Hemospermia is one of the diseases of the male reproductive system, whose main symptom is the ejaculation of red semen during intercourse, mostly seen in modern medicine as seminal vesiculitis, which is less common clinically. The disease is often complicated with prostatitis, and its infection is mostly through direct spread of urethral and prostate infection; secondly, lymphatic infection and bloodstream infection. The invasion of bacteria and the stimulation of inflammation cause the seminal vesicles to become congested, and when sexual intercourse occurs, the smooth muscle and blood vessels contract, resulting in a large number of red blood cells and pus cells in the seminal fluid. According to Chinese medicine, hematosperm is usually caused by the patient’s deficiency of kidney yin and vigorous fire, forcing the blood to flow delicately; or by excessive intercourse, which damages the blood channels and causes the blood to flow with the semen; or by the downward injection of damp heat, which fumigates the seminal chamber and causes the blood heat to flow delicately. The diagnosis of hematosperm is diagnosed when semen containing blood is ejaculated during sexual intercourse or masturbation or seminal emission. In adult men who have had intercourse or seminal emission for a longer period of time (several months), the semen ejaculated is often thick and yellowish in color, and if the ejaculation is accompanied by discomfort or pain in the lesser abdomen or perineum, it should be distinguished from hematosperm. Examination: A large number of red blood cells in the semen found under the microscope can also confirm the diagnosis of this disease. Classification of hematosperm Those with abnormal color that can be detected by the naked eye are also called hematosperm of the naked eye. In addition, more often than not, abnormalities cannot be seen by the naked eye, but with the help of microscopic examination, a small amount of red blood cells can be found in the semen, which is classified as microscopic hematosperm. The reason for hematosperm Generally speaking, hematosperm is not easy for people to notice immediately, unless there is more bleeding, otherwise it is more difficult to find during sexual intercourse. Even if blood is found on the penis and clothing after intercourse, people tend to think that it is the woman’s fault first. If you wear a condom during intercourse or ejaculate outside the body, it is not difficult to find bloody semen. When people suddenly find that the color of semen has changed, they are nervous and often anxiously meditate on what is going on. When semen suddenly changes from its normal milky white color to blood red, reddish brown or mixed with blood, of course, blood is mixed in. So where does the blood come from? It could be a lesion in one of the tissue areas of the sperm pathway, such as bleeding, inflammation, or even a tumor. Don’t take hematosperm lightly, it can also be a sign of a serious disease, it is best to see a specialist for serious examination. Clinically, hematospermia is not uncommon, and after detailed clinical and laboratory examinations, most of them can be controlled or cured with treatment, while only a very small number of tumor patients need further treatment. Since semen is composed of components other than spermatozoa of very small volume, it mainly comes from the seminal vesicle gland, followed by the prostate gland. Anatomically, the ejaculatory duct connecting the seminal vesicle gland opens at the urethral crest of the posterior urethra and is surrounded by 10-20 prostatic glandular openings. In fact, the seminal vesicle gland, prostate gland and posterior urethra are in communication with each other and inflammation can easily spread from one of them to the other two. In addition, the wall of the seminal vesicle gland is very thin, and once it is congested, the vascularized vesicle wall can bleed easily. Therefore, the most common cause of hematospermia is firstly vesicourethritis, followed by prostatitis and posterior urethritis or posterior urethral congestion. Inflammation, swelling, congestion and bleeding of the wall of the seminal vesicle gland can also be caused by the spread of inflammation in other adjacent organs. Generally, at least 70% of hematospermia under the age of 30 is caused by inflammation. If hematospermia occurs only occasionally and no specific changes are found upon examination, it may also be caused by the rupture and bleeding of microscopic small blood vessels in certain tissues due to acute congestion and mechanical collision during sexual intercourse. The actual fact is that you will be able to get a lot more than just a couple of weeks of suspension of intercourse to fully recover. The inflammation caused by the bleeding is most often good and bad, but does not last long. If the hematemesis persists and keeps increasing, the possibility of a tumor cannot be ruled out. Individual patients with a tendency to combine extensive bleeding from other parts of the body are likely to have systemic hematologic bleeding disorders, such as leukemia and thrombocytopenia, and will not be a consequence of local lesions. Other etiologies include: seminal vesicle stones, tuberculosis, seminal cysts, seminal gland tumors, prostate cancer, cirrhotic portal hypertension, trauma, urinary tract obstruction, prostatic hypertrophy, etc. Clinical manifestations of hematospermia The routes of infection, etiology, clinical manifestations and symptoms of seminal vesiculitis and prostatitis are basically similar. It is mostly due to bacterial infection, but it can also be caused by too frequent sexual intercourse or long-term abstinence, where sexual tension is not released causing organ congestion. The main symptom of vesicouterine adenitis is hematemesis during sexual intercourse, accompanied by reduced libido, premature ejaculation, mild pain or swelling in the perineum, painful ejaculation, frequent and painful urination, etc. Prostatitis is also accompanied by burning sensation of urination, urinary urgency, dripping after urination or milky mucus flowing out of the urethra after urination, which does not locate pain, and even sexual dysfunction such as premature ejaculation, seminal emission and erectile insecurity. Due to their complex anatomy and poor drainage, they can easily turn chronic, thus causing secondary vas deferens obstruction and edema obstruction at the ejaculatory orifice, resulting in dry ejaculation with only ejaculatory action but no semen discharge. This is the mechanism by which hematosperm causes infertility. Other causes of infertility include changes in seminal plasma composition during seminal vesicle adenitis, where bacteria eat nutrients in the seminal plasma, compete for oxygen, expel toxins and metabolites, undoubtedly exposing sperm to an extremely unfavorable environment and reducing fertility; increased acidity in seminal plasma during inflammation, causing the pH of seminal fluid to drop from the usual alkaline 7.2-8.9, which is suitable for sperm survival, to the minimum sperm survival requirement of 6- 6.5. In the case of inflammation, because of the presence of a large number of cells and white blood cells in the seminal plasma, which may also be interspersed with pus, the viscosity increases significantly, and the ejaculated semen is not easily liquefied, so that the sperm cannot move and cannot drive straight into the cervix. The volume of seminal plasma is too little in inflammation, which is not conducive to sperm survival; too much, which makes sperm dilution also not conducive to fertility. In fact, many links or causes are not clear and remain to be studied and explored, as many patients with mild inflammation do not affect fertility. Of course, the problem is further complicated if the ejaculatory ducts are chronically obstructed and anti-sperm antibodies are produced in the body. Spermatoglandular cysts are usually asymptomatic and are congenital lesions. Hemospermia can occur secondary to vesicourethritis and is prone to recurrent episodes. Oversized cysts can also compress the bladder urethra causing symptoms of dyspareunia. In patients with difficult-to-cure hematospermia, if a percutaneous puncture of the vas deferens is used to take an X-ray with contrast, a cystic mass with a smooth inner wall can be found in the seminal vesicle gland. After contrast, antibiotics can be injected directly into the cyst through a catheter, and if this is not effective, surgical removal of the cyst is possible. The tumor of the spermatic gland is much rarer. The mass is solid on B-mode ultrasound, and the contrast filling defect formed by the tumor occupying the space is shown on the spermatic gland imaging, at which time the mass should be surgically removed. The appearance of hematosperm differs due to different bleeding sites and blood volume: blood from the urethral mucosa that is congested during erection is bright red and does not mix with semen, like mixed blood. Hemosperm caused by various inflammatory and traumatic conditions is well mixed and reddish to coffee colored, which is due to a change in color of blood stored for a longer period of time. Since the semen accumulated in the seminal glands cannot be emptied in a single ejaculation, even with timely and adequate treatment, hematospermia will persist for some time before disappearing. The clinical laboratory examination should pay attention to the relationship between the area of pressure and the secretion when collecting the secretion specimen, massage the prostate gland first to collect the prostatic fluid, and then massage the left and right seminal vesicle glands respectively after urination to collect the seminal vesicle gland fluid, which will help in the differential diagnosis of the two. If necessary, seminal vesiculoscopy or seminal vesiculography can be performed to clarify the diagnosis. Laboratory examination can reveal a large number of red blood cells in semen. At present, our hospital uses seminal vesicle microscopy to detect seminal vesicle stones, inflammation and tumors and can treat them directly. The treatment principles for hematospermia are basically the same (except for tumors, tuberculosis and stones that require special treatment), the main thing to note during acute bleeding is 1. 4, hot water sitz bath once a day, each time 15-20 minutes, water temperature 41-42 ° C (30 days a course, rest 10 days before the next course); 5, antibiotic treatment; 6, hemostatic drugs and other symptomatic treatment is also necessary 7, if the above methods are not effective or recurrent should be performed vesiculoscopy or surgical treatment. Physiotherapy and Chinese medicine can also be used, and posterior urethritis can be treated with posterior urethral infusion therapy. As long as the treatment is proper, the healing will not affect intercourse and fertility, so there is no need to worry about it. However, you should not be paralyzed in order to avoid delaying the treatment and the development of fertility.