Hemospermia or hematospermia (bloody semen) is a rare urological problem. Sometimes it can be a symptom of a serious underlying disease, cancer. It is not usually a sign of serious illness at a young age. In older men and especially in recurrent cases, it is definitely useful to see a urology specialist. In this article, I will give general information about hemospermia (hematospermia) in the light of my own experiences and literature.

What does hematospermia mean?

Hematospermia or hemospermia means bleeding from the semen or bloody semen. Normally, there is no blood in the semen and the color of the semen is cream-colored. Hemospermia can be seen microscopically, that is, only under microscopic examination, or sometimes in the form of crimson blood. It is not normal to see blood from the semen visible in this way and it disturbs people.

Is bleeding from the semen common?

The incidence of this disease is not very common. It is a rare condition. It is not a very common situation as people generally do not check their semen after ejaculation. However, in severe and recurrent cases, patients notice and refer to a Urologist.

Bleeding from the semen (hematospermia) is most common in sexually active men between the ages of 30-40.

Does hemospermia go away on its own?

The answer to this question depends on the factor. If there is no underlying cause, hemospermia is usually a benign disease and will go away on its own. According to our own experience, we have observed that almost all of these patients recover spontaneously if there is no infection in the patients and if it is due to excessive sexual intercourse or masturbation.

How does hematospermia pass by itself?

How hemospermia will pass and whether treatment will be required is a matter of great interest to our patients. It is not correct to give a clear answer to this issue. First of all, we recommend these patients to be examined by a Urologist. The urologist primarily determines the cause of hemospermia.

After the cause is determined, treatment is planned. If it is due to infection, it should be treated with appropriate antibiotic therapy. An organic cause should be investigated in patients over 40 years of age. Prostate diseases are one of the common causes of hemospermia in this age group. Prostate examination and treatment planning should be done according to the result.

Is brown semen discharge hematospermia?

Sometimes semen can come in dark, brown color. Such conditions are confused with hemospermia. Dark, brownish semen (ejaculate) does not always mean bleeding. Dark or brown semen may be due to the accumulation of semen as a result of prolonged inability to ejaculate or have intercourse. To understand whether there is bleeding, the semen should be examined microscopically. If there is blood (erythrocyte) in the microscopic examination, then it means that there is hemospermia, that is, blood in the semen.

What are the causes of hematospermia?

There are many causes of hematospermia. In young people, it is usually due to benign causes such as infection. It may be the result of malignant conditions, albeit very rarely, in advanced ages. Prostate cancer should be ruled out in patients over 50 years of age.

The reasons for bleeding from the semen are:

• Tearing of small blood vessels during ejaculation
• Genitourinary system traumas
• Excessive sexual activity or masturbation
• Surgical interventions on the genital system (testicle, epididymis, vas deferens, vesicle seminalis, prostate)
• After prostate biopsy: In patients who have undergone diagnostic prostate biopsy for prostate cancer, semen may be bloody for 4-6 weeks. This is normal, it is a result of trauma to the biopsy needle.
• After vasectomy surgery: In men, blood may come from the semen after sterilization (for birth control) and ligation of the semen ducts on both sides (vasectomy). This goes away after 1-2 weeks.
• Radiation therapy to the prostate area due to prostate cancer
• Infection: It can be seen as a result of infection or inflammation of the semen ducts.
• Sexually transmitted diseases
• Prostate diseases: BPH (benign prostate enlargement), prostate cancer, prostatitis, prostate cysts and polyps
• Testicular and epididymal diseases: It is usually seen as a result of infectious diseases. Like orchitis, epididymitis.
• Vesicle seminalis diseases: Vesicle seminalis are auxiliary reproductive organs in men. As a result of their infection, blood may appear in the semen.
• Blood diseases: As a result of diseases such as bleeding disorders and sickle cell anemia, this condition can be seen, albeit rarely.
• Use of blood thinners
• High blood pressure: Due to excessive blood pressure, the capillaries may crack and blood may come from the semen. This situation occurs infrequently.
• Chronic infections: As a result of chronic infections of the genitourinary system such as tuberculosis and schistosomiasis, blood may appear in the semen.
• Cancers: There may be hematospermia due to cancers of the testis, epididymis, bladder, prostate, seminal vesicle, and urethra.

• Other causes: Blood can be seen in the seminal fluid in leukemia patients, liver and HIV (AIDS, human immunodeficiency syndrome) patients.

What is the most common cause of hemospermia?

The most common cause of hematospermia, especially in young and sexually active men under the age of 40, is urogenital system infections. Among these, Chlamidia trachomatis, ureaplasma urealyticum, herpes simplex virus, Cytomegalovirus and parasitic agents are common.

Is hematospermia dangerous?

Since bloody semen is a rare condition, it can alarm people. But this may not always be dangerous. Most people think of this condition as a sign of cancer and panic. Especially when it is seen in men over 50 years of age, diseases such as prostate cancer should be suspected. It is important for these people to apply to a Urologist and be checked.

Hemospermia should be carefully investigated if:

• In cases over 40 years old and frequently recurring
• If the patient also has complaints about urine and ejaculation
• Patients at high risk of cancer

When should patients with hemospermia see a doctor?

Macroscopic blood coming from the semen is not normal under normal conditions. Especially in young men, there is usually no underlying disease. This condition is not actually a disease, but a symptom of any disease. Although it is usually a benign condition, patients should definitely consult a Urologist and investigate the situation.

Patients with hematospermia should definitely consult a Urologist in the following cases:

• Men over 40
• Patients with hematospermia lasting more than 3-4 weeks
• Frequently recurring patients
• If urinary system complaints accompany
• People with cancer, bleeding disorder, congenital genitourinary system development disorder
• Those with sexually transmitted diseases

Which doctor should patients with hematospermia go to?

Patients with the complaint of bleeding from the semen should consult a Urology specialist. Patients are evaluated by a Urologist, preferably experienced in Andrology. The urologist makes a detailed questioning of the patient, requests the examination and analyzes, and finally, the diagnosis is made and treatment planning is made.

How is the diagnosis of hematospermia made?

A systematic approach is required to diagnose patients with hemospermia. The diagnosis of the disease is made by detailed questioning of the patients, examination, laboratory tests and radiological examinations.

• Anamnesis: The patients undergo a general questioning such as the onset of the complaint, how often it occurs, the drugs used, sexual life, and habits.
• Examination: A detailed examination of the genitourinary system is performed.
• Rectal examination: The prostate and surrounding structures are evaluated.
• Blood pressure measurement: It is known that some high blood pressure patients, especially those with uncontrolled high blood pressure, come with bloody sperm after intercourse. Therefore, the blood pressure of these patients should also be checked.
• Urine culture and antibiogram: Important for the detection of a causative infectious agent.
• Investigation of sexually transmitted diseases: Since it may be the cause of hemospermia, sexually transmitted diseases should be investigated in these patients.
• PSA test: Men over 50 years of age should have a PSA test in the blood to rule out the possibility of prostate cancer.
• Transrectal ultrasonography (USG): Prostate and seminal vesicles are evaluated radiologically by transrectal USG in these patients. If there is cancer, cyst, stone, infection, it is possible to diagnose with USG.
• MR, CT: As further tests, if underlying malignant diseases are suspected, advanced imaging methods such as MR and CT can be used.

What complaints occur in patients with hematospermia?

Patients with hematospermia sometimes apply to the doctor only with the complaint of blood coming from the semen. Sometimes there may be other complaints (symptoms) of the urinary system. Common complaints in patients with hemospermia are as follows:

• Blood in the urine (hematuria): It can be in the form of macroscopic or microscopic hematuria.
• Dysuria: Burning while urinating, painful urination. In this case, an infection in the urinary tract should be suspected.
• Difficulty urinating: If this is the case in men over the age of 50, prostate diseases should be investigated.
• Pain in the lower abdomen: Pain in the bladder area may suggest bladder diseases as the cause.
• Painful ejaculation: If there is painful ejaculation after intercourse, infection in the semen ducts can be considered.
• Urethral discharge: Sexually transmitted diseases can cause hematospermia. If there is urethral discharge, it is necessary to consider sexually transmitted diseases.
• High blood pressure: Rarely, in patients with high blood pressure, a container may come from the semen. This is due to the rupture of capillaries due to increased blood pressure.
• Trauma: As a result of traumas of the genitourinary system, hematospermia can be seen again. If there are traces of trauma to the urinary and genital system organs in the examination, it should be kept in mind that this may be the cause.

How is the treatment done in patients with hemospermia?

Treatment of patients with hemospermia varies according to the underlying cause and the duration and severity of the disease. If the disease is seen in young, sexually active patients, if it is short-lived and does not recur, there is usually no serious underlying disease and is followed up spontaneously. If it recurs during follow-ups, more effective treatment should be arranged according to further research and results.

If an infection in the genitourinary system is detected as the cause, then antibiotic therapy should be applied to the causative microorganism.

In patients over 40-50 years old, prostate examination should be done and the cause of the disease should be revealed. We perform a detailed prostate examination for this group of patients, especially to rule out prostate cancer.

How long does it take to treat hematospermia?

The duration of treatment varies according to the factor. If the cause of hematospermia is infection, the infection disappears after treatment. This may take a few days to weeks. If hematospermia has developed as a result of prostate biopsy, the seminal fluid returns to normal after 4-6 weeks.

In summary; Rare hematospermia is usually benign, there is no serious underlying disease. This condition is age related. Men under the age of 40 usually do not have a serious underlying disease. A Urology specialist should be consulted for men over 40 years of age and in recurrent cases.

Prof. Dr. Emin ÖZBEK

Urology Specialist

Istanbul/ Turkey