Patient's question:
After ejaculation, it was found that all that came out was blood. What should be done?Doctor's answer:
Generally speaking, hematospermia is not easily noticed immediately unless there is significant bleeding. Otherwise, it is difficult to detect during sexual intercourse. Even if blood-stained semen is found on the penis or clothing after intercourse, people often first suspect the cause is related to the female partner. If sexual intercourse is conducted with a condom or through withdrawal ejaculation, hematospermia can be easily identified. 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, suddenly changes to blood-red, reddish-brown, or mixed with blood streaks—clearly 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 spermatic pathway, such as bleeding, inflammation, or even a tumor. Do not take hematospermia lightly; it could also 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 examinations, the majority of cases can be controlled or cured with treatment, while only a small number of tumor patients require further treatment. The composition of semen consists mainly of a 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 vesicle is very thin, and once it becomes congested, the blood-filled wall is prone to bleeding. Therefore, the most common cause of hematospermia is 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.
If hematospermia occurs only occasionally and no specific abnormalities are found during examination, it may be due to minor blood vessel rupture and bleeding in certain tissues during intercourse caused by rapid congestion and mechanical trauma. In such cases of transient hematospermia, there is no need to panic—complete recovery can usually be achieved by abstaining from sexual activity for one to two weeks. Hemorrhage caused by inflammation tends to fluctuate but does not last long. If hematospermia persists and worsens progressively, the possibility of a tumor cannot be ruled out. In some cases, if the patient also exhibits widespread bleeding tendencies in other parts of the body, it may indicate a systemic hemorrhagic disorder, such as leukemia or thrombocytopenia, rather than a localized condition.