Blood in semen (haematospermia)
Causes of blood in the semen continued...
Polyps in the reproductive tract, which are benign growths that don't cause any medical problem, can also cause blood in semen.
Blood vessel problems. All of the delicate structures involved in ejaculation, from the prostate to the tiny tubes that carry sperm, contain blood vessels. These can be damaged resulting in blood in the semen.
Other medical conditions. High blood pressure, HIV, liver disease, leukaemia and other medical conditions are also associated with blood in semen.
As many as 15% of cases of blood in semen can't be traced to a known cause. Many of these cases are also self-limiting. That means that the blood in the semen goes away by itself without medical treatment.
When looking for an underlying cause of blood in the semen, the doctor will ask about any related symptoms, including:
- Blood in the urine (called haematuria)
- Hot, burning urination or other symptoms of painful urination
- Difficulty emptying your bladder completely
- A painful bladder that feels distended
- Painful ejaculation
- Swollen or painful areas on the sex organs or obvious scrapes from injury
- Penis discharge or other signs of an STI
- Fever, racing pulse and higher-than- normal blood pressure
Blood in semen: Tests and evaluation
To diagnose blood in the semen the doctor will take a complete medical history. That will include a history of any recent sexual activity. The doctor will also perform a physical examination. This will include examining the genitals for lumps or swelling and a digital rectal examination to check the prostate for swelling, tenderness and other symptoms. The doctor may also arrange the following tests:
- Urinalysis or urine culture to identify infection or other abnormalities.
- STI testing if a sexually transmitted infection is suspected.
- The "condom test" if there's a possibility that blood in the semen is actually coming from a sexual partner's menstrual cycle. The man will be told to wear a condom and then examine the "protected" semen for blood.
- PSA testing, to help determine prostate cancer by measuring a substance called prostate-specific antigen in the blood.
- Other urological tests such as cystoscopy, ultrasound, CT and MRI to further evaluate the patient.
Treatment for blood in semen
Treatments target the known cause:
- Antibiotics are used for infections.
- An anti-inflammatory medication may be prescribed for some types of inflammation.
- If an STI or medical condition such as high blood pressure or liver disease is the culprit, the doctor will treat that condition.
- When blood in semen stems from a recent urology procedure, it usually disappears by itself in a matter of weeks.
In younger men, blood in the semen that happens once or twice without any additional symptoms or history of certain medical conditions can disappear on its own without treatment.
If you have repeated episodes of blood in the semen along with painful urinary or ejaculatory symptoms, the doctor may refer you to a urologist.
If the doctor suspects prostate cancer, or another form of cancer, the doctor may refer you to a urologist for further tests that include a prostate biopsy to evaluate the tissue for cancer. The incidence of prostate cancer is low in younger men - with a small number of cases occurring in men younger than 45. However, for men of any age with risk factors for cancer, testing that rules out prostate cancer may be the most reassuring part of treatment for blood in semen.