Blood in semen ?

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KevinS

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< yes I have talked to my Dr about this >

Anyone ever have blood in their semen when they shoot? has been happening off and on for several months - and started before I started TRT in July. Primary Dr says not to worry, it is usually nothing in 'older men' I am 60, but it is kind of freaky.
K
 
Defy Medical TRT clinic doctor
I believe it's from a small blood vessel that breaks during ejaculation.

Usually it's nothing to worry about and should go away in 3 to 4 weeks.
 
He said to keep an eye on it, but that is isn't unusual. Dr checked my prostate/psa - good there. the first bout of it was about 6 weeks, stopped for a few weeks, then started happening again a week ago. No heavy ball play or anything out of the ordinary otherwise.
 
I had that about 10 years ago. Came and went over the course of several months, then resolved. Had a scrotal ultrasound, on antibiotics. One doctor told me it's hematospermia which is related to rheumatoid arthritis, inflammation and other autoimmune problems, At the time I also had significant muscle aches and fatigue.

When I was in my 20's I had prostatitis but never had blood in my semen, just bladder discomfort but for certain, you can't rule out prostatitis.
 
@Nelson Vergel/As I wrote, I don't doubt that prostatitis could present with blood in the semen.
Neither my primary nor the urologist suggested that - will poke them with that idea.

Very weird it has gone on as long as it did, then came back. I don't seem to have any other symptoms. no blood in urine, no other urinary symptoms. An occasional dribble, but just think that is putting things away too quick. I do have chronic back pain anyway. I sometimes have a for lack of a better way to describe it a brief 'twinge' on ejaculation, not really pain but uncomfortable sensation, for just a second. I have had some ball pain since starting TRT. That is mostly gone after ~4 months.
 
I had that about 10 years ago. Came and went over the course of several months, then resolved. Had a scrotal ultrasound, on antibiotics. One doctor told me it's hematospermia which is related to rheumatoid arthritis, inflammation and other autoimmune problems, At the time I also had significant muscle aches and fatigue.

When I was in my 20's I had prostatitis but never had blood in my semen, just bladder discomfort but for certain, you can't rule

I did not have any symptoms. I freaked out a sex partner with a bloody load, though. Pretty embarrassing.
It really was a WTF freak out the first time it happened. I was almost going to go to the ER but was able to get through to my Dr's office.
 
Neither my primary nor the urologist suggested that - will poke them with that idea.

Very weird it has gone on as long as it did, then came back. I don't seem to have any other symptoms. no blood in urine, no other urinary symptoms. An occasional dribble, but just think that is putting things away too quick. I do have chronic back pain anyway. I sometimes have a for lack of a better way to describe it a brief 'twinge' on ejaculation, not really pain but uncomfortable sensation, for just a second. I have had some ball pain since starting TRT. That is mostly gone after ~4 months.
I had back pain, too, and the urologist I saw told me it was related to prostatitis, though he didn't connect the blood in the semen to that. A my wife and I were down to infrequent sex, he told me to masturbate everyday. It was my primary who connected it to autoimmune problems, since I'd been experiencing, for months, muscle aches and fatigue, for which I was taking ginger and turmeric capsules. Some research center should hire me as their human lab rat and pay me a salary!
 
Bout 5 years ago same thing happened to me only I was in Thailand.....was so worried I flew back to US the next day...went to emergency ward and doctor said most likely busted a blood vessel in my nuts ..said would be better in a couple of weeks......and it did....too much banging em in Thailand.
.hope you get well
 
< yes I have talked to my Dr about this >

Anyone ever have blood in their semen when they shoot? has been happening off and on for several months - and started before I started TRT in July. Primary Dr says not to worry, it is usually nothing in 'older men' I am 60, but it is kind of freaky.
K
Pseudoephedrine was my culprit
 
< yes I have talked to my Dr about this >

Anyone ever have blood in their semen when they shoot? has been happening off and on for several months - and started before I started TRT in July. Primary Dr says not to worry, it is usually nothing in 'older men' I am 60, but it is kind of freaky.
K

EAU Guidelines on Sexual and Reproductive Health (2021)

6.8 Haemospermia

6.8.1 Definition and classification

Haemospermia is defined as the appearance of blood in the ejaculate.
Although it is often regarded as a symptom of minor significance, blood in the ejaculate causes anxiety in many men and may be indicative of underlying pathology [224].


6.8.2 Pathophysiology and risk factors


Several causes of haemospermia have been acknowledged and can be classified into the following subcategories; idiopathic, congenital malformations, inflammatory conditions, obstruction, malignancies, vascular abnormalities, iatrogenic/trauma, and systemic causes (Table 23) [902].

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The risk of any malignancy in patients presenting with haemospermia is approximately 3.5% (0-13.1%) [903]. In an observational study of 300 consecutive patients over a 30-month period, 81% had no identified cause of haemospermia. In those patients for whom a cause was identified, the diagnosis varied dependent upon the age of presentation. When the patients were divided into those under and those over 40 years of age, UTIs were more common among younger compared to older patients (15% vs. 10.3%). In the older group (> 40 years), stones (2.2% vs. 1.4%) and malignancy (6.2% vs. 1.4%) were more common when compared with the younger cohort. In the > 40 years group, 13 patients had PCa and one had low-grade urethral carcinoma. In the < 40 years group, one patient had testicular cancer [223]. In a recent study in which 342 patients with haemospermia were included, the most relevant etiology for haemospermia was inflammation/infection (49.4%) while genitourinary cancers (i.e., prostate and testis) only accounted for 3.2% of the cases [904].


6.8.3 Investigations

As with other clinical conditions, a systematic clinical history and assessment to help identify the cause of haemospermia is undertaken. Although the differential diagnosis is extensive, most cases are caused by infections or other inflammatory processes [224].

The basic examination of haemospermia should start with a thorough symptom-specific and systemic clinical history. The first step is to understand if the patient has true haemospermia.
Pseudo-haemospermia may occur as a consequence of haematuria or even suction of a partner’s blood into the urethra during copulation [865, 905, 906]. A sexual history should be taken to identify those whose haemospermia may be a consequence of a sexually transmitted disease. Recent foreign travel to areas affected by schistosomiasis or tuberculosis should also be considered. The possibility of co-existing systemic diseases such as hypertension, liver disease, and coagulopathy should be investigated along with systemic features of malignancy such as weight loss, loss of appetite, or bone pain. Examination of the patient should also include measurement of blood pressure, as there have been several case reports suggesting an association between uncontrolled hypertension and haemospermia [907, 908].

Most authors who propose an investigative baseline agree on the initial diagnostic tests, but there is no consensus in this regard [902, 903, 905].
Urinalysis should be performed along with sending the urine for culture and sensitivity testing, as well as microscopy. If tuberculosis or schistosomiasis is the suspected cause, the semen or prostatic secretions should be sent for analysis. A full sexually-transmitted disease screen including first-void urine as well as serum and genitourinary samples should be tested for Chlamydia, Ureaplasma, and Herpes Simplex virus. Using this strategy, it may be possible to find an infectious agent among cases that would have been labeled as idiopathic haemospermia [909].

Serum PSA should be taken in men aged > 40 years who have been appropriately counseled [225]. Blood work including a full blood count, liver function tests, and a clotting screen should be taken to identify systemic diseases. The question of whether further investigation is warranted depends on clinician judgment, patient age, and an assessment of risk factors [902]. Digital rectal examination (DRE) should also be performed and the meatus re-examined after DRE for bloody discharge [910]. Detection of a palpable nodule in the prostate is important because an association between haemospermia and PCa has been postulated although not completely proven.

Magnetic resonance imaging is being increasingly used as a definitive means to investigate haemospermia. The multiplanar ability of MRI to accurately represent structural changes in the prostate, seminal vesicles, ampulla of vas deferens, and ejaculatory ducts has enabled the technique to be particularly useful in determining the origin of midline or paramedian prostatic cysts and in determining optimal surgical management [911]. The addition of an endorectal coil can improve the diagnostic accuracy for identifying the site and possible causes of haemorrhage [912].


Cystoscopy has been included in most suggested investigative protocols in patients with high-risk features (patients who are refractory to conservative treatment and who have persistent haemospermia).
It can provide invaluable information as it allows direct visualization of the main structures in the urinary tract that can be attributed to causes of haemospermia, such as polyps, urethritis, prostatic cysts, foreign bodies, calcifications, and vascular abnormalities [913, 914].

With the advancement of optics, the ability to create ureteroscopes of diameters small enough to allow insertion into the ejaculatory duct and seminal vesicles has been made possible [915]. In a prospective study, 106 patients with prolonged haemospermia underwent the transrectal US and seminal vesiculoscopy.
With both methods combined, the diagnosis was made in 87.7% of patients. When compared head-to-head, the diagnostic yield for TRUS vs. seminal vesiculoscopy was 45.3% and 74.5%, respectively (P < 0.001) [916].

Melanospermia is a consequence of malignant melanoma involving the genitourinary tract and is a rare condition that has been described in two case reports [917, 918]. Chromatography of the semen sample can be used to distinguish the two by identifying the presence of melanin if needed.
 

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*As with other clinical conditions, a systematic clinical history, and assessment to help identify the cause of haemospermia is undertaken. Although the differential diagnosis is extensive, most cases are caused by infections or other inflammatory processes
 
I had that about 10 years ago. Came and went over the course of several months, then resolved. Had a scrotal ultrasound, on antibiotics. One doctor told me it's hematospermia which is related to rheumatoid arthritis, inflammation and other autoimmune problems, At the time I also had significant muscle aches and fatigue.

When I was in my 20's I had prostatitis but never had blood in my semen, just bladder discomfort but for certain, you can't rule out prostatitis.
The one that resolved, u said it went for several months, did you take the same antibiotics for that lenghty period? I am 50 yo, have had this for several months..since July 2022, seen 3 urologist with 3 different antibiotics..the blood still presence. The look is like sand like, dotted red, many small blood clots.
 
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