Patient's question:
I have a long history of masturbation, but have never had any problems. Last night, when I was masturbating, I exerted more force than usual and deliberately avoided ejaculation to prolong the duration. Unintentionally, when I finally ejaculated, there was blood in the semen, which was the first time in my life. I heard it might be hematospermia, so I am very anxious. Please help me understand this from a doctor. Thank you.First follow-up question: (2007-9-16 16:23:43) Could this be what is called "temporary hematospermia," caused by overly intense masturbation? Should I wait a few days before seeking medical attention? If I need to be examined, it might involve involving my parents... it's quite embarrassing...
Second follow-up question: (200
Doctor's answer:
It is necessary to check for seminal vesiculitis. Seminal vesiculitis is a relatively common disease among young and middle-aged men. It is caused by bacteria such as Escherichia coli, Klebsiella pneumoniae, Proteus, and Pseudomonas. When the surrounding organs of the seminal vesicle, such as the prostate, posterior urethra, and colon, are infected or any condition leads to congestion of the prostate and seminal vesicle, the malicious bacteria take advantage of the opportunity to cause trouble, invading the seminal vesicle and triggering seminal vesiculitis. Clinically, seminal vesiculitis is divided into two categories.(1) Acute seminal vesiculitis presents with systemic symptoms such as general body pain, chills, fever, even shivering, high fever, nausea, and vomiting. The main urinary symptoms include a burning sensation in the urethra, frequent urination, urgent urination, painful urination, terminal hematuria, and a dripping urine flow, along with prostatitis symptoms such as severe pain in the perineum and rectum. Pain intensifies during defecation, and severe cases may affect sexual function, causing intense pain during intercourse. Blood tests show elevated total white blood cell count and differential counts.
(2) Chronic seminal vesiculitis often results from severe acute seminal vesiculitis or incomplete treatment. Some patients develop chronic seminal vesiculitis due to frequent sexual arousal or masturbation, leading to congestion of the seminal vesicle and prostate, followed by infection. The symptoms of chronic seminal vesiculitis are similar to those of chronic prostatitis and often coexist. Hematuria (blood in semen) is a characteristic feature of chronic seminal vesiculitis and is persistent, occurring during ejaculation and lasting for months.
Treatment: The seminal vesicle is not an organ for storing semen but rather an accessory gland of the male reproductive system. It consists of a pair of elongated, oval-shaped sacs located posterior to the bladder base and lateral to the ampulla of the vas deferens. The shape is wider at the top and narrower at the bottom, slightly flattened front and back, with an uneven surface. The upper end is free and dilated, forming the base of the seminal vesicle, while the lower end is thin and straight, serving as its excretory duct. Due to the anatomical features of the seminal vesicle, when inflammation occurs, drainage is poor, making it easy for bacteria to persist and difficult to cure completely. To prevent chronic seminal vesiculitis from worsening, both acute and chronic cases should be treated thoroughly.
(1) Appropriate antibiotics should be selected. For acute seminal vesiculitis, treatment should continue for 1–2 weeks after symptoms completely disappear. For chronic seminal vesiculitis, treatment should last more than 4 weeks to consolidate the effect. Based on our experience, ceftriaxone (a third-generation cephalosporin) and ofloxacin (a quinolone) administered intravenously have shown good results.
(2) Local treatment: Berberine iontophoresis. After defecation, 20 mL of 1‰ berberine solution is used for enema. A gauze pad soaked in the solution is placed in the perineum and connected to the positive electrode of a direct current therapeutic device, while the negative electrode is applied to the pubic bone. The treatment lasts 20 minutes per session, once daily, with 10 sessions constituting one course. Warm sitz baths (water temperature 42°C) and heat applications to the perineum can improve local blood circulation and aid in reducing inflammation. Avoid prolonged sitting to prevent pelvic congestion.
(3) Rest in bed and take laxatives to ensure bowel regularity.
(4) Avoid excessive sexual activity to reduce congestion in the sexual organs. Patients with chronic seminal vesiculitis can undergo regular (1–2 times per week) massage of the seminal vesicle and prostate to enhance blood circulation and promote the discharge of inflammatory substances.
(5) Maintain a regular lifestyle, balance rest and activity, and avoid smoking, alcohol, and spicy, irritating foods.
(6) Provide psychological support to alleviate patients' concerns, especially those with hematuria, and boost their confidence in overcoming the disease.
(7) Chinese medicine: Oral administration of blood-activating, detoxifying, and softening herbs. 12g of Salvia miltiorrhiza, 12g of Paeonia lactiflora, 15g of Carthamus tinctorius, 15g of Persicae Semen, 15g of Lindera aggregata, 15g of Vitex negundo, 15g of Patrinia scabiosa, 4g of Panax notoginseng, 15g of both Cirsium japonicum and Cirsium setosum, and 10g of Imperata cylindrica.
(8) For hematuria, ethinyl estradiol (1mg) and prednisone (5mg) can be taken orally three times daily for 2–3 weeks, which often stops hematuria.
It should be noted that seminal vesiculitis, especially when combined with chronic prostatitis, tends to persist. Persistence in treatment is crucial, and patients must not lose confidence or delay treatment, as this may lead to secondary infertility and other complications, causing lifelong regret.