The presence of blood in the ejaculate is called haematospermia. Haematospermia is not uncommon and may affect men of any age after puberty, but its peak incidence is in men 30 to 40 years old. About 85 to 90 percent of all patients that have haematospermia will have repeated episodes.
”Causes of haematospermia
In about 50% of patients the cause of haematospermia is not clearly understood or known. Semen originates from multiple organs, including the testicles, epididymis, vas deferens, seminal vesicles and prostate. Most of the semen comes from the seminal vesicles and prostate and infections or inflammation of these organs account for most of the cases. Cancers rarely cause haematospermia and account for a very small percentage of cases. Ultrasound-guided biopsy of the prostate can also result in haematospermia. This occurs in about a third of patients undergoing this procedure and is not cause for alarm.
patients with haematospermia are usually categorised into two different groups. The first group, or ‘primary haematospermia is when blood in the ejaculate is the only symptom. That means no blood in the urine, either visually or under the microscope, is found, and the patient has no evidence of any urinary irritation or infection and physical exam is completely unremarkable. The condition is self-limited, that means it will go away in time without treatment. About 15% of patients will have one episode and never have another.
primary haematospermia patients have been studied extensively in the past with x-rays and telescopic examination of the urinary tract (cystoscopy). In most studies no other associated problems were found. Consequently no treatment is felt to be needed for patients in whom haematospermia is the only complaint and the physical exam and urine analysis are normal.
”Treatment of primary haematospermia
Generally it is recommended that no therapy be given for primary haematospermia as it usually resolves spontaneously.
The term ‘secondary haematospermia is used when a cause of bleeding is known or suspected, such as immediately after a prostate biopsy, or in the presence of a urinary or prostate infection or cancer. Unusual causes include tuberculosis, parasitic infections, and any diseases that affect blood clotting such as haemophilia and chronic liver disease.
patients who have haematospermia associated with symptoms of urinary infection or visual or microscopic blood in the urine require a complete urological evaluation. If blood is seen in the urine, an x-ray or ultrasound of the urinary tract, as well as a telescopic examination of the bladder and prostate (cystoscopy) is indicated. If the prostate or seminal vesicle is felt to have suspicious areas on rectal examination, or if the screening test for prostate cancer is suspicious (prostate specific antigen or PSA), ultrasound examination and biopsy may be indicated.
In summary, haematospermia can be a very frightening occurrence to any male, but when all is said and done, most of these patients are found to have absolutely no abnormalities and require no therapy. Haematospermia is liable to continue on and off, but it is usually self-limited and carries with it no increased risk of any other disease, nor is the patient felt to be putting his sexual partner at risk.
To reiterate, malignant cancers of the testicle and prostate are very rarely associated with haematospermia.