What does blood in semen mean?

Introduction
Infection or inflammation
Duct Blockage
Tumors
Vascular problems
Diseases
Organ injury
Management of hematospermia
Do prostate diseases cause hematospermia?
References


Semen is a fluid made up of sperm as well as fluids from the prostate and other glands. The resulting seminal fluid or ejaculate passes through several channels on its way to the urethra.

First come the seminal vesicles, accessory sex organs in men, located just above the prostate and behind the bladder, one on each side. These flat elongated organs produce and store seminal fluid. Their secretion flows into the ampullae of the vasa.

Sperm is transported from the epididymis of the testis via the vas deferens to the vasal ampullae, two tubes passing between the seminal vesicles. The prostate is a gland located at the base of the bladder and wrapped around the neck of the bladder. The ejaculatory duct is formed in the prostate by the junction of the vasal ampullae and the seminal vesicles. It crosses the prostate to enter the urethra.

The presence of blood in the seminal fluid is often a shock. It has been reported as early as the time of Hippocrates. About 15% of cases still occur without an obvious cause. The rest can be attributed to several causes.

Most patients with blood in semen are under the age of 40 and have self-limited bleeding episodes. Older patients are more likely to have recurrent bleeding episodes.

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Infection or inflammation

The most common causes include cysts in the seminal vesicles or ejaculatory duct or bleeding into the duct, accounting for more than two-thirds of patients with hematospermia in one study.

All organs involved in the production and passage of seminal fluid can become inflamed, including the seminal vesicles, vas deferens, testicles, epididymis, prostate, or urethra. Irritation of the gland, injury, the presence of calcified foci or stones in the tubular organs or infections – bacterial, viral, fungal or parasitic – can cause inflammation. Sexually transmitted diseases (STDs), including gonorrhea, herpes, or chlamydia, can also cause hematospermia.

Duct Blockage

Any blockage of the ejaculatory duct or cysts formed inside the prostate or seminal vesicles can cause blood to appear in the semen. This is due to the dilation of blood vessels near the blocked channel, causing the vessel to rupture.

Urethritis is a known cause of hematospermia, more commonly in younger men. Cysts and other benign growths, urethral strictures or warts may be responsible for some cases.

Tumors

The growth of tumors, including benign polyps or cancers of the testicles, prostate, epididymis, or seminal vesicles, can cause hematospermia. Yet the risk of cancer in men with this symptom remains low, at 3.5%. Cancer is almost never the cause in men under 40 and is rare even in older men.

Prostate tumor

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Vascular problems

Sometimes the blood vessels supplying or passing through these organs can be abnormally dilated, like telangiectasias or varicose veins, causing blood to leak into the semen.

Diseases

Conditions such as hypertension, hemophilia, or chronic liver disease can trigger bleeding in semen. Along with hypertension, severe and uncontrolled increases in blood pressure, elevated serum creatinine, severe proteinuria, and kidney blood vessel disease are risk factors for hematospermia. Tuberculosis of the vas deferens could also trigger hematospermia, as could hyperuricemia.

Organ injury

Hematospermia is mostly due to medical procedures, including prostate biopsy (up to 84% in some studies), radiation therapy, or prostate surgery. Pelvic fractures, damage to the perineal region or testicles, and prolonged abstinence from sexual intercourse are less common causes.

Management of hematospermia

The doctor should look for the presence of blood in the semen. A careful history, examination of the area, and relevant blood and urine tests will help distinguish between different causes. A check may be ordered to rule out prostate cancer, called a prostate-specific antigen (PSA) test.

In most cases, the hematospermia disappears within two months, and if not, other tests may be necessary. Chronic bleeding or recurrent episodes should trigger further evaluation.

Ultrasound may be helpful if blood persists in the prostate. Treatment will depend on the cause, of course, but a policy of watchful waiting can be adopted if none is found.

hematospermia

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Do prostate diseases cause hematospermia?

Obstruction of the urethra by an enlarged prostate, as in benign prostatic hyperplasia, can also cause hematospermia.

Prostate biopsy is thought to be most often related to hematospermia, although it is usually self-limited. Prostate cancer is another possible cause, but it is still thought to be rare. Some studies have reported a risk of around 14% with this symptom. Yet others have shown it to be present in 6% of men over 40 who have elevated PSA or abnormal prostate exam results.

Thus, those who have crossed 40 years might find it helpful to screen for prostate cancer if persistent hematospermia presents at any time that is not explained by other causes. These include prostatitis, including bacterial prostatitis; cysts of seminal vesicles or other accessory glands; stones in the prostate; or prostatic cysts.

Red flags indicating the need for further investigation aside from age include a family history of prostate cancer, African descent, or features of malignancy such as loss of appetite, bone pain and weight loss.

People under this age who have one or very few episodes of hematospermia and are at low risk for prostate cancer should be screened for other common diseases of the genitourinary system and managed Consequently.

References:

Further reading

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