Prostate Cancer

Hematospermia: Blood in Semen

Semen is the substance that is ejaculated during sexual intercourse and masturbation. It is a critical part of the reproductive process1.

The sperm found in semen enters the female body to fertilize an egg. This is what results in pregnancy.

Usually, semen has a white transparent color. There are times where certain conditions in the male body can affect semen.

In some men, semen may have a red or pinkish appearance. This can signal the presence of blood in semen. When this happens, it is understandable that the patient will be alarmed. The man may be concerned as blood in semen is not considered normal.

There are many reasons why this can happen. Sometimes, the cause is nothing for the man to worry about. Other times, it can be linked to a severe underlying problem.

We look at what hematospermia is. The post also considers the causes and accompanying symptoms that men should recognize. Furthermore, we discuss how the underlying condition is diagnosed and what treatments are available.

What Is Blood In Semen?

Blood is semen refers to a change in the color of a man’ semen. When blood is present in semen, it will usually cause the substance to have a pinkish or red color. The color will be a deeper red when there is a higher concentration of blood that is ejaculated with the semen.

Blood in semen is seemingly concerning the problem. The man will immediately recognize that it is not normal for their semen to have such an appearance.

There are many reasons why blood can be present in semen. This is not considered a condition itself, however. Instead, the medical industry would classify blood in semen as a symptom. The problem signals the presence of an underlying condition in the male body.

When a man experiences this problem, they should consider other symptoms too. This will tell them if the blood should be something to worry about.

There are cases where blood in semen is linked to a prostate problem. This can even include prostate cancer.

What Causes Blood In Semen?

As a symptom, there are a large number of factors that can be the cause of blood in semen. Men do need to understand all of the possible causes behind the symptom.

This will help the patient identify the potential reason they are experiencing hematospermia. It also makes the process of diagnosing and treating the issue easier. The man would be able to discuss their findings with a doctor. Any part of the genitourinary tract may contribute.

When it comes to looking at the causes, it is essential to understand how sperm and semen moves. The pathway of sperm starts at the testicles and ends at the tip of the penis – where it is expelled from the body during ejaculation2. There are several tubes and other structures that semen needs to pass through before it can be ejaculated.

Problems can develop at any location where semen passes through. Blood vessels can become damaged, for example. When this happens, blood may leak into the tube, which then combines with semen as it travels toward the urethra.

Before considering the possible causes, it is important to note that there are many cases where a doctor is unable to determine the exact reason for hematospermia. Most men will not be able to find a cause behind the blood that can be observed in their semen.

Still, a few potential causes have been identified. Some serious medical conditions may cause blood in semen. These can be considered to provide a more effective treatment strategy for the patient.

How Inflammation Causes Blood In Semen

Inflammation is one of the most important factors that may contribute to blood in the man’s semen. When inflammation is the cause, it is usually the seminal vesicles that are affected by the swelling. This can cause complications with blood vessels in the area. The blood vessel may break.

When this happens, blood leaks into the vesicles. Since semen travel through seminal vesicles, it will likely cause blood in semen.

There are other organs, tubes, and ducts in the male reproductive system that may be affected by inflammation too. In these cases, the inflammation can also lead to blood leaking into the semen.

A few conditions are known to cause inflammation in these areas. These conditions include:

  • Epididymitis causes the epididymis to swell up. This is a tube found at the rear side of the testicles. It stores sperm. A bacterial infection can cause epididymitis. This includes certain sexually transmitted infections.

  • Urethritis is another possible cause. This condition refers to a swelling that affects the male urethra.

  • Prostatitis can also lead to blood in semen. The condition causes the prostate gland to become inflamed.

How Infection Can Lead To Hematospermia

Inflammation is not the only issue that can lead to hematospermia in men. A man who has an infection may also be at risk of seeing blood in his semen. An infection can develop in almost every part of the male reproductive system.

The same parts that inflammation can affect can become infected. In fact, inflammation is often a result of an infection in the genital tract.

Sexually transmitted diseases are common causes where an infection leads to hematospermia. Chlamydia and gonorrhea are prevalent. Some men with herpes also experience blood in their semen.

Other types of infections not linked to sexual activity should not be ruled out. Infections in the genital tract can be caused by fungi, bacteria, and viruses. All of these infections can cause inflammation and lead to blood vessel leakage.

It should be noted that a urinary tract infection may also lead to these symptoms. In such a case, seeing a urologist may be useful.

Tumors And Hematospermia

While rare, sometimes tumors can lead to blood in semen too. It is important to note that it is not only malignant tumors that may lead to this problem as a symptom. There are cases where a benign tumor may cause hematospermia is a symptom too.

These tumors can affect various parts of the male reproductive tract. This includes the seminal vesicles, the epididymis, the testicles, and even the prostate. Prostate cancer and testicular cancer both need to be considered.

Among men, prostate cancer is a common type of cancerous disease3. Almost 200,000 new cases of prostate cancer are diagnosed in the United States each year. Even though prostate cancer has a high survival rate, it can lead to life-threatening complications. This is especially the case when the cancer is not diagnosed and treated during an early stage.

Other Causes Of Hematospermia

While inflammation and infection are common causes of blood in semen, there are times where something else may be the underlying factor. Men should not limit their knowledge to only the more common causes.

Vascular abnormalities that affect the genital tract in a man’s body can lead to blood leakage into semen. Men with hypertension may also find that they have a higher risk of finding blood in their semen.

Those male patients with hemophilia are also more likely to experience this problem. This is due to the high risk of excessive and easy bleeding.

Other problems and risk factors that have been linked to hematospermia include:

  • Trauma directly to the testicles, which is a somewhat common issue among sports players

  • A medical procedure that caused damage to any structure in the genital tract

  • Chronic liver disease may increase the risk of hematospermia

  • Some men with leukemia will also find blood in the semen

  • An obstruction in the ejaculatory ducts can cause blood vessels to break, which can lead to hematospermia

Men with an enlarged prostate need to consider their risk too. Benign prostatic hyperplasia causes pressure on the ejaculatory ducts, as well as other areas of the male genital tract.

What Are The Accompanying Symptoms?

Blood that appears in semen is a symptom of something else going on in the male body. Each potential cause has its own specific symptoms that may appear, apart from hematospermia.

Men should take note of any other symptoms they may experience. This can help the man determine what the problem could be. It will also ensure the man has a better idea when the blood in their semen means something serious is going on.

A more significant amount of blood in the semen is obviously something to be concerned about. Other accompanying symptoms that men may experience include:

  • Some men may find that their groin area is tender

  • There may be swelling that affects the scrotum

  • The scrotum may also be tender to the touch

  • There may be blood in the urine
  • Some men may experience pain in their lower back area

  • Pain symptoms may develop when the man ejaculates

Some of these symptoms are more concerning than others. The symptoms are often also not specific. This makes diagnosing and finding the underlying cause more difficult for the doctor.

How Is Blood In Semen Diagnosed?

A doctor will not diagnose blood in semen as a condition. The doctor will consider the hematospermia as a worrisome sign that another condition has developed.

It is often difficult to provide a diagnosis for the case. In some cases, no cause is found at all. This is especially the case where the symptom fades on its own.

The diagnosis process will start with the patient setting up a consultation with their doctor. The doctor will ask the man about any accompanying symptoms they experience. The patient should advise their doctor about symptoms other than the blood they see in their own semen. This helps the doctor get a better idea of what is going on.

The doctor will need to perform a physical examination. During the examination, the doctor examines several parts of the pelvis. This includes the testicles. The examination helps the doctor determine if there are signs of inflammation and infection in the pelvis area. The doctor may also feel if the scrotum is swollen.

A digital rectal examination may be performed in the doctor suspects something is wrong with the patient’s prostate.

There are a few additional tests that will likely be ordered. A physical exam alone will usually not give the doctor enough data to offer patient treatment.

Tests for common sexually transmitted infections that can affect the male genital tract are important. This includes testing for herpes, gonorrhea, and chlamydia. If the patient is tested positive for any of these three, the doctor may provide adequate treatment.

A urinalysis can be performed too. This helps the doctor determine if there are any type of bacteria that causes infection in the patient’s urine. In such a case, an infection in the urinary or genital tract could be suspected.

The patient may be asked to undergo a PSA test. This tests for prostate-specific antigens in the body. It helps the doctor see how healthy the patient’s prostate. It can also help when problems like benign prostatic hyperplasia and prostate cancer are suspected.

Certain imaging and screening tests are often used too. Ultrasounds and CT scans are commonly used to see if there are any obstructions in the genital tract. An MRI scan may also be used.

A transrectal ultrasound may be used. This helps the doctor analyze the patient’s prostate. It is useful for detecting certain prostate problems that can cause blood in semen.

When To See A Doctor?

Some causes behind hematospermia may be serious. In these cases, complications can develop. Many of these complications can be prevented. The problem is, a lot of men do not see their doctor early enough. The patient may postpone seeing the doctor.

The idea may be to see if the problem would go away on its own. Unfortunately, this leaves an opportunity for complications to develop.

Men over 40 finding blood in their semen definitely need to see a doctor. Even though there is a good chance it may not be something serious, the man should still get the doctor to rule out dangerous conditions.

At this age, the man’s risk of certain conditions becomes higher. This includes a higher risk of an enlarged prostate, as well as prostate cancer.

In younger men, there may often be no need to see a doctor. The man should consider whether or not there are any accompanying symptoms. If the man only experiences blood in their semen, then they may consider waiting a while. Sometimes, the symptom goes away on its own.

If the patient waits and see no improvements in the symptom, then they should consider seeing a doctor. This is also the case when accompanying symptoms are present. Men should also take note of a fever, as well as pain. These may be signs of an infection. In such a case, it is a better idea to see a doctor.

Treatment

Diagnosis and treatment for hematospermia is not a straightforward process. Sometimes, no treatment is needed. A lot of men find that the problem goes away without any medical intervention. There are, however, cases where treatment is essential.

To treat hematospermia, a doctor first needs to know what causes the problem. The treatment depends on why the man has blood in their semen.
If there is no cause identified during an appointment with a doctor, home treatment may be advised.

The doctor may tell the man to use an ice pack. The ice pack is placed in the groin area. This can help when swelling or trauma are behind the hematospermia.

When there is a cause identified during a consultation with a doctor, appropriate treatment is given to the man. A medical procedure can be offered based on the identified cause.

Antibiotics will be prescribed if there is a bacterial infection. These antibiotics can help with different types of bacterial infections. A man with chlamydia or gonorrhea will also receive antibiotics to treat the sexually transmitted infection4.

Anti-inflammatory medications may be used to reduce swelling and pain.
In some rare cases, surgery may be needed. This is usually the case when there is a blockage in the genital tract. The surgery will aim to remove the blockage, thus allowing the normal movement of sperm. Surgery may also be needed if bladder stones, kidney stones, or a tumor are causing blood in the patient’s urine.

The patient needs to go to a specialist if they have cancer. An oncologist will develop an appropriate treatment plan. A prostate biopsy may need to be taken first. This may include the use of chemotherapy, as well as radiation therapy5.

Conclusion

When a man finds blood in their semen, concern is sure to follow. In most cases, the man has nothing to worry about. The major causes of blood in semen tend to resolve itself.

A few serious causes can happen too. In these cases, a man should consider the accompanying symptoms they experience. Early diagnosis of a serious condition makes treatment more effective. This also helps to reduce the patient’s risk of experiencing complications.

Sources

  1. Endotext [Internet]. (2000) The composition of human semen (adapted from Ganong (17)). [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK279008/table/benign-prstate-dsrdr.colourwhit/
  2.  MedlinePlus. Pathway of sperm. [online] Available at: https://medlineplus.gov/ency/imagepages/19073.htm
  3. Cancer.Net. (2020) Prostate Cancer: Statistics. [online] Available at: https://www.cancer.net/cancer-types/prostate-cancer/statistics
  4. StatPearls [Internet]. (2019) Chlamydia. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK537286/
  5. PDQ Cancer Information Summaries [Internet]. (2019) Prostate Cancer Treatment (PDQ). [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK65915/

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