsible for blood in semen. STI like Chlamydia, gonorrhea or any other bacterial or viral infection often presents with hematospermia. However, some studies suggests that most STI are not associated with hematospermia.
• Inflammation of the genital tract: Inflammation and infection are considered as culprits of blo

• od in semen. This include prostatitis, epididymitis, orchitis etc.
• Injury: Any serious injury or blockage in the male reproductive system or prostate and seminal vesicles can also cause appearance of blood in the semen; such as spinal injury, road traffic accident, instrumental injury, etc. It is believed that in approximately one-third men, ultrasound guided biopsy of prostate gland is implicated as the key cause of onset of blood in the semen. Testicular cancer and prostate cancer are also known to cause seeping of blood in the semen. However, men with prostate cancer are unlikely to detect the problem unless they go through prostate biopsy.

Classification Of Hematospermia

Clinically, hematospermia can be classified into or secondary.

• Primary Hematospermia: In this condition, onset of blood in semen is the only symptom (i.e. no other complaint is reported). During physical examination no underlying problem is detected that can be linked to the primary complaint. In addition, no traces of blood are found in the urine. These types of issues resolves spontaneously.
• Secondary Hematospermia: In this condition, appearance of blood in the semen can be explained by an underlying disease process such as prostate infection, prostate biopsy, urinary infection etc. In exceptional cases, cancer of prostate or testes can also present with Hematospermia. Ultrasound is recommended for men above 50 years with BPG- benign prostate enlargement or with calcification. Several medical conditions like HIV, high blood pressure, leukemia, etc. can also present with blood in semen. In addition, clinical data also indicates that in rare cases; parasitic infections, tuberculosis, chronic liver disease and hemophilia (a disease which affects blood clotting and blood thinning mechanisms) as well as certain medications (such as Panitumumab and other anti-cancer drugs) can also cause secondary hematospermia.

What Should You Know About Hematospermia?

A male (or his partner) can observe blood in the semen during or after sex. However, the myth of rough sex to be the cause of bleeding is not true. Severe injuries of genital or urinary tract can also cause release of blood from the urethra but this should not be confused with hematospermia.

• Antibiotics and anti-inflammatory medication are commonly prescribed to address benign hematospermia.
• If the cause is an underlying medical condition, then management of primary issue often helps in resolving the symptoms, without needing any direct treatment for blood in semen.
• If the problem stems due to a recent urological procedure (like prostate biopsy), the symptoms usually resolves spontaneously within a week or two.

But if you are experiencing multiple episodes of blood in semen accompanied with painful ejaculatory or urinary symptoms, you should consult an expert urologist on emergent basis for optimal management.

References

1. 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.

2. 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.

3. Karatas, F., Sahin, S., Imamoglu, G. I., & Altinbas, M. (2015). Panitumumab as a possible cause of hematospermia: what is the mechanism?. Future Oncology, 11(24), 3229-3231.

4. Akhter, W., Khan, F., & Chinegwundoh, F. (2013). Should every patient with hematospermia be investigated? A critical review. Central European journal of urology, 66(1), 79.