Patient's question:
After ejaculation, it was found that all that came out was blood. What should be done?Doctor's answer:
Generally speaking, hematospermia is not easily noticeable unless there is significant bleeding. It is often difficult to detect during sexual intercourse unless the bleeding is considerable. Even if blood-stained semen is found on the penis or clothing after intercourse, people often first suspect issues with the female partner. If using condoms or practicing withdrawal ejaculation, hematospermia becomes more apparent. When people suddenly notice a change in semen color, they often become anxious and worry about what is happening. Semen, which is normally milky white, may suddenly turn blood-red, reddish-brown, or mixed with blood streaks, indicating the presence of blood. So, where does the blood come from? It is usually due to a pathological condition in some part of the spermatic pathway, such as bleeding, inflammation, or even a tumor. Hematospermia should not be taken lightly, as it could be a sign of a serious disease. It is best to consult a specialist doctor for a thorough examination. Clinically, hematospermia is not uncommon. After detailed clinical and laboratory tests, the majority of cases can be controlled or cured through treatment, though only a small number of tumor patients may require further treatment.The composition of semen consists mainly of a small volume of sperm, with the rest coming from the seminal vesicles, followed by the prostate. Anatomically, the ejaculatory ducts connecting the seminal vesicles open into the posterior urethral crest, surrounded by 10–20 openings of prostatic ducts. In fact, the seminal vesicles, prostate, and posterior urethra are interconnected, making it easy for inflammation to spread from one to the others. Additionally, the wall of the seminal vesicle is very thin, and when congested, the blood-filled wall is prone to bleeding. Therefore, the most common cause of hematospermia is seminal vesiculitis, followed by prostatitis, posterior urethritis, or posterior urethral congestion. It can also be caused by inflammation spreading from nearby organs, leading to inflammation, swelling, congestion, and bleeding of the seminal vesicle wall. Generally, at least 70% of hematospermia cases in individuals under 30 are due to inflammation. If hematospermia occurs only occasionally and no specific abnormalities are found during examination, it may be due to minor blood vessel rupture and bleeding caused by rapid congestion and mechanical trauma during intercourse. In such cases, there is no need to panic—cessation of sexual activity for one or two weeks is usually sufficient for full recovery. However, bleeding caused by inflammation tends to fluctuate but does not last long. If hematospermia persists and worsens, the possibility of a tumor cannot be ruled out. In some cases, if there is a widespread bleeding tendency in other parts of the body, it may indicate a systemic hemorrhagic disorder, such as leukemia or thrombocytopenia, rather than a localized condition.