Hematospermia

Apart from identifying a primary cause of blood in the semen, the doctor will look out for any associated symptoms, including:

• Blood in the urine is called haematuria
• Hot, burning sensation during urination or any other symptoms of painful urination
• Difficulty while emptying the bladder completely
• A painful bladder that feels bloated
• Painful ejaculation
• Swollen or painful regions on the sex organs or obvious wounds from an injury
• Penis discharge or other prominent signs of an STD
• Fever, racing pulse, and higher-than-normal blood pressure

The most probable cause of blood in semen are:

• Trauma due to a prostate biopsy. The episode of bleeding persists for up to four weeks after the procedure.
• Trauma from a vasectomy. Bleeding prevails for about a week.
• Treatment of prostate cancer is done with the help of external beam radiation or brachytherapy.
• A seminal tract infection or inflammation.

The outburst of blood from a small blood vessel ruptures while ejaculation, just like in a very similar way a person gets a nosebleed after forcefully blowing their nose.

Other potential causes may include Sexually Transmitted Infections (STI): Including chlamydia, gonorrhoea, or other bacterial or viral infection.

• Prostate conditions: Including acute bacterial prostatitis, benign prostatic hyperplasia, cysts and polyps.
• Testicular and epididymis conditions: Including orchitis, epididymitis.
• Seminal vesicle disorders: Including stones and cysts.
• Blood disorders: Including sickle cell disease or clotting disorders
• Chronic infections: Including schistosomiasis or tuberculosis.
• Cancers: Including bladder cancer, testicular/epididymal cancer, prostate cancer, seminal vessel cancer, and urethral tumour.

Other medical problems: Including human immunodeficiency virus (HIV), severe, uncontrolled high blood pressure, liver diseases, and leukaemia (blood cancer).

The doctor begins the diagnosis by assessing the patient thoroughly and taking a medical history, including the history of any recent episode of sexual intercourse. This is accompanied by a physical examination that includes checking of genitals for any kind of swelling or lumps. Apart from this, a digital rectal examination is also carried out to look for swelling, tenderness or any other symptoms.

Various other tests used in the diagnosis of this condition are as follows:

• Urine culture or urinalysis to identify infection or any other associated abnormalities.
• STD testing in case a sexually transmitted disease is suspected.
• PSA testing is carried out to test for prostate cancer by measuring prostate-specific antigen in the blood.
• Specialized tests include transrectal ultrasound to diagnose various prostate issues like cysts, calculi, varices and inflammatory changes.
• CT scan and MRI for detailed and in-depth assessment of the patient.

Treatment of this condition depends various factors which are as follows:

• Duration and extent of the presence of blood in semen
• Age
• Presence of other symptoms

Patients under 40 years of age having one or two episodes of bleeding in semen usually don't require any treatment, and the issue resolves on its own.

However, in the case of recurrent episodes, the treatment plan comprises the following:

• Antibiotics in case of an infection.
• Anti-inflammatory drugs.
• Finasteride (Proscar), a medication to shrink an enlarged prostate, can often stop hematospermia.
• Medicines to treat other medical conditions.

If this condition is caused by a blockage in the genitourinary tract, surgery may be required, and it includes the removal of a bladder stone that's obstructing the urinary tract or the removal of tumours. If cancer is responsible for this condition, the doctor will probably refer the patient to an oncologist who will determine the best treatment.

The prognosis relates to the underlying cause, and if the cause can be identified, treating this condition is easier. However, most cases of hematospermia are benign and resolve without treatment. This condition appears to be scarier and indicates some malignancy, but in most cases, it's not a symptom of a serious condition. If the patient experiences recurrent episodes of bleeding, then referral to an urologist or oncologist is strongly recommended. They can help treat any serious underlying causes of blood in the semen.

Reviewed by Dr. Anjani Kumar Agrawal, Associate Director & Unit Head – Andrology, Urology on 16-Dec-2022.

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