Patient's question:
In the most recent sexual intercourse, there were blood streaks in the semen released during ejaculation. Currently, how should this situation be handled? Does this affect future fertility? Is a chromosomal test necessary??? Please help me find a solution and good advice from the doctors. Thank you very much, looking forward to your reply.?? First follow-up question: The semen was normal at the beginning of ejaculation, but it contained blood at the very end. Please help me analyze this further, doctors. I'm feeling scared.Doctor's answer:
Generally speaking, hematospermia is not easily noticed unless there is significant bleeding. It is often difficult to detect during sexual intercourse unless the bleeding is considerable. Even if blood-stained discharge is observed on the penis or clothing after intercourse, people often first suspect factors related to the female partner. If sexual intercourse is conducted with a condom or through withdrawal, hematospermia is more easily detected. When people suddenly notice a change in the color of their semen, they often become anxious and worry about what is happening.The semen, which is normally milky white, may suddenly turn blood-red, reddish-brown, or contain streaks of blood, 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 seminal tract, such as bleeding or inflammation, or even a tumor. Hematospermia should not be taken lightly, as it may 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, although a small number of tumor patients may require further treatment.
The composition of semen consists mainly of a small volume of sperm, with the majority derived from the seminal vesicles, followed by the prostate. Anatomically, the ejaculatory ducts connecting the seminal vesicles open into the posterior urethra at the urethral crest, surrounded by 10–20 openings of prostatic ducts. In fact, the seminal vesicles, prostate, and posterior urethra are interconnected, and inflammation can easily spread from one to the others. Additionally, the wall of the seminal vesicle is very thin, and once it becomes congested, the blood-filled wall is prone to bleeding. Therefore, the most common causes or reasons for hematospermia are seminal vesiculitis, followed by prostatitis and posterior urethritis or 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 caused by 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 of transient hematospermia, there is no need to panic. A temporary abstinence of one to two weeks is usually sufficient for complete recovery. Bleeding caused by inflammation, however, tends to fluctuate and does not last long. If hematospermia persists and worsens progressively, 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.
Other causes include tuberculosis, seminal vesicle cysts, seminal vesicle tumors, prostate cancer, portal hypertension due to liver cirrhosis, trauma, urinary tract obstruction, and benign prostatic hyperplasia.