Patient's question:
I had a medical check-up in the hospital a few days ago and was diagnosed with prostatitis. Due to work reasons, I haven't had sexual activity for four months. In the past month, I've been experiencing nocturnal emissions almost every week, but I've never masturbated before. Yesterday, when I masturbated, I actually ejaculated blood, which has never happened before. Then, when I went to urinate, I felt a burning sensation in my urethra. Could you please tell me what might be causing this situation?Doctor's answer:
Hello: Semen suddenly changes from its normal milky white color to blood-red, reddish-brown, or mixed with blood streaks, of course containing blood. So where does the blood come from? It must be due to a pathological change in some part of the spermatic pathway, such as bleeding, inflammation, or even a tumor. Do not take hematospermia lightly, as it could also be a signal 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 examinations, the majority can be controlled or cured through treatment, with only a small number of tumor patients requiring further treatment.
The composition of semen consists mainly of the small volume of sperm, with the majority coming from the seminal vesicles, followed by the prostate. Anatomically, the ejaculatory ducts connecting the seminal vesicles open into the posterior urethral crest of the posterior urethra, 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 vesicles is very thin, and once congested, the blood-filled wall is prone to bleeding. Therefore, the most common cause of hematospermia is first 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 caused by inflammation.
Other causes include: tuberculosis, seminal vesicle cysts, seminal vesicle tumors, prostate cancer, portal hypertension due to liver cirrhosis, trauma, urinary tract obstruction, and prostatitis.