Men whose sole symptom is hematospermia are more likely to have prostate cancer than men who don’t have blood in their semen, but the chances are slim. Tumorsīenign polyps and malignant tumors of the prostate, testicles, epididymis, and seminal vesicles may cause hematospermia. An enlarged prostate, also called benign prostatic hyperplasia, pinches the urethra and can lead to hematospermia, too. When ducts are blocked, nearby blood vessels can dilate and rupture. Obstructed ducts, such as the ejaculatory duct, and the formation of cysts in the prostate or seminal vesicles can cause hematospermia. Note that only a portion of the vas deferens, which transports sperm from the epididymis to the seminal vesicles, is shown. Any of the organs, glands, or ducts shown here may be the source of the bleeding, though the cause and source of the bleeding often can’t be determined. Inflammation and infection, an obstruction, a tumor, vascular abnormalities, systemic factors, medical procedures, and trauma may cause bleeding that shows up in semen, a condition called hematospermia, or hemospermia. Some studies have shown that inflammation and infection are the most common causes of hematospermia in younger men (the average age of hematospermia patients is 37) and up to 39% of cases over all. Sexually transmitted diseases, such as herpes, gonorrhea, and chlamydia, have also been implicated in hematospermia. Inflammation can be caused by irritation or trauma stones or calcified deposits in the prostate, seminal vesicles, bladder, or urethra and infections with viruses, bacteria, fungi, or parasites. These include the seminal vesicles, vas deferens, epididymis, prostate, and urethra (see Figure 1 below). Inflammation of any of the organs, glands, or ducts involved in the production or storage of seminal fluid can lead to hematospermia. The rest of the cases were attributed to dozens of other factors that they grouped into six categories, as follows. The condition, researchers believed, was “benign and self-limited.” But in 2003, thanks to improved imaging techniques, a team of researchers classified only about 15% of cases as idiopathic. As the authors of an article in The Journal of Urology explain, patients were “warned about excessive overindulgence and prolonged sexual abstinence.” And as recently as a decade ago, most cases (up to 70% in some studies) were diagnosed as idiopathic, meaning that they had no obvious cause. Historically, doctors linked hematospermia to sexual behavior. From there, they can either prescribe medication or another treatment, or offer an anxious patient some much-needed reassurance that the condition will resolve on its own. And some cases certainly go unreported by men who’d rather not find out what ails them.Īlthough health care professionals can’t quantify hematospermia’s prevalence, they have been increasingly able to ascribe the condition to a particular cause, thanks to better diagnostic techniques, advances in medical imaging, and some good old-fashioned sleuthing.
A busy urologist may see several patients a year with hematospermia, but it’s likely that far more cases go unnoticed by a man or his partner during intercourse. But the true prevalence of the condition remains a mystery.
Just as puzzling, the condition can be limited to a single episode or can occur repeatedly over several weeks or months before disappearing completely.ĭoctors have been diagnosing hematospermia for centuries - even the Greek physician Hippocrates, who lived from around 460 to 377 B.C., described it. In many instances, it has no apparent cause. While it’s true that hematospermia may indicate prostate cancer or another urologic disease, that’s usually not the case. It conjures fears of cancer or a sexually transmitted disease. “Well,” he said, “my wife and I had sex last night, and she noticed that there was blood in my semen.”įew things alarm a man and his partner more than seeing bloody ejaculate, a condition called hematospermia, or hemospermia. “What makes you think that you might have prostate cancer?” I asked. “I haven’t had a PSA test recently, and I’ve never had a biopsy,” he replied. After a moment of stunned silence, I asked him about his prostate-specific antigen (PSA) level and whether he had had a biopsy. “I think I might have prostate cancer,” he said quietly.
An anxious colleague recently came into my office and closed the door.
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