Blood in semen (hemospermia)

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What is it about ?

Hemospermia (or hematospermia) means that there is blood in the semen. Hemospermia is usually a mild symptom with no specific, identifiable cause.

The causes that may explain the problem are as follows:

  • urological intervention (prostate surgery or sterilization);
  • trauma to the urethra, possibly associated with sexual activity;
  • a prostate infection ;
  • a sexually transmitted infection (STI), such as a chlamydia infection gonorrhea, Where herpes ;
  • a blood clotting disorder or taking anticoagulant therapy;

Rarely, a prostate tumor or another urinary tract tumor (hardly ever in men under 50).

What is its frequency?

We do not have exact figures on the number of cases of hemospermia in our country. Studies show that the problem usually occurs in men at a rather young age: 37 years on average. In about 15% of cases, symptoms only occur once. They are more chronic in all other cases.

How to recognize it?

In hemospermia, there is blood in the semen.

How is the diagnosis made?

The doctor will start by asking questions to find out the precise nature of the complaint:

  • how many times have you already had this problem?
  • could it be related to your intercourse or masturbation?
  • Could the problem be the result of injury or surgery to the urethra or urinary or reproductive system?
  • do you have pain or a burning sensation when urinating or during orgasm?
  • Is there fluid or pus coming out of the urethra?
  • do you also see blood when you urinate ?
  • do you also have difficulty urinating (urinating more difficult, weaker jet, droplets after urinating)?
  • do you have a history of (unprotected) sexual contact (risk of STIs)?
  • have you ever traveled to the tropics (risk of schistosomiasis, a tropical parasitic disease)?

Then the doctor will auscultate you. He checks for secretions leaking from the urethra and for any abnormalities in the genitals. Following an examination of the prostate (passing through the anus (rectal examination)), he will examine whether the prostate is swollen, painful or abnormal.

A urine sample is taken to see if there is any blood in the urine (hematuria). If the doctor suspects inflammation of the urethra (urethritis) after the discussion and examination, samples are also taken to check for the presence of an STI.

If in doubt, a semen analysis can rule out true hemospermia.

If the hemospermia is repeated, additional examinations (often specialized) are indicated, in particular in men from 40 to 50 years. For example, a Prostate Specific Antigen (PSA) measurement, an ultrasound of the prostate, and possibly a bladder exam with a small camera inserted into the urethra (cystoscopy).

What can your doctor do?

Depending on the severity of the symptoms and the age, the doctor will reassure you, treat you or refer you to a specialist.

He will above all take care of reassuring men of young age who have had hemospermia only once and in whom there is no other anomaly or the slightest worrying indication. In addition, following a prostate biopsy or sterilization, it is normal to have blood in the semen for up to 2 months after the procedure.

If there are any signs of inflammation of the prostate and / or seminal vesicles or an STI, it should of course be treated.

In the event of repeated complaints in men from the age of 40 to 50 years or in the event of abnormal examinations, an additional urological examination is usually required for which you will be referred to a specialist.

Want to know more?

Source

Foreign clinical practice guide ‘Hemospermia’ (2000), updated on 08/09/2016 and adapted to the Belgian context on 07/02/2019 – ebpracticenet

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