Blood in semen, also known as hematospermia, though a frightening condition, is rarely serious. It is a rare condition and may happen to men of any age group. It is more commonly seen in men of 30-40 years.
Men above 50 years also have an increased risk of this condition due to enlargement of the prostate. Most of the cases of blood in semen may resolve without any specific treatment.
Episodes of hematospermia are often unnoticed in many. In some patients, blood in semen is the first indication of an underlying medical condition like urologic diseases.
Repeated episodes of hematospermia, associated symptoms, and high risk of cancer or bleeding disorders need medical evaluation and treatment. Most of the patients with this condition have more than one episode and this may be spread over weeks or months.
Some of the associated symptoms of this condition are:
Medical procedures like prostate biopsy and trauma, like being hit on testicles, are also known causes of this symptom.
Physical examination follows the evaluation of medical history and review of symptoms. Other tests and investigations used in the diagnosis of the cause of blood in semen are STD test, urinalysis, prostate-created antigens (PSA) test, and imaging techniques. If blood in semen is a regular issue for more than a month, transrectal ultrasound is suggested.
Treatment is suggested after the diagnosis of the actual cause of the condition. Home treatment is often helpful in resolving the issue. Most cases resolve on its own. Applying ice and resting help in alleviating bleeding in mild cases.
Antibiotics are used to control infection, which in turn will help in controlling blood in semen. Surgery is the treatment method for obstruction in the genitourinary tract. When cancer is the cause of the condition, specific treatment will be initiated. Drainage of cysts helps to control bleeding. Blood clotting disorders are also treated by an appropriate specialist.
The actual cause of blood in semen is not determined in half of the cases. In the majority of the cases, it is usually associated with inflammation of different parts of the genitourinary system like seminal vesicles and prostate gland.
Some of the common causes of hematospermia are:
Conditions of prostate – lesions of the prostate is a common cause of hematospermia. Prostate biopsy is the most common etiological factor. Prostatitis or inflammation of prostate is yet another cause of blood in semen.
Some studies have shown prostate cancer as a possible cause of bleeding. Prostatic telangiectasia and varices can also cause blood in semen. Transurethral resection of the prostate may result in hematospermia in some cases.
Conditions of urethra – in younger men, urethritis is a common cause of the symptom. Cysts, polyps, condylomata, and strictures also lead to hematospermia. Many patients with urethral polyps have blood in semen as the most common presenting symptom.
Lesions in seminal vesicle – studies show seminal vesicle cysts as a cause of hematospermia. Cysts in seminal vesicle can be congenital or acquired. Congenital cysts in seminal vesicles are formed due to abnormal embryological development, while acquired seminal vesicle cysts develop from infectious processes.
Malignancies in seminal vesicles may also lead to acquired cysts in the organ. Amyloidosis of the seminal vesicles is also related to the development of hematospermia. One of the identifiable cause of hematospermia related to seminal vesicle is the presence of hemorrhagic lesions in the vesicles.
Infections and inflammation – About 40% of the cases of hematospermia are caused by infections and inflammation. Tuberculosis, HIV, and cytomegalovirus infection are implicated in hematospermia.
Infection by herpes simplex, chlamydia trochomatis, enterococcus faecalis, and ureaplasma urealyticum are also known to cause blood in semen. Schistosomiasis in the genitourinary tract is reported to cause hemaotospermia. Infection by the parasite Echinococcus that cause hydatid disease is also related to the symptom.
Trauma – Many cases report trauma as a common cause of blood in semen. Hemorrhoidal sclerosing injection, urethral self-instrumentation, and blunt trauma of testicles result in hematospermia. Transrectal prostate needle biopsy causes trauma of the prostate glands, a common cause of blood in semen.
Systemic disorders – systemic diseases like hypertension, chronic liver disease, amyloidosis, lymphoma, and bleeding diatheses are etiologic factors of hematospermia. Controlling hypertension in patient help to resolve blood in the semen.
Severe uncontrolled hypertension, severe proteinuria, renovascular disease, and elevated serum creatinine levels increase the risk of occurrence of this symptom. Hyperuricemia is a possible condition that causes blood in semen.
Obstruction – blockages or obstruction in any of the ducts or tubes in the genitourinary tract cause breakage of blood vessels in the region. This leads to bleeding that is sent out with semen.
Blood vessel problems – issues in any of the blood vessels present in the region may result in bleeding. Vascular cysts may also lead to hematospermia.
Vasectomy may lead to bleeding after the procedure. When blood in semen is the only symptom present, it is referred to as primary hematospermia. Secondary hematospermia is caused by an underlying condition or a known cause of bleeding. It is generally very difficult to find the actual cause of primary hematospermia.
3 Diagnosis and Treatment
Review of symptoms and medical history is followed by physical examination. In younger men without persistent and associated symptom, digital rectal examination is conducted as a part of the physical examination.
In men above 50 years without persistent symptom, digital rectal examination and test for prostate-specific antigens are recommended. For persistent hematospermia other tests and investigations are suggested including:
For persistent hematospermia other tests and investigations are suggested including:
Urinalysis – this is helpful in indicating urogenital infections. Urine culture may also be done along with analysis.
Semen analysis and culture – this is usually recommended to differentiate hematospermia from other causes of discoloration of semen.
Blood tests – prostate-specific antigen tests and coagulation studies are recommended for confirmatory diagnosis in men with persistent blood in semen.
Transrectal ultrasonography – this procedure helps to visualize different parts of the genitourinary system including seminal vesicles, prostate, and vas deferens. This helps to pin point the etiological factor of blood in semen. This method is not generally recommended for people who are presenting with hematospermia for the first time. It is useful in case of patients who are above 50 years and have persistent hematospermia.
Magnetic resonance imaging (MRI) – MRI is useful in detecting cysts, dilatation, inflammatory disorders, neoplasm, and hemorrhage.
CT scan – this imaging study may be useful in visualizing the structure of seminal vesicles.
Cystourethroscopy – this procedure helps in locating the origin of bleeding. All patients can undergo this diagnostic procedure, irrespective of the frequency of episode.
Seminal vesicle endoscopy – this procedure is used to visualize the inner parts of the seminal vesicles and to obtain specimens for biopsy.
Reducing the fear of the patient is often the first step in the treatment of blood in semen. Treatment depends on the age of the patient, duration of hematospermia, recurrence of hematospermia, and the presence of other symptoms like hematuria.
The chronic form of hematospermia may require aggressive treatment. Antibiotic therapy is suggested for urogenital infections, including enterobacterial and chlamydial infections. Cysts, of seminal vesicle and prostate, are aspirated transrectally.
Endoscopic treatment is suggested for the removal of calculi in ejaculatory ducts and seminal vesicles. Specific treatment is recommended for hematospermia caused by systemic diseases.
For example, if cancer is the cause of the symptom the patient may be referred to an oncologist. Radiotherapy, surgery, and chemotherapy may be suggested, depending on the condition.
Bleeding prostatic variceal veins are corrected by a surgical procedure called fulguration. Surgical repair is also suggested for bladder stones and tumors that cause blood in semen. Anti-inflammatory medications are suggested for the treatment of inflammations that result in hematospermia.
Prognosis of hematospermia depends on the underlying cause of the condition. Most forms of this symptom resolve on its own without any specific treatment. If no abnormalities are found in the evaluation, monitoring of the symptoms would help in controlling the condition. Any further bleeding in the semen should be reported to the doctor for evaluation.
A complete medical history and physical examination are performed for evaluating snoring as a symptom. The patient is asked about sleep habits, sleep pattern, daytime sleepiness, awakening in the night, and other associated symptoms.
During the physical examination, the patient’s body weight and neck circumference are taken. Throat, nasal and oral cavities are checked to determine to narrow of airways.
Partners often gave important clues on other symptoms like sudden gasping or snorting followed by awakening. Leg kicking during sleep may indicate restless leg syndrome. If sleep apnea is suspected, a sleep specialist may be consulted.
A sleep study is used to identify sleep apnea and other problems that cause sleep disturbance. Most of the people with poor sleep in the night have excessive daytime sleepiness. Sleepiness is measured using objective tests like multiple sleep latency test and maintenance of wakefulness test.
Imaging studies like x-ray, CT scan, and MRI are recommended, in some cases, to check for problems in airways. These studies are useful in studying conditions like deviated nasal septum. In-depth analysis of sleep is done by a sleep study.
In this procedure called polysomnography, the body is connected to many devices during sleep. The devices measure many parameters like brain waves, the oxygen level in blood, heart and breathing rate, and stages of sleep.
Movements of legs and eyes during different stages of sleep are also recorded. A sleep study is recommended depending on other medical conditions and suspected condition that lead to snoring.
The first step in the treatment of snoring is lifestyle changes. Major changes suggested are losing excess body weight, avoiding alcohol, and taking home remedies for nasal congestion. Developing good sleep habits is equally important in controlling snoring. For snoring caused by sleep apnea, different treatment methods are suggested.
Some common treatment methods for controlling snoring are:
Oral appliances – appliances or devices that help to advance the jaw help to keep the airways open throughout. This reduces snoring.
Continuous positive airway pressure – or CPAP, as it is commonly known as, is a procedure in which a pressurized mask is placed over the nose during sleep. The mask is connected to an air pump which keeps the air flow continuous without obstruction.
Palatal implants – implantation of polyester filament strands into the palate stiffens the soft palate and reduces snoring.
Surgical repair – uvulopalatopharyngoplasty is a surgical procedure in which the excess tissues from the throat is removed. In laser-assisted uvulopalatopharyngoplasty, the laser is used to remove the excess tissue from the throat.
Somnoplasty – in this procedure, low-frequency radio waves are used to shrink the tissue that blocks the airways.
Some lifestyle tips and home remedies that would be of help in reducing the symptom include:
Lose excess body weight – this reduces the extra throat tissue that blocks airways
Change sleep position – sleeping on side prevents the fall of the tongue back into the throat, blocking the airways. This reduces the obstruction of airways, reducing snoring.
Keep the head in raised position while sleeping
Use nasal strips – adhesive nasal strips are now available that helps in increasing the nasal passage and improving breathing
Treat nasal congestion – nasal congestions and allergies increase the chance of snoring. An oral decongestant is often suggested but for a short period. Prescription steroid sprays are recommended for persistent nasal congestion.
Limit alcohol consumption – alcoholic drinks should be limited, particularly before bedtime. Alcohol and sedatives cause relaxation of throat muscles that causes snoring.
Quit smoking – smoking increases chances of snoring and hence should be reduced or stopped.
Get adequate sleep and rest – without adequate sleep, the tissues undergo further relaxation, narrowing the airways.
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