Oh my G-d, I just ejaculated blood. It’s Hematospermia: Don’t panic

Hematospermia literally means blood in the ejaculate. For men who have experienced it, it can be a shocking situation and a cause for tremendous anxiety. The cause for it is (not universally but) most commonly, benign. Why and how does it happen?

The majority fluid in the ejaculate comes from 2 sources: the prostate and seminal vesicles; they account for 95% of the fluid. The prostate sits below a man’s bladder and surrounds the prostatic urethra. The Seminal vesicles lie above and behind the prostate and join the ampulla of the vas to form the ejaculatory ducts. Those ducts travel through the prostate to empty into the prostatic urethra.

The vasa carry sperm from the testis and epididymis to the ejaculatory ducts. The sperm contribution accounts for almost 5 % of the ejaculate volume. Separately, Cowpers (bulbourethral) glands can also contribute a little fluid.

The true prevalence and incidence of hematospermia is unknown, but a urologist typically sees at least a few unnerved individuals a year with this complaint. Some patients have only one episode. However, once there is blood in the seminal vesicle, the hematospermia can recur over 2 weeks to 2 months without significance.

The typical approach at first presentation is for the physician to obtain a history including history relevant to risk for urinary infection and or sexually transmitted disease. A physical examination including a prostate examination (which also includes examination of the seminal vesicles) is performed and a urine analysis is performed. In cases of persistent or recurrent hematospermia, the physician may order imaging studies such as prostate ultrasound or pelvic MRI. Pelvic MRI currently offers the most sensitive and specific means of looking for any anatomic abnormality in the pelvis.

The cause for hematospermia is idiopathic (happens by itself) in the majority of cases. Less commonly, infection may be involved. Some anatomic abnormalities such as a cyst in the prostate or ejaculatory duct can be associated with the condition. Prostate calculi or stones have also (rarely) been seen in association. Surgical procedures such as prostate biopsy or prostate resection (TURP) have also been commonly associated. Uncommon or rare causes of hematospermia include a vascular malformation in the pelvis or a tumor.

When due to a benign cause, the course of hematospermia is usually self limited. Sometimes, when associated with enlarged prostate in men older than forty, use of a five alpha reductase inhibitor such as proscar or Avodart are helpful in the faster resolution of symptoms.

Having practiced for 20 years, I still have not seen a patient with hematospermia due to a malignant cause in my practice. However, despite the fact that the majority of cases are due to benign causes, evaluation by a physician is still appropriate.

You Might Also Enjoy...

Men Suffer From Hormone Imbalance Too

Hormone imbalance is often labeled as a women’s health issue. While it’s true that hormonal changes in menopause trigger notorious symptoms, men are at risk for hormone imbalance too. Learn more about low testosterone and how it can be treated.

What Is a Varicocele?

A varicocele is an enlarged vein in your scrotum, and it’s a leading cause of male infertility. Learn the signs and symptoms of varicoceles and what your treatment options are here.

What Are the Risks of Having a Vasectomy?

Hundreds of thousands of American men get vasectomies each year. It’s a popular and effective form of permanent birth control for men, but is it safe? Learn the possible risks of vasectomy and find out how you can reduce your risks here.

Can You Prevent Kidney Stones?

Kidney stones are common — and painful. Once you have one kidney stone, your risk of developing more increases. The good news is that there’s a lot you can do to lower your risk of kidney stone formation. Get our prevention tips here.

Recovering From a Vasectomy Reversal

Regretting your vasectomy? A vasectomy reversal could be the solution you’re seeking. It’s an outpatient procedure that can be up to 90% effective. Find out more about it and what to expect during recovery.

What Every Man Should Know About His Prostate

The prostate is a small gland in the male reproductive system. From how it functions to the importance of regular prostate screenings, find out what you need to know about your prostate health here.