Blood in the ejaculate or bloody semen is of great concern to men. The medical term is haematospermia and is a common occurrence, causing fear and perturbation among the men who experience it. Seen in young and old men, it may be an insignificant symptom or a harbinger of serious disease.

What is the ejaculate?

The semen consists of sperm, prostate and seminal fluids. These combine in the urethra (channel in the penis) to form the liquid released by ejaculations. Semen thickens initially but, after 30 to 60 minutes, it liquefies. Normal semen does not contain blood. Bloody semen may be missed because most ejaculations occur inside the vagina.

Causes of bloody semen

Bloody semen may arise from problems in any part of the male genito-urinary system. Thus, conditions in the prostate, urethra, and seminal vesicles may cause a bloody ejaculate. Problems in the prostate include prostate biopsy, prostate infections and enlarged blood vessels (varicose veins) in the prostate. Most men worry about cancers when blood is seen in the semen. Prostate cancer is rarely associated with this condition but should be considered in older men and when the bloody semen does not resolve. Congenital cysts, polyps and cancers may rarely occur in the seminal vesicles causing bloody semen.

Sexually transmitted infections

In younger men, the chief cause of blood in the semen is an infection in the urethra. These infections include tuberculosis (TB), HIV infection and cytomegalovirus. Other sexually-transmitted infections such as chlamydia and herpes may cause bloody semen. This condition may also arise because of inflammation in the seminal vesicles. These are tiny organs, located above the prostate and behind the bladder. Most times, the condition resolves spontaneously in one or two months.

Systemic problems

Systemic problems such as hypertension, liver and kidney disease and bleeding disorders are also associated with blood in the ejaculate. Therefore, this problem warrants a visit to the doctor for a thorough evaluation.

Medical care

Blood in the semen is usually not associated with any sinister condition. This is especially true for younger men because the condition often does not recur. Young men should seek a complete physical examination including a digital rectal examination. Their urine should also be checked for blood. If infections are present, these will be treated. They should continue to observe their ejaculate to check for recurrence of the problem.

Men who are over 40 years of age and any man who reports a problem with bloody semen, in excess of two months, should be thoroughly evaluated to identify the cause. These men should consult with a urologist for in-depth assessment. This will include a complete physical examination as well as ultrasound evaluation and other specialised tests. Treatment will depend on the underlying cause and may require medications or surgical care.

Dr Pauline Williams-Green is a family physician and president of the Caribbean College of Family Physicians. Email: yourhealth@gleanerjm.com.