Patient's question:
What is the reason for blood in semen in people who do not have frequent sexual activity?Doctor's answer:
Analysis of the Condition: Hello, blood is mixed in the semen. Medically, this is known as hematospermia. Normal semen has a light grayish-white color, and after abstinence for a while, it may turn light yellow, slightly viscous. It turns into a liquid within about 20 minutes after ejaculation, known as semen liquefaction. The main components of semen include seminal fluid (50%-80%), prostatic fluid (15%-30%), as well as small amounts of epididymal fluid, sperm, bulbourethral gland fluid, and paraurethral gland fluid. Therefore, if there is bleeding in any part of the seminal vesicles, seminal duct, ejaculatory duct, or posterior urethra, the semen may appear brownish-red. Posterior urethral bleeding is usually fresh blood, making the semen appear red or pink. The appearance of blood in semen can be intermittent or persistent for months or even years. It may occur without any other symptoms, or it may be accompanied by pain during ejaculation, initial hematuria, or difficulty urinating.Causes: There are three types of causes: pathological, functional, and idiopathic. Pathological causes include:
1. Inflammation, most commonly seminal vesitis and prostatitis, which often occur together. These are usually bacterial infections, but mycoplasma infection should also be considered.
2. Seminal vesicle or prostatic cysts, stones, tuberculosis, or filariasis.
3. Varicose veins or hemangiomas on the posterior urethra or an enlarged prostate, as well as conditions like perineal abscesses.
4. For individuals over 40, malignancies of the seminal vesicles, prostate, or posterior urethra should be strongly considered.
Functional causes are primarily due to long-term sexual abstinence leading to excessive distension of the seminal vesicles, followed by excessive sexual activity, which may cause repeated contractions of the seminal vesicles and rupture of their mucosal blood vessels. Idiopathic hematospermia refers to blood in semen with no known cause.
Guidance:
Treatment: Patients with hematospermia often experience significant psychological stress. Doctors should conduct a thorough examination to rule out pathological causes. For patients over 40, tumors should be ruled out first. If the cause is inflammation, antibiotics may be used. If the bleeding is due to seminal vesitis without bacterial infection, mycoplasma infection should be considered. This condition is sometimes referred to as hemorrhagic seminal vesitis, and under medical guidance, low-dose female hormones may be used, often leading to recovery. For symptomatic treatment, vitamin K and hemostatic agents like Anluo blood may be administered.
When treating hematospermia, the underlying cause must be addressed first. For seminal vesitis or prostatitis, antibacterial and anti-inflammatory treatments are recommended. During the acute phase, broad-spectrum antibiotics may be administered intravenously, followed by oral antibiotics once the condition stabilizes. Warm baths with high-manganese potassium permanganate solution (1:5000 dilution), local heat therapy via the perineum or rectum, or hot compresses can all improve local microcirculation and promote inflammation resolution. Weekly massage of the seminal vesicles and prostate can help expel fluid from the seminal vesicles.
After active treatment, if seminal vesitis is cured, hematospermia will disappear, and fertility will not be significantly affected. Sexual activity should be avoided until hematospermia resolves. If the cause is stones, varicocele, or tumors, surgical treatment may be considered. For hematospermia caused by systemic diseases, the underlying condition should be treated aggressively.
I hope this response is helpful to you. Wishing you good health.