The normal color of semen in men is off-white, and may darken to yellow if there has been no ejaculation for some time. The presence of blood in semen is a rather “scary” phenomenon for a man, and it often occurs in sexually active young adults, especially in men under the age of 40. In most cases, hematemesis occurs without any warning, and the blood may be evenly distributed in the semen, or it may appear unevenly as bands or patches, with or without blood clots. The color can be bright red, pink, dark red, orange, or brown. So, how does hematosperm come about? Specialized urological male doctors are used to classify hematosperm into two types: primary and secondary. Primary hematosperm is more common and generally manifests itself episodically, making it clinically difficult to find the cause; secondary hematosperm occurs from some specific underlying disease, i.e., the disease is present first and then the hematosperm appears. Let’s see, what diseases or conditions can cause secondary hematospermia? In a nutshell, any local or systemic lesion involving the organs and tissues that produce sperm and transport and store semen can theoretically cause hematospermia. Sperm are produced by the testes and first reach the epididymis for incubation and activation, then enter the vas deferens in the spermatic cord and reach the seminal vesicles in the upper posterior part of the prostate for storage, where sperm seminal fluid and fluid secreted by the prostate gland are added to form seminal fluid. When there is sexual activity, the seminal vesicles contract, the ejaculatory ducts open, and semen enters the urethra (a component of the urinary system) and is ejected out of the body through a series of coordinated muscular movements. This process actually involves the passage of sperm and multiple semen components from the exterior of the body cavity (the contents of the scrotum) to the interior of the body cavity and then flushing out of the body. The journey is over the mountains from the place of origin and involves the male reproductive and urinary systems, not unlike the famous Northern Hemisphere’s “Journey to Damascus”. With this in mind, the causes of hematospermia are well understood. Common causes include: testicular injury, tumor, inflammation, infection; epididymitis, tuberculosis, tumor, trauma; spermatic cord inflammation, torsion, trauma; surgery or radiotherapy in the scrotum; seminal cysts, stones, infection, tumor; prostate puncture, prostate cancer, hyperplasia, radiotherapy, prostatitis and infection, urethritis, uroepithelial cancer, polyps, bladder urethral stones, abnormal erection of the penis, prepuce glansitis, lower urinary tract sexually transmitted diseases, etc. Systemic factors include: lesions affecting coagulation function or vascular fragility, such as hematological diseases (hemophilia, leukemia, lymphoma, purpura, etc.), hypertension, systemic vascular immune diseases (arteritis, lupus, etc.), cirrhosis of the liver, taking anticoagulant drugs, etc. Prolonged abstinence or strenuous sexual activity is also thought to be the cause. There are also some so-called risk factors for hematospermia i.e. certain groups of people are prone to hematospermia, including middle-aged men, history of cancer, bleeding disorders, trauma or genitourinary tract abnormalities, and patients with sexually transmitted diseases. Patients with hematosperm tend to be more nervous, as do their spouses, and sometimes both of them will come to the doctor together. As a doctor, you will take a detailed medical history, with particular emphasis on the hematosperm itself and accompanying symptoms. If the blood and semen are evenly mixed, there is a greater chance of problems with the prostate and seminal vesicles and above. Unevenly mixed blood will indicate bleeding closer to the outside. The color of the blood will also represent the duration of the bleeding. Fresh ones are more pink or bright red and will slowly change color over time as they migrate. After the red blood cells are destroyed the hemoglobin is eventually metabolized to heme, so it will change from red to brownish yellow the longer it takes. Besides hematospermia, doctors usually focus on whether there are accompanying symptoms and kinds, such as painful urination, urethral discharge, straining to urinate, difficulty in ejaculation, hematuria, back pain, scrotal swelling, groin swelling, perineal discomfort, back pain, and even fever, etc. All of these are helpful in determining the cause of hematospermia. Also, proper physical examination should be done. Palpation of the abdomen and scrotum is done to check for liver and pelvic pathologies, as well as abnormalities of the epididymal spermatic cord of the testes. A direct examination of the prostate and seminal vesicle area through the anus is also necessary for rectal examination. If the physician has suspicions, laboratory tests such as urine routine and culture, semen analysis, urethral discharge smear, prostate fluid examination, prostate-specific antigen (PSA except for prostate cancer), blood clotting function, blood count, and ultrasound of the prostatic seminal vesicles will also be done. CT, MRI, etc. will be prescribed in special cases. What the doctor does is to rule out factors such as infections, tumors, stones, malformations occurring in the testes epididymis seminal cords, prostate seminal vesicles, urinary tract, as well as secondary factors such as systemic coagulation abnormalities (medications or blood disorders), immune disorders, diabetes mellitus, etc. The good thing is that hematospermia is primary in most cases, which means that even a specialized doctor cannot probe to clarify the cause and bleeding site of hematospermia in a particular patient. However, although it seems somewhat helpless, the doctor can at least except whether the patient really has a life-threatening or organ-killing lesion, and it is not always necessary to run all of the above lab tests. Experienced physicians often eliminate the majority of causes through history and examination, and rule out serious underlying pathologies through one or two simple visual tests. If there is a real direction for hematospermia to occur, treatment for the cause will certainly “cure” the problem. The medicine here is not necessarily just the medicine you take, but may also include endoscopic exploration of the seminal vesicles or surgical removal of malignant tumors. In the home, you can do some simple treatment, such as rest, cold compresses and monitoring after minor injuries; stop using anticoagulant drugs such as aspirin (be sure to seek the advice of the prescribing doctor); drink more water; and appropriate hemostatic drugs. However, it is best to see a medical professional to determine the best. Hemospermia can sometimes be prevented by taking a number of measures, including safe sex or avoiding sexually transmitted diseases, prompt medical treatment and avoiding trauma as much as possible. To summarize, hematospermia can occur in men of any age after puberty, and most patients rarely have serious illnesses that can heal on their own. If its cause can be determined, treatment will be targeted.
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