The appearance of blood in semen, medically termed hematospermia, is a concerning event for any patient. While often alarming, this symptom is usually benign and self-limiting, particularly in men under the age of 40 without accompanying symptoms. Blood thinners, which include anticoagulants (like warfarin or apixaban) and antiplatelet drugs (such as aspirin), introduce a compounding factor. These medications do not cause the initial injury, but they can significantly influence the severity and duration of the bleeding event.
How Anticoagulants Affect Bleeding Risk
Anticoagulant and antiplatelet medications work by disrupting the normal blood clotting cascade, which is the body’s defense mechanism against bleeding. Anticoagulants, such as Direct Oral Anticoagulants (DOACs) or Warfarin, prevent the formation of fibrin, the protein that forms the meshwork of a clot. Antiplatelet agents, such as aspirin, prevent platelets from sticking together to form an initial plug at a site of injury.
These medications lead to a systemic reduction in the ability to stop bleeding, affecting all parts of the body, including the genitourinary tract. The delicate network of small blood vessels lining the seminal vesicles, prostate, and urethra are susceptible to minor injury or inflammation. In a person not taking blood thinners, bleeding from these microscopic tears would typically stop almost immediately.
For patients on these medications, this natural self-sealing process is impaired, allowing blood to flow into the seminal fluid. While the blood thinner does not create the initial lesion, it transforms a minor vascular leak into a clinically visible episode of hematospermia. This acquired anticoagulable state is recognized as a systemic factor that contributes to hematospermia.
Common Non-Medication Causes of Hematospermia
Even when a patient is taking blood thinners, the most frequent origins of hematospermia are non-medication related and localized to the male reproductive tract. Inflammation and infection represent the most common underlying causes, particularly in the prostate gland and seminal vesicles. Conditions such as prostatitis, epididymitis, and urethritis cause irritation, mucosal fragility, and increased blood flow, which can lead to bleeding.
Infections, including sexually transmitted infections like chlamydia or gonorrhea, can also cause inflammation in the seminal tract. The inflammatory process causes the blood vessel walls to become fragile and prone to rupture during ejaculation. This type of bleeding is often self-limited and resolves once the underlying infection or inflammation is treated.
Physical trauma is another common cause, which can be minor and easily overlooked. This includes vigorous sexual activity or recent urological procedures like a prostate biopsy or cystoscopy. Trauma from a prostate biopsy, for instance, is a frequent cause of hematospermia that can persist for up to four weeks.
Structural issues, such as cysts or blockages within the seminal vesicles or ejaculatory ducts, can also increase localized pressure, leading to the rupture of mucosal blood vessels and subsequent bleeding.
When to Consult a Healthcare Provider
Although hematospermia is often benign, especially in younger men, medical evaluation is warranted when blood is observed in the semen. It is important to consult a healthcare provider if the episode is recurrent or persists beyond a few weeks, or if the patient is over the age of 40. Men in this older age group require investigation to rule out conditions like prostate cancer.
Immediate medical attention is necessary if the hematospermia is accompanied by systemic symptoms such as fever, chills, or unexplained weight loss, which may indicate a more serious infection or systemic disease. Other concerning associated symptoms include pain during urination or ejaculation, difficulty emptying the bladder, or visible blood in the urine. These concurrent issues suggest the possibility of an underlying problem that is not simply due to the blood thinner.
The consultation will involve a detailed medical history, focusing on the duration of the symptom, recent trauma or procedures, and a review of all medications, including the specific blood thinner being taken. A physical examination and initial tests, such as a urinalysis to check for infection or blood in the urine, will typically be performed. For patients on anticoagulants, the doctor may request coagulation studies to assess the level of blood thinning.
It is important not to self-adjust the medication dosage; any change to a blood-thinning regimen must be managed by the prescribing physician. Investigation is especially important to rule out rare but serious causes, such as a systemic bleeding disorder or a malignancy.