Should I worry about finding blood in my semen? 

Unusual bleeding may be a potential cancer symptom thus seeing blood in the semen can make a man anxious. Fortunately, it is uncommon and rarely signals a major medical problem especially in men younger than 40. 

Hematospermia (also called hemospermia), which refers to the presence of blood in the semen, often does not last long, as it is usually a self-resolving problem.

Dr. Enrique Ian Lorenzo, urologist from The Medical City (TMC), says hematospermia is more often than not a benign occurrence which usually resolves spontaneously. However, an evaluation of a urologist may be necessary to rule out other causes especially in men who are at risk for certain diseases.

Causes of blood in the semen

It may be caused by infection or an inflammation. Infection may occur in the urinary tract and subsequently affect the tubes where semen passes through or even the prostate. This can develop due to typical urinary tract infections (UTIs) or sexually transmitted infections (STIs) like gonorrhea or chlamydia, or from other viral or bacterial infections.

Men with an infection may notice other symptoms, including pain or pressure when urinating,  painful ejaculation, swelling in the genital area, a fever or generally feeling sick, and frequent urination or difficulty emptying the bladder.

Sustaining an injury to the urinary tract or genitals may also cause blood to appear in the semen. More serious injuries can cause swelling, chronic bleeding, and serious damage to the genitals. When this happens, a person may notice bloody semen that either lasts for a long time or comes and goes following an impact to the genitals, genital surgery, or a fall. These injuries should be managed in an urgent manner.

Men with bleeding disorders may also present with blood in the semen but is often accompanied by bleeding in other areas as well such as in the urine, gums, nose, or bruises in the body. 

Prostate issues

Problems with the prostate may give rise to bloody semen. One of the most common issues is prostatitis which can be a chronic issue due to inflammation or a sudden problem due to an infection. In either case, the person may notice symptoms other than hematospermia, including blood in the urine, painful urination, painful sex, and a feeling of fullness or swelling in the rectum or genital area.

Other common known causes of blood in the semen are surgical procedures such as prostate biopsy. Bleeding can last a few weeks or so after a prostate biopsy. Similarly, it may also occur during the first week or two after a vasectomy.

Dr. Lorenzo points out that on rare occasions, particularly for men over 45 years of age, blood in the semen can be a sign of prostate cancer. When this happens, a person may sometimes notice repeated bouts of hematospermia as well as other symptoms, such as difficulty in urination, pain in the groin or blood in the urine.

Men who have any of these warning signs and are over 45 should see a doctor within a few weeks.

Testing and Evaluation

Men with hematospermia are evaluated by the urologist first clinically by history and physical examination. Based from the gathered information, tests may be requested such as urinalysis, urine culture, ultrasound, and blood tests.

In most cases, especially in men younger than 40, and men who recently had a prostate biopsy, blood in semen may resolve on its own. However, further testing is done if the doctor suspects certain potentially serious disorders. 

In the evaluation for prostate cancer, testing typically includes prostate-specific antigen (PSA) test and digital rectal exam (DRE). Occasionally, magnetic resonance imaging (MRI) scan and cystoscopy (to see inside the urethra and bladder) are needed.

With the continuous progress in medicine, the role of MRI scans of the prostate has evolved. It now plays a role in certain patients to identify lesions that are highly probable to be cancerous especially the aggressive type. Lesions identified in the MRI can then be targeted using a new method.

MRI Fusion Prostate Biopsy, a fully integrated fusion biopsy system specifically created for personalized prostate care, has been offered at The Medical City since 2018. With this technology, “targeted” biopsies are made possible by the fusion of ultrasound images of the prostate with MRI scans in real time to help urologists precisely target the area of the prostate that needs to be biopsied. Not only does this system guide in targeting lesions but it also confirms if the target was sampled. Now even small lesions can be biopsied with high confidence. 

Prostate cancer is treatable especially if caught early. When confined within the prostate, the cancer can be eradicated.

To learn more about prostate cancer screening, diagnosis, and treatments available at The Medical City, please contacts The Medical City Augusto P. Sarmiento Cancer Institute (TMC-APSCI) at 89881000 or 89887000 ext. 6214 or email cancerinstitute@themedicalcity.com