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What to do about a bloody ejaculation

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Blood in the ejaculate was first described 2,500 years ago by Hippocrates (460 BC-370 BC), the father of Western medicine. This condition, known as “hematosper­mia” often creates great anxiety in the patient and his wife though most of the time no definite cause can be uncovered and no underlying disease can be found.

However, because it is possible for this finding of blood in the ejaculate to be a symptom of a more serious condition, a thorough medical and urological evaluation is indicated if the condition persists for at least 10 ejaculations. Sometimes, the condition can persist for as long as two years and then disappear. If a condom is used, it is easy to distinguish whether the blood is coming from the husband or the wife. If the blood is inside the condom, it is coming from the man.

Further evaluation can include sonogram of the prostate, cystoscopy, urine culture for ordinary bacteria as well as for tuberculosis, urine cytology, FISH test and occasionally an MRI may be required. Sometimes, small concretions or stones are seen within the prostate.

Following a prostate biopsy, done to detect suspected prostate cancer, “hematosper­mia” may occur after about one third of the biopsies and last for up to a month after the biopsy. The investigation searching for a possible cause of blood in the ejaculate depends on a thorough questioning of the patient looking for evidence of symptoms of infection, injury or a disorder of the blood clotting mechanism.

Injuries can occur from external blunt trauma or from internal trauma caused by the insertion of foreign bodies inside the urethra. Men who suffer with bleeding from the nose are more likely to have “hematosper­mia.” Even high blood pressure can be implicated. The penis, the vas, the prostate and the seminal vesicles must be carefully examined for evidence of inflammation. The digital rectal examination is essential to detect seminal vesicle abnormalities.

Prostate cancer is not often related to blood in the ejaculate but it has been known to occur. Much more common are varicosities of the prostate, midline cysts of the prostate and urethral polyps. More rarely, amyloidal involvement of the seminal vesicles, lymphoma or liver disease can be associated with this condition. The most common associated conditions are infections and inflammations of the prostate and seminal vesicles.

While microwave thermotherapy has been very successfully used for the treatment of symptomatic benign prostate enlargement and chronic prostatitis with or without prostate stones, it has not yet been used for the treatment of “hematosper­mia” since in the majority of cases this condition provokes much more anxiety than serious consequences. It is usually self-limiting and when it spontaneously disappears, there is no need for further investigation or treatment. Persistence of the symptoms of a slow, weak, intermittent stream, urgency, frequency and sleep interruption do require serious attention.

Have a Question? Call Dr. Okun at 718-241-6767

Updated 5:09 pm, July 9, 2018
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