Ejaculating blood, medically known as hematospermia, can be a startling experience. While often benign and self-limiting, any instance of hematospermia warrants a thorough medical evaluation to identify its underlying cause.
Potential Causes
Inflammation or infection within the male reproductive system is a frequent cause of blood in the ejaculate. Conditions like prostatitis, an inflammation of the prostate gland, or seminal vesiculitis, which affects the seminal vesicles, can lead to localized irritation and bleeding from delicate blood vessels. Infections involving the epididymis or urethra, including sexually transmitted infections like chlamydia or gonorrhea, can also cause these symptoms. These processes weaken small blood vessels, making them prone to rupture during ejaculation.
Trauma to the pelvic or genital area can also result in hematospermia. Causes include vigorous sexual activity, direct impact to the groin, or certain medical procedures. For instance, a recent prostate biopsy, vasectomy, or cystoscopy can disrupt small blood vessels within the genitourinary tract, leading to temporary bleeding into the semen. Such procedural causes are transient and resolve as tissues heal.
Prostate gland issues are another common source of hematospermia. An enlarged prostate, known as benign prostatic hyperplasia (BPH), can cause congestion and fragility of blood vessels surrounding the urethra and seminal vesicles. Prostate stones may also irritate surrounding tissues and lead to bleeding. While prostate cancer is a concern, it is rarely the sole cause of hematospermia without other associated symptoms, especially in younger men.
Abnormalities in blood vessels, such as varices, can also cause hematospermia. These are dilated, weakened veins within the seminal vesicles or other parts of the reproductive tract that are more susceptible to bleeding. These vascular anomalies can rupture under pressure during ejaculation, leading to visible blood. Such conditions are less common but are considered in persistent cases.
Systemic conditions can cause hematospermia. Uncontrolled high blood pressure, for example, can strain small, fragile blood vessels throughout the body, including those in the reproductive organs. Individuals with bleeding disorders, such as hemophilia or von Willebrand disease, or those taking anticoagulant medications like warfarin or aspirin, may experience hematospermia due to impaired blood clotting. These factors can prevent minor bleeds from sealing effectively.
When to Seek Medical Attention
Medical attention is advisable when hematospermia is accompanied by other concerning symptoms. Individuals experiencing fever, chills, or severe pain in the lower abdomen, groin, or back should consult a healthcare professional. Difficulty urinating, particularly if acute and sudden, also warrants medical evaluation, as these symptoms can indicate a more serious underlying infection or obstruction.
See a doctor if hematospermia is recurrent. Men over 40 should seek medical advice for any instance of blood in their ejaculate, given the increased risk of prostate-related issues with age. The presence of blood in the urine, known as hematuria, alongside hematospermia, also indicates a medical visit. Pain or swelling in the genital area, or a history of recent travel to regions with specific endemic infections, also requires medical assessment. While a single, isolated episode in younger men often resolves without specific intervention, a medical check-up is still prudent to rule out any underlying conditions.
Diagnostic Process
A medical evaluation for hematospermia begins with a review of the patient’s medical history. Questions cover the onset, duration, and frequency of bleeding, and any associated symptoms like pain, fever, or urinary changes. Sexual history, recent medical procedures, and current medications are also gathered. This history helps guide the physical examination and diagnostic tests.
A physical examination includes an assessment of the abdomen and genital area. A digital rectal examination (DRE) is performed to evaluate the prostate gland for tenderness, enlargement, or any unusual masses. This assessment provides clues regarding prostate health or potential inflammatory processes affecting nearby structures. The DRE is a routine part of the evaluation for male genitourinary symptoms.
Urine tests are ordered to check for infection or other urinary tract issues. A urinalysis can detect blood, white blood cells (indicating inflammation or infection), or bacteria. If an infection is suspected, a urine culture may be performed to identify the specific type of bacteria present, to guide antibiotic treatment. These tests help differentiate between a problem originating in the urinary tract versus the reproductive system.
Blood tests may be conducted based on age and symptoms. A prostate-specific antigen (PSA) test may be performed, especially in older men, to screen for prostate issues. If a bleeding disorder or medication effect is suspected, blood clotting tests, such as prothrombin time (PT) and activated partial thromboplastin time (aPTT), may be ordered. These tests assess the blood’s ability to clot properly.
Imaging studies are used to visualize the internal structures of the reproductive system. A scrotal ultrasound assesses the epididymis and testes for inflammation or other abnormalities. A transrectal ultrasound (TRUS) provides detailed images of the prostate and seminal vesicles, identifying cysts, stones, or other structural issues. In more complex or persistent cases, or if other imaging is inconclusive, magnetic resonance imaging (MRI) of the pelvis may be considered for a comprehensive view. Depending on findings, a referral to a urologist, a specialist in male reproductive and urinary health, may be made for further evaluation and management.
Treatment Approaches
Treatment for hematospermia is tailored to the identified underlying cause. If an infection is diagnosed, antibiotics are prescribed. The choice of antibiotic depends on the type of bacteria identified through urine or semen cultures, or it may be an empirical broad-spectrum antibiotic if the exact pathogen is not yet known. Reducing inflammation is also important.
Anti-inflammatory medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), are used to alleviate swelling and discomfort associated with conditions like prostatitis or seminal vesiculitis. These medications reduce the inflammatory response that can contribute to blood vessel fragility. Managing systemic conditions also helps resolve hematospermia.
For individuals with high blood pressure, adjustments to medication or lifestyle changes may be recommended. If anticoagulant medications are contributing to the bleeding, their dosage may be adjusted or a different medication considered, but only under strict medical supervision. These systemic interventions aim to stabilize the body’s overall physiological balance.
In rare instances, surgical procedures may be considered for specific anatomical issues. This may involve the removal of large seminal vesicle cysts causing obstruction or persistent bleeding. Cauterization of a specific bleeding vessel, while extremely uncommon, may be performed in select cases where a precise bleeding point is identified and other treatments have failed. These interventions are typically reserved for complex or intractable cases.
For many cases, especially isolated episodes in younger men with no other concerning symptoms, a “watchful waiting” approach may be recommended. This involves monitoring the condition for spontaneous resolution, as many benign causes of hematospermia do. Reassurance and education about the benign nature of the condition, once serious causes are ruled out, also help manage patient anxiety.