Patient's question:
Description of the problem: A week ago during ejaculation, I strongly restrained myself from climaxing (the restraint was very intense, so it had a significant impact). Today, there are some red granular substances in my semen. Please let me know if there is a relationship between the two, what I should do, and what I should pay attention to!Doctor's answer:
Normal semen from a healthy male is milky white or creamy yellow. If the semen appears pink, red, brownish-red, or contains blood streaks or clots, and microscopic examination of the smear shows a large number of red blood cells, it is referred to as hematospermia. In medicine, it is classified as either macroscopic hematospermia or microscopic hematospermia, and in traditional Chinese medicine, it is also known as "chì zhuó." Hematospermia is more common in young and middle-aged men aged 25 to 40 and is a common urological condition. Patients often discover blood in their semen after masturbation or sexual intercourse, and this phenomenon may persist for a long time, often causing mental stress, increased psychological burden, or even fear.Most cases of hematospermia are benign and self-limiting, with the primary cause being lesions of the seminal vesicles, such as seminal vesiculitis, tuberculosis of the seminal vesicles, or tumors of the seminal vesicles, with seminal vesiculitis being the most common. Although hematospermia is generally unrelated to major diseases, it may sometimes be a symptom of certain systemic diseases or severe organic conditions. Some experts suggest that hematospermia may occur due to the collateral circulation between the hemorrhoidal venous plexus and the prostatic venous plexus during liver cirrhosis. There have also been reports linking hematospermia to schistosomiasis, with live schistosoma larvae found in the semen. Additionally, hematospermia has been associated with hypertension, seminal vesicle cancer, renal tuberculosis, and early prostate cancer.
Therefore, when hematospermia occurs, especially if it persists despite standard antibiotic treatment, special examinations should be conducted to rule out other possible organic diseases. Only by identifying the true cause of hematospermia and treating it accordingly can satisfactory results be achieved.
In daily life, if hematospermia is observed, one should pay attention to any accompanying symptoms, such as frequent urination, urgency, or dysuria (urinary tract infection symptoms); coughing with sputum, hemoptysis, low-grade fever in the afternoon, or night sweats (tuberculosis symptoms); a tendency to bleed easily; difficulty urinating (urinary obstruction symptoms); ejaculation pain or abnormal sexual function; lower abdominal pain, perineal pain, or pain in other areas.
Certain antibiotics used to treat cystitis can also change the color of semen, so a semen analysis is necessary for patients with hematospermia. Some hospitals may also require a stepwise ejaculation test, which not only confirms the presence of red or white blood cells in the semen but also provides an initial assessment of the condition of accessory glands and the source of hematospermia. For certain patients, a semen bacterial culture and drug sensitivity test may be performed, allowing the doctor to select appropriate antibiotics.
The doctor may also request imaging tests, such as transrectal ultrasound, which is considered the preferred method for screening for stones, tumors, hyperplasia, or other abnormalities in the prostate and seminal vesicles. For patients with abnormal findings on digital rectal examination or ultrasound, especially the elderly, further tests such as PSA, X-ray, or CT scans may be necessary to rule out conditions such as benign prostatic hyperplasia, prostate cancer, seminal vesicle cancer, or genitourinary tuberculosis.
If hematuria is also present, a urethral scope examination may be performed. In severe cases of hematospermia, such as when white blood cells are found in the semen and the condition does not improve after repeated antibiotic treatments, tuberculosis should be considered. For, the possibility of systemic diseases should be considered, including hematological disorders like purpura, scurvy, or leukemia, as well as portal hypertension due to liver cirrhosis.
In summary, although hematospermia caused by life-threatening diseases is uncommon, if it occurs, it is important to seek medical attention at a general hospital's urology department promptly. Attention should be paid to ruling out sensitive causes such as trauma, bleeding disorders, stones in the seminal vesicles or prostate, prostatitis or seminal vesiculitis, or benign prostatic hyperplasia.
Treatment for hematospermia primarily focuses on addressing the underlying cause. At the same time, maintaining a relaxed and positive mindset, eliminating psychological concerns and fears, leading a regular lifestyle, avoiding alcohol and spicy foods, eating a light diet with plenty of fruits, ensuring smooth bowel movements, and maintaining a healthy and normal sexual life are also important.