Have you ever noticed a reddish or pinkish tint to your semen? If so, it could have been blood and it normally should not be there. The medical term for blood in the semen is hematospermia. It can sometimes be the first indicator of an underlying urologic disease or systemic disorder. But in most cases, it is associated with an infectious and/or inflammatory condition of the seminal vesicles or prostate. The condition is often self-limited and resolves within 1-2 months, but if it persists beyond 2 months, or if there is a concern to know what is the underlying cause, further workup is recommended. 

What are some of the possible reasons for blood to be in the semen? There are a few things that could cause this, for example injury or trauma that occurs at home could lead to hematospermia, but it may also be associated with trauma from recent procedures such as cystoscopy, urinary catheter placement, surgeries, prostate biopsies, etc. Mild bleeding after a procedure or surgery is sometimes expected and usually resolves without intervention. Injuries that occur at home may also resolve without intervention but evaluating for severity may be required to determine if intervention is indicated. Other causes may include infection with some type of organism such as a bacterium, virus, or even fungus. Infections (including STIs and non-STIs) can cause irritation to the inner lining of the urethra or other urinary and reproductive organs which may lead to hematospermia (and sometimes other types of discharge). Prostate cancer is also a possible cause, especially in older men. And other underlying reasons include things like cysts, polyps, condyloma (genital warts), strictures, or systemic conditions such as liver disease, lymphoma, hypertension, and other bleeding disorders. Medications used as blood thinners can also cause or contribute to hematospermia. 

Hematospermia can be light red/pinkish, bright or dark red, and can include clots depending on how much time has passed since the hemorrhage took place. It can be accompanied by pain with ejaculation or penetration, increased urinary frequency, burning with voids, rashes, sores, swelling, etc., but can also occur without any other signs, symptoms, or any recent obvious trauma. Effort must be made to make sure the blood is not coming from somewhere else because in some cases, it does not originate in the male reproductive system; it can come from other areas such as the urinary system or even be blood from the sexual partner.

A careful collection of history, a good physical examination, and proper testing is always important. Hematospermia has been associated with high blood pressure similar to that associated with epistaxis (nose bleeds) so being familiar with your blood pressure is vital. Knowing the correct dose when taking blood thinners or being aware that some conditions or other medications can increase their strength is also vital. Age is important as well. Urogenital infections are more common in men younger than 40 (i.e., STIs) and excluding urogenital malignancy is essential in men 40 and above. 

The physical exam should include the penis, urethral meatus, the scrotum, the prostate (digital rectal exam), etc. It may also include observing other areas for signs of bleeding such as multiple bruises or petechiae (small round red spots under the skin). 

Testing may include:

• A urinalysis and urine culture to make sure the blood is not coming from the urinary system and to rule in/out urinary tract infection (if blood is noted in the urine it mandates further evaluation to rule in/out bladder cancer, kidney stones, kidney disease, etc.). 
• A semen culture to rule in/out reproductive tract infections (e.g., prostatitis, epididymitis, etc.). 
• A prostate specific antigen (PSA) blood test to screen for prostate cancer.
• Cystoscopy may aid in pinpointing the source of the bleeding (e.g., lesions, stricture, etc.).
• A transrectal ultrasound (TRUS) to rule in/out abnormalities of the prostate or seminal vesicles (i.e., as calculi, dilatation, cysts, obstruction, abnormal lobulation, asymmetry, etc.).
• MRI can help detect changes in anatomic structure secondary to endocrine therapy, radiation, inflammatory disorders, and neoplasia; however, the biggest advantage of MRI over TRUS is its ability to demonstrate hemorrhage within the seminal vesicles or prostate.

Treatment is dependent on the underlying condition causing hematospermia. It may consist of antibiotics, surgery, further evaluation if needed, or it may consist of taking a watch-and-wait approach after ruling out all other causes. Noticing blood in the semen is never a pleasant surprise. If you experience this, stop by The Y Factor for a proper evaluation and we will develop a treatment plan for you. Women have OB-GYns | Men have The Y Factor! 

Benancio Martinez Jr is a certified Family Nurse Practitioner and one of the newest integral parts of the Y Factor team. Benancio is the medical provider in charge of the Northpointe location and brings to the Y Factor 10 years of nursing experience obtained through the emergency departments of the VA and Kingwood medical centers, as well as clinical experience in family practice, hematology, and oncology.