A frequent question I am asked is: “What does blood in my semen mean?” Men are not used to seeing anything but clear, whitish, or slightly yellow/green color in their semen, all normal. But when the semen is suddenly red or brown, their first thought is often times “cancer.”
The good news is that, almost always, blood in the semen, or “hematospermia,” is a benign finding. Getting confirmation from a urologist is a good idea.
The seminal vesicles are small paired organs that insert just behind the prostate gland. They join with the vas deferens (bringing sperm from the testicles) to form the ejaculatory ducts which end in the prostatic urethra. Seminal vesicles are responsible for 90% of the ejaculate volume. They look like little baggies and both produce and store seminal fluid. Inside the seminal vesicles is an extensive network of capillaries, those tiniest of blood vessels. Capillaries are fragile, and a break in even just one or two can leak a noticeable amount of blood into the storage cavity of the seminal vesicles. Because the seminal vesicles are only emptied with ejaculation, the time in between ejaculations can store up visible blood.
The reason for the bleeding is frequently due to infection of the prostate, or “prostatitis.” This benign but annoying condition can result in urinary frequency, urgency, pelvic and/or low back discomfort, testicular and groin discomfort, and sometimes urine infection. Just as a UTI can cause blood in the urine, the inflammation from prostatitis can affect the seminal vesicles, resulting in some internal bleeding. The volume of the seminal vesicles is about 3 cc, or 1/10th of an ounce. Thus, even a tiny drop of blood can make the semen look pretty red or brown.
Other causes for the blood in the semen can be small stones which form in the ejaculatory ducts, trauma to the prostate or pelvis (biopsy or surgery), and rarely cancer. Cancer if present, is almost always from the prostate. A cancer arising solely from the seminal vesicles is almost unheard of. Other uncommon causes of hematospermia can include STD’s, polyps, and cysts in the urinary tract. Sometimes blood in the urine can be misinterpreted as hematospermia. Remember, if your doctor is concerned, an ultrasound, cystoscopy or other imaging of the area may be appropriate.
Since hematuria is a benign condition most of the time, don’t be alarmed. Do discuss this condition with your doctor, and ask for the appropriate referral to a urologist.
Wishing you the best in health,
Clifford Gluck M.D. FACS