Patient's question:
Description of the problem: A week ago during ejaculation, I strongly restrained myself from releasing (the restraint was very strong, so it had a significant impact), today there are some red granular substances in the semen. Please ask if there is a relationship between the two, what should I do, and what should I pay attention to!Doctor's answer:
Normal semen from a healthy male is milky white or creamy yellow. If the semen appears pink, red, brownish-red, or contains blood streaks or clots, and a microscopic smear shows a large number of red blood cells, it is referred to as hematospermia. In medicine, it is classified as either macroscopic hematospermia or microscopic hematospermia, and in traditional Chinese medicine, it is also known as "chì zhuó." Hematospermia is more common in young and middle-aged men aged 25 to 40 and is a common urological condition. Patients often discover blood in their semen after masturbation or sexual intercourse, and this phenomenon may persist for a long time, often causing mental stress, increased psychological burden, or even fear.Most cases of hematospermia are benign and self-limiting, with the primary cause being lesions of the seminal vesicles, such as seminal vesiculitis, tuberculosis of the seminal vesicles, or tumors of the seminal vesicles, with seminal vesiculitis being the most common. Although hematospermia is generally unrelated to major diseases, it may sometimes be a symptom of certain systemic diseases or severe organic conditions. Some experts suggest that hematospermia may occur due to the collateral circulation between the hemorrhoidal venous plexus and the prostatic venous plexus during liver cirrhosis. There have also been reports of hematospermia caused by schistosomiasis, with live schistosoma larvae found in the semen. Additionally, hematospermia has been linked to hypertension, seminal vesicle cancer, renal tuberculosis, and early prostate cancer.
Therefore, when hematospermia occurs, especially if it persists despite standard antibiotic treatment, special examinations should be conducted to rule out other possible organic diseases. Only by identifying the true cause of hematospermia and treating it accordingly can satisfactory results be achieved.
In daily life, if hematospermia is observed, one should pay attention to any accompanying symptoms, such as frequent urination, urgency, or dysuria (urinary tract infection symptoms); coughing, hemoptysis, low-grade fever in the afternoon, or night sweats (tuberculosis symptoms); a tendency to bleed easily; difficulty urinating (urinary obstruction symptoms); ejaculation pain or abnormal sexual function; lower abdominal pain, perineal pain, or pain in other areas.
Certain antibiotics used to treat cystitis can also change the color of the semen, so a semen analysis is necessary for patients with hematospermia. Some hospitals may also require a stepwise ejaculation test, which can not only determine whether red or white blood cells are present in the semen but also provide an initial assessment of the condition of accessory glands and the source of hematospermia. For certain patients, a semen bacterial culture and drug sensitivity test may be performed, allowing the doctor to select appropriate antibiotics.
The doctor may also request imaging tests, such as transrectal ultrasound, which is considered the preferred method for screening for stones, tumors, hyperplasia, or other abnormalities in the prostate and seminal vesicles. For patients with abnormal findings on digital rectal examination or ultrasound, especially the elderly, further tests such as PSA, X-ray, or CT scans may be necessary to rule out conditions such as benign prostatic hyperplasia, prostate cancer, seminal vesicle cancer, or genitourinary tuberculosis.
If hematuria is also present, a urethral scope examination may be performed. In severe cases of hematospermia, if white blood cells are found in the semen and the condition does not improve after repeated antibiotic treatment, tuberculosis should be considered. For difficult cases, the possibility of systemic diseases should be ruled out, including hematological disorders such as purpura, scurvy, or leukemia, as well as portal hypertension due to liver cirrhosis.
In summary, although hematospermia caused by life-threatening diseases is uncommon, if it occurs, it is important to seek medical attention at a general hospital's urology department promptly. Special attention should be paid to ruling out sensitive causes such as trauma, bleeding disorders, stones in the seminal vesicles or prostate, prostatitis or seminal vesiculitis, or benign prostatic hyperplasia.
Treatment for hematospermia primarily focuses on addressing the underlying cause. At the same time, maintaining a relaxed and pleasant mood, eliminating psychological concerns and fear, leading a regular lifestyle, avoiding alcohol and spicy foods, eating a light diet with plenty of fruits, ensuring smooth bowel movements, and maintaining a healthy and normal sexual life are all important.