Hematospermia: Is Blood In Semen Normal?

About Hematospermia

Hematospermia: not many of us are able to readily identify this term, let alone be aware of the meaning behind it. For those who have been exposed to this word before, you probably have just shuddered in your seat. Hematospermia is a term used to describe blood in the semen that occurs during ejaculation.

Unless a guy specifically looks for blood in his semen, instances of hematospermia often go unnoticed. Therefore, doctors have been unable to accurately place a number on the prevalence of this condition in the global male population. Since Hematospermia may be due to a number of underlying causes in the body, it is advisable to identify the root cause of the condition.

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The Onset of Hematospermia

Witnessing hematospermia is not pleasant. After each sexual experience, you would normally experience a sense of pure relief. However, if you notice blood in your semen, the mood takes a drastic turn and a heightened sense of anxiety kicks in. Most people go into a state of shock before recovering their composure and contemplating their next course of action. Fortunately, a quick search on the internet will show that hematospermia doesn’t usually indicate any serious medical issues.

For men who are under 40 years old, display no risk factors, and have no outstanding symptoms, the occurrence of blood in their semen is generally a one-off event and eventually disappears by itself. In contrast, for men who are over 40 or who have experienced hematospermia repeatedly, professional consultation and evaluation of their health is recommended. The onset of hematospermia in this group of high-risk men normally indicates a serious underlying health condition.

The risks factors that contribute towards the prevalence of blood in the semen include:

  • History of cancer
  • Bleeding disorders
  • Urogenital malformation

The following symptoms are associated with the presence of hematospermia:

Traditionally, health experts tended to attribute hematospermia to either excessive indulgence in sexual activities or extended periods of sexual inactivity.

They believed that these two factors played a vital role in causing blood to be present in the semen. Based on this general guideline, every 7 out of 10 cases of hematospermia were found to be unique occurrences without any obvious cause. Doctors referred to these as idiopathic.

Fortunately, a breakthrough study published in 2003 highlighted the major inadequacy in this approach towards hematospermia. The study was conducted as a joint initiative between two medical institutes in Hungary: the National Medical Centre and Semmelweis University.

The researchers highlighted the need for a comprehensive health evaluation of any male patient suffering from hematospermia. More specifically, they recommended that a personal health history, physical examination, and microscopic analysis of the semen sample are essential ingredients towards an accurate diagnosis.


They also noted that new noninvasive imagery techniques such as magnetic resonance imaging, computer tomography, and ultrasound are suitable methods to identify malignant conditions. More importantly, the study provided essential takeaway points towards the onset of hematospermia:

  • 97.6% of patients under 40 years old were diagnosed with benign cases of hematospermia.
  • 15% of patients suffered from the sudden onset of hematospermia with no underlying condition.
  • High-risk patients over the age of 40 are advised to undergo a thorough health examination.

A separate research study published in 2009 also echoed these findings. Published in the International Urology and Nephrology journal, the authors compared all hematospermia research papers from 1996 to 2009 and arrived at the following conclusions:

  • Most patients younger than 40 experience hematospermia due to inflammation or infection.
  • For patients over 40, hematospermia could be an indication of a more serious underlying health condition.
  • Reported idiopathic cases of hematospermia have been overestimated.

Hematospermia Causes

Hematospermia Causes

Based on the study above, 85% of hematospermia cases can be accurately diagnosed to identify the root of the problem. These causes can be divided into 6 different categories: Inflammation/Infection, Obstruction/Vascular Abnormalities, Tumors, Systemic Factors, and Medical Procedures/Trauma.

Inflammation / Infection

Several parts of the body are involved in the production of seminal fluids. Any inflammation in these parts can lead to the occurrence of hematospermia. These parts include:

  • Vas Deferens
  • Prostate
  • Urethra
  • Seminal Vesicles
  • Epididymis

All of these parts are susceptible to inflammation caused by any of the following:

  • Irritation
  • Trauma
  • Calcified Deposits

On the other hand, a wide range of infections can also cause blood to be present in the semen:

Perhaps the most worrying subject in this aspect is the onset of hematospermia caused by sexually transmitted diseases. Fortunately, advances in the medical field have facilitated the detection of these diseases and increased the chances of an accurate diagnosis and effective treatment. This is evident in research conducted as a joint initiative among various medical facilities in Israel.

In this research, 12 patients out of an initial 16 were found to be infected with sexually transmitted diseases, along with hematospermia. Through accurate diagnosis and treatment, all 12 patients were able to make a full recovery and remained disease-free after one year.

Obstruction / Vascular Abnormalities

The ejaculatory system can become obstructed by the formation of cysts in the prostate or seminal vesicles. An obstructed duct can cause a neighboring blood vessel to rupture, releasing blood into the semen. Similarly, an enlarged prostate can also place excessive pressure on the urethra and cause hematospermia.

On the other hand, abnormalities in the blood vessels surrounding vital parts involved in producing seminal fluids can also lead to blood content in the semen.

Tumors

The prostate, epididymis, testicles, and seminal vesicles are vulnerable to malignant tumors or benign polyps. A clinical trial in 2004,done by the Feinberg School of Medicine’s Department of Urology at Northwestern Universityin Chicago, set out to find the association between prostate cancer and hematospermia. Out of 26,126 male participants, 139 were suffering from hematospermia. Of this small group, only 19 men were diagnosed with prostate cancer.

While the results do not indicate an overwhelming association between prostate cancer and hematospermia, an underlying finding can be deduced. In a normal prostate screening group, only 0.5% of the participants are diagnosed with hematospermia. However, for prostate cancer patients, 13.7% of them are also diagnosed with hematospermia. This indicates that the risk of experiencing blood in the semen increases* when prostate cancer is present.

Systemic Factors A small percentage of hematospermia can be attributed to systemic factors such as severe hypertension, chronic liver disease, leukemia, and hemophilia(a certain type of bleeding abnormality).

Medical Procedures / Trauma

Unfortunately, a high number of hematospermia cases are caused by medical procedures. Common medical procedures known to provoke the occurrence of blood in the semen include:

  • Prostate biopsy
  • Radiation therapy
  • Vasectomy
  • Brachytherapy
  • Transurethral resection of the prostate

The following examples of traumatic events are also known to inadvertently cause hematospermia.

  • Pelvic fracture
  • Testicular/Perineal trauma
  • Prolonged sexual abstinence
  • Sex-related injuries

Hematospermia Treatment

For each of the categories above, doctors prescribe different forms of treatment to aid in a full recovery.

Inflammation/Infection

Inflammation in any part of the seminal fluid production process can be addressed by prescribing anti-inflammatory medication. Similarly, antibiotics are prescribed to tackle specific cases of infections. Referring to the research done in Israel that was mentioned earlier, doctors were able to accurately diagnose all 12 patients:

  • 5 patients with herpes
  • 4 patients with Chlamydia trachomatis
  • 2 patients with Enterococcus faecalis
  • 1 patient with Ureaplasma urealyticum

Based on their diseases, the patients were prescribed various medications and made a full recovery. To further stress the effectiveness of the diagnosis and treatment, all patients remained clear of the disease during their one year follow up.

Obstruction/Vascular Abnormalities

When obstructions in ejaculatory ducts or blood vessel abnormalities occur, doctors recommend undergoing electric current treatment to remedy the condition and stop the hematospermia.

Systemic Factors

If systemic factors are responsible for causing hematospermia, doctors usually do not address the condition directly. Instead, medication is prescribed according to the initial assessment such as chronic liver disease, leukemia, or severe hypertension. As these conditions are cured, the occurrence of hematospermia disappears along with them.

Medical Procedures/Trauma

In cases where blood in the semen is caused by recent medical procedures or traumatic events, no treatment is necessary. A wait-and-see approach is more suitable in these instances, and the condition should correct itself within a couple of weeks. Should blood content continue to be present in the semen, an additional health evaluation is required as it could indicate other complications.

Tumors

As the risk of hematospermia and tumors are extremely low for younger men, undergoing a test to rule out prostate cancer might be the best form of assurance for them. In cases where a positive diagnosis of prostate cancer is determined, treatment methods that address the cancer directly would also help ease the symptoms of hematospermia.

Conclusion

Health professionals have constantly been outwitted by hematospermia, as most men do not notice blood in the semen during ejaculation. Due to this lack of attention, an accurate estimate of the prevalence of hematospermia cannot be determined. Nonetheless, if you notice blood in your semen, it inevitably raises alarms in your mind, sending all sorts of shockwaves throughout your body. While statistics have shown that the majority of hematospermia cases are benign and can be treated with medication, you should be educated on the causes of this condition. If you are over 40 or display high-risk factors, it is highly recommended that you consult with a health professional and undergo a full health evaluation to determine the source of hematospermia. Naturally, the best possible outcome would be an idiopathic diagnosis. By identifying the root cause of hematospermia, it enables the doctors to come up with the best solution of tackling the condition. In unfortunate cases where other underlying health conditions are present, you may also take comfort in the fact that advancement in the medical field mean that you have an increased chance of a full recovery.

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Author

Contributor : Dr. Ahmed Zayed (Consumer Health Digest)

Dr. Ahmed Zayed Helmy holds a baccalaureate of Medicine and Surgery. He has completed his degree in 2011 at the University of Alexandria, Egypt. Dr. Ahmed believes in providing knowledgeable information to readers. Other than his passion for writing, currently he is working as a Plastic surgeon and is doing his masters at Ain shams University.

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