When semen suddenly turns from its normal milky white color to blood red, reddish brown or mixed with blood, it is of course mixed with blood. So where does the blood come from? It could be a lesion in a part of the sperm pathway, such as bleeding, inflammation, or even a tumor. Don’t take hematemesis lightly, it can also be a sign of a serious disease, and it is best to see a specialist for a 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 easily bleed. Therefore, the most common cause of hematospermia is firstly vesiculitis, 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 suspended sexual intercourse to recover completely. The inflammation caused by the bleeding is mostly 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: tuberculosis, seminal vesicle gland cysts, seminal vesicle gland tumors, prostate cancer, cirrhotic portal hypertension, trauma, urinary tract obstruction, and prostate hypertrophy. Clinical manifestations: The routes of infection, etiology, clinical manifestations and symptoms of seminal vesicle adenitis and prostatitis are basically similar. It is mostly due to bacterial infection, but it can also be due to frequent sexual intercourse or long-term abstinence, and 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 the composition of seminal plasma during seminal vesiculitis, where bacteria eat nutrients in the seminal plasma, compete for oxygen, and excrete toxins and metabolites, undoubtedly exposing sperm to an extremely unfavorable environment and decreasing fertility; increased acidity of 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 In inflammation, because of the presence of a large number of cells and white blood cells in the seminal plasma, as well as pus, the viscosity increases significantly, and the ejaculated semen does not liquefy easily, so the sperm cannot move and cannot drive straight into the cervix. The volume of sperm plasma is too little for sperm survival in inflammation; too much, making sperm dilution is also not conducive to fertility. Of course, these analyses are only superficial, in fact many links or causes are not clear and still need to be studied and explored, because many patients with mild inflammation do not affect fertility. Of course, if the ejaculatory ducts are blocked for a long time, there is a possibility that anti-sperm antibodies are produced in the body, as in the case of vasectomy, which further complicates the problem. 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 excision 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 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, hematospermia will persist for some time before it disappears even if it is treated promptly and adequately. The treatment principles for hematospermia are basically the same (except for tumors and tuberculosis which require special treatment), the main thing is to abstain from intercourse during the acute bleeding period, after the hematosperm disappears you should still rest for 1-2 weeks, and intercourse should not be too frequent and intense after recovery; abstain from drinking alcohol and spicy and stimulating food to avoid aggravating the degree of congestion; do not ride bicycles or horses for long distances; massage the prostate gland of the seminal vesicles once a week It helps to discharge inflammatory secretions; hot water sitz bath once a day, 15-20 minutes each time, water temperature 41-42°C (30 days a course, rest 10 days before the next course), antibiotics, hemostatic drugs and other symptomatic treatment is also necessary.