Posts Tagged ‘hematospermia’

Bloody Semen: Frightening, But Usually Not To Worry

September 2, 2017

Andrew Siegel MD  9/2/17

Hematospermia is medical speak for a bloody ejaculation. It is a not uncommon occurrence, usually resulting from inflammation of one of the male reproductive parts, typically the prostate or seminal vesicles.  As scary as it is, it is rarely indicative of a serious underlying disorder.  Like a nosebleed, it can be due simply to a ruptured blood vessel. It is almost always benign and self-limited,  typically resolving within several weeks. On occasion it may become recurrent or chronic, causing concern and anxiety, but again, rarely due to a serious problem.

Factoid: The most common cause of a bloody ejaculation is following a prostate biopsy.



Thank you, Wikipedia, for image above, public domain

What is semen?

Semen is a nutrient vehicle for sperm that is a concoction of secretions from the testes, epididymis, urethral glands, prostate gland, and seminal vesicles.  The clear secretions from the urethral glands account for a tiny component, the milky white prostate gland secretions for a small amount of the fluid, and the viscous secretions from the seminal vesicles for the bulk of the semen. Sperm makes up only a minimal contribution.

Factoid:  After vasectomy the semen appears no different since sperm make up a negligible portion of the total seminal volume.

What exactly occurs during ejaculation?

After a sufficient level of sexual stimulation is achieved (the “ejaculatory threshold”), secretions from the prostate gland, seminal vesicles, epididymis, and vas deferens are deposited into the part of the urethra within the prostate gland.  Shortly thereafter, the bladder neck pinches closed while the prostate and seminal vesicles contract and the pelvic floor muscles spasm rhythmically, sending wave-like contractions rippling down the urethra to propel the semen out.

Factoid:  Ejaculation is an event that takes place in the penis; orgasm occurs in the brain.

Factoid: It is the pelvic floor muscles that are the muscle power behind ejaculation.  Remember this: strong pelvic muscles = strong ejaculation.

Since the prostate and seminal vesicles contribute most of the volume of the semen, bleeding, inflammation or other pathology of these organs is usually responsible for bloody ejaculations. The bleeding may cause blood in the initial, middle, or terminal portions of the ejaculate.  Typically, blood arising from the prostate occurs in the initial portion, whereas blood arising from the seminal vesicles occurs later. The color of the semen can vary from bright red, indicative of recent or active bleeding, to a rust or brown color, indicative of old bleeding.

What are some of the causes of blood in the semen?

  • Infection or inflammation (urethritis, epididymitis, orchitis, prostatitis, seminal vesiculitis, etc.)
  • Ruptured blood vessel, often from intense sexual activity
  • Reproductive organ cysts or stones
  • Following prostate biopsy (from numerous needle punctures); following vasectomy
  • Pelvic trauma
  • Rarely malignancy, most commonly prostate cancer and less commonly, urethral cancer
  • Coagulation issues or use of blood thinners

 How is hematospermia evaluated and treated?

A brief history reveals how long the problem has been ongoing, the number of episodes, the appearance of the semen and the presence of any inciting factors and associated urinary or sexual symptoms. Physical examination involves examination of the genitals and a digital rectal examination to check the size and consistency of the prostate. Laboratory evaluation is a urinalysis to check for urinary infection and blood in the urine, and a PSA (prostate specific antigen) blood test.  At times a urine culture and/or semen culture needs to be done.

Hematospermia is typically managed with a course of oral antibiotics because of the infection/inflammation that is often the underlying cause.  In most cases, the situation resolves rapidly.

If the bloody ejaculations continue, further workup is required.  This may involve imaging with either trans-rectal ultrasonography (TRUS) or magnetic resonance imaging (MRI) and at times, cystoscopy. TRUS is an office procedure in which the prostate and seminal vesicles are imaged by placing an ultrasound probe in the rectum. MRI imaging is performed at an imaging center under the supervision of a radiologist. The MRI provides a more thorough diagnostic evaluation, but is more expensive and time consuming.  Both TRUS and MRI can show dilated seminal vesicles, cysts of the ejaculatory ducts, prostate or other reproductive organs, and ejaculatory or seminal vesicle stones.  MRI can also show sites suspicious for prostate cancer. Cystoscopy is a visual inspection of the inner lining of the urethra, prostate and bladder with a small-caliber, flexible instrument. Treatment is based on the findings of the imaging and diagnostic studies, but again, it is important to emphasize the typical benign and self-limited nature of hematospermia.

Bottom Line: Blood in the ejaculation is not uncommon and is frightening, but is usually benign and self-limited and easily treated. In the rare situation where it persists, it can be thoroughly evaluated to assess the underlying cause.  If you experience hematospermia, visit your friendly urologist to have it checked out.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

The aforementioned books will teach men and women, respectively, how to strengthen their pelvic floor muscles.


5 Things Every Woman Should Know About Her Man’s Pelvic Health

November 28, 2015

Andrew Siegel MD   11/28/15

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(Attribution: Pier-Luc Bergeron, A happy couple and a happy photographer; no changes made,

Since this is Thanksgiving weekend and a broadly celebrated family holiday, I cannot think of a better time to blog about how wives/girlfriends/partners can help empower their men’s pelvic health.

  1. His Erections
  2. Prostate Cancer
  3. Bleeding
  4. Testes Lumps/Bumps
  5. Urinary Woes


Erectile Dysfunction: A “Canary in the Trousers”

If his erections are absent or lacking in rigidity or sustainability, it may just be the “tip of the iceberg,” indicative of more serious underlying medical problems. The quality of his erections can be a barometer of his cardiovascular health. Since penile arteries are tiny (diameter of 1-2 millimeters) and heart arteries larger (4 millimeters), it stands to reason that if vascular disease is affecting the penile arteries, it may affect the coronary arteries as well—if not now, then perhaps soon in the future. Since fatty plaque deposits in arteries compromise blood flow to smaller blood vessels before they do so to larger arteries, erectile dysfunction may be considered a genital “stress test.”

Bottom Line: If your man is not functioning well in the bedroom, think strongly about getting him checked for cardiovascular disease. His limp penis just may be the clue to an underlying more pervasive and serious problem.

Prostate Cancer

One in seven American men will develop prostate cancer in their lifetimes and most have no symptoms whatsoever, the diagnosis made via a biopsy because of an elevated or accelerated PSA (Prostate Specific Antigen) blood test and/or an abnormal rectal exam that reveals an asymmetry or lump. Similar to high blood pressure and glaucoma, prostate cancer causes no symptoms in its earliest phases and needs to be actively sought after.

With annual PSA testing, he can expect a small increase each year correlating with prostate growth. A PSA acceleration by more than a small increment is a “red flag.” The digital exam is simply the placement of a gloved, lubricated finger in the rectum to feel the size, contour and consistency of the prostate gland, seeking hardness, lumps or asymmetry that can be a clue to prostate cancer. It is not unlike the female  pelvic exam.

Bottom Line:  As breast cancer is actively screened for with physical examination and mammography, so prostate cancer should be screened for with PSA and digital rectal exam. In the event that prostate cancer is diagnosed, it is a treatable and curable cancer. Not all prostate cancers demand treatment as those with favorable features can be followed carefully, but for other men, treatment can be lifesaving.


Blood in the urine can be visible or only show up on dipstick or microscopic exam of the urine. Blood in the urine should also be thought of as a “red flag” that mandates an evaluation to rule out serious causes including cancers of the kidney and bladder. However, there are many causes of blood in the urine not indicative of a serious problem, including stones, urinary infections and prostate enlargement.

Blood in the semen is not uncommonly encountered in men and usually results from a benign inflammatory process that is usually self-limited, resolving within several weeks. It is rarely indicative of a serious underlying disorder, as frightening as it is to see blood in the ejaculate. Nonetheless, it should be checked out, particularly if it does not resolve.

Bottom Line: If blood is present when there should be none—including visible blood in the urine, blood stains on his undershorts or blood apparent under the microscope—it should not be ignored, but should be evaluated. If after having sex with your partner you notice a bloody vaginal discharge and you are not menstruating, consider that it might be his issue and make sure that he gets followed up.

Testes Lumps and Bumps

Most lumps and bumps of the testes are benign and not problematic. Although rare, testicular cancer is the most common solid malignancy in young men, with the greatest incidence being in the late 20s, striking men at the peak of life. The excellent news is that it is very treatable, especially so when picked up in its earliest stages, when it is commonly curable.

A testicular exam is a simple task that can be lifesaving. One of the great advantages of having his gonads located in such an accessible locale—conveniently “gift wrapped” in the scrotal satchel—is that it makes them so easy to examine. This is as opposed to your ovaries, which are internal and not amenable to ready inspection. This explains why early testes cancer diagnosis is a cinch as opposed to ovarian cancer, which most often presents at an advanced stage. In its earliest phases, testes cancer will cause a lump, irregularity, asymmetry, enlargement or heaviness of the testicle. It most often does not cause pain, so his absence of pain should not dissuade him from getting an abnormality looked into.

Your guy should be doing a careful exam of his testes every few weeks or so in the shower, with the warm and soapy conditions beneficial to an exam. If your man is a stoic kind of guy who is not likely to examine himself, consider taking matters into your own hands—literally: At a passionate moment, pursue a subtle, not-too-clinical exam under the guise of intimacy—it may just end up saving his life.

Bottom Line: Have the “cajones” to check his cajones. Because sperm production requires that his testes are kept cooler than core temperature, nature has conveniently designed mankind with his testicles dangling from his mid-section. There are no organs in the body—save your breasts—that are more external and easily accessible. If your man is not willing to do self-exams, at a moment of intimacy do a “stealth” exam under the guise of affection—it just might be lifesaving.

Urinary Woes

Most organs shrink with the aging process. However, his nose, ears, scrotum and prostate are the exceptions, enlarging as he ages. Unfortunately, the prostate is wrapped precariously around the urinary channel and as it enlarges it can constrict the flow of urine and can cause a host of symptoms. These include a weaker stream that hesitates to start, takes longer to empty, starts and stops and gives him the feeling that he has not emptied completely. He might notice that he urinates more often, gets up several times at night to empty his bladder and when he has to urinate it comes on with much greater urgency than it used to. He might be waking you up at night because of his frequent trips to the bathroom. Almost universal with aging is post-void dribbling, an annoying after-dribble.

Bottom Line: It is normal for him to experience some of these urinary symptoms as he ages. However, if he is getting up frequently at night, dribbling on the floor by the toilet, or has symptoms that annoy him and interfere with his quality of life, it is time to consider having him looked at by your friendly urologist to ensure that the symptoms are due to benign prostate enlargement and not other causes, to make sure that no harm has been done to the urinary tract and to offer treatment options.

Wishing you the best of health and a wonderful Thanksgiving weekend,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: or Amazon.

Eyes Wide Open: Genital Mindfulness

May 9, 2015

Andrew Siegel MD 5/9/15

Pay careful attention to your body, including your genitals. Erectile function (or lack) is a barometer of your overall health and a bellwether for disease as well as an indicator of cardiovascular health.


Be Mindful

Observe your penis in both flaccid and erect states. Carefully watch and listen to your urinary stream. Keep an eye on  your urine and semen. It sounds strange, but by doing so you will gain insight into your general and pelvic health. Don’t forget to examine your testicles periodically when showering, feeling for lumps, bumps or asymmetry.

Skin Matters

Are there any rashes or skin lesions on the penis or scrotum? The genital skin—like the rest of our skin—can be subject to allergic responses, infections and cancers.

Power Tool No More?

Are you “limping” in the bedroom with less rigid and durable erections? This may be a sign of a problem with the cardiovascular system. The penile arteries are smaller than the coronary arteries of the heart and narrow before those of the heart have an opportunity to do so, so ED can be a predictor of a more generalized disease process involving other blood vessels.

Sex Drive Gone South?

Are you more interested in baseball than in sexual matters? If so, it may be time for a libido check and an evaluation of your testosterone level, as T is the “governor” of sex drive.

Erection Curved like a Banana?

Has your formerly straight erection gone “rogue”? Does it appear curved like a banana or is it angled like a periscope? Is there an area of narrowing that looks like a “waist” giving it an “hourglass” appearance? If so, you may have Peyronie’s disease, scarring of the sheath of the erectile cylinders of the penis causing a painful curvature.

Dribbling Instead of Shooting?

Did your previously powerful and intense ejaculation morph into a weak sputter of a small volume of semen with diminished intensity? If this is the case, you may have weakened pelvic floor muscles.

What’s That?

Is there a discharge from your urethra? If so, you might have a urethral infection/inflammation known as urethritis or other sexually transmitted infection. If you have not ejaculated in some time, it is possible that there will be a milky white discharge at the time of a bowel movement as the prostate is “milked” by the act of defecation.

Funky Colored Urine?

Urine color ranges from clear to amber, depending upon your state of hydration. When well hydrated, your urine will look clear or very pale yellow, like light American beer. When dehydrated, your urine becomes very concentrated, appearing dark amber, like a strong German beer.

Fresh bleeding in the urinary tract makes the urine appear bright red whereas old blood appears tea or cola-colored. In either case, blood in the urine is abnormal and should be investigated to ensure that the bleeding is not on the basis of a serious condition such as bladder or kidney cancer.

Excessive vitamin B intake can result in light orange urine. Overconsumption of beets, blackberries, and rhubarb can sometimes impart a red color to urine. Cloudy urine may be indicative of a urinary tract infection, but can also occur when one’s diet consists of foods high in phosphates.

When urine is occasionally foamy or sudsy, it is considered to be normal. When it occurs consistently, it can be a sign of protein in the urine, often indicative of kidney disease.

Funky Smelling Urine?

A sweet smell may indicate diabetes. A foul odor may be on the basis of a urinary infection or the intake of certain foods, e.g., asparagus. Vitamin intake can also cause the urine to have an unpleasant odor. Vitamins B and C are water soluble and therefore not stored in the body and any excess above what is necessary for the body’s use is excreted in the urine. Malodorous urine that has a fecal odor may indicate a bad urinary infection or possibly an abnormal connection between the colon and the bladder known as a fistula. This happens most commonly from diverticular disease of the colon and when it occurs, there is often air in the urine as well.

Does It Burn?

If urination is painful, it may indicate a urethral or urinary infection.

Can’t Put Out a Fire Anymore?

When you observe your flow, does it hesitate before it gets going? Is the stream weak and split into several streams or sprays like a spigot? Does it start and stop and seem to take forever to empty? When you have to go, do you have little warning and a tremendous desire to urinate? Are you leaking urine before you get to the toilet? Do you have an after-dribble? Does the sound of your urination that once was like the rapids of a powerful river now sound like a meek creek? If so, you may have plumbing issues on the basis of prostate enlargement, scar tissue in the urethra, or an overactive or underactive bladder.

Bloody Show?

Blood in the semen can literally scare the “daylights” out of you. However, the majority of men with “hematospermia” have a benign inflammation of the prostate that is not a serious problem, often as innocuous as a nosebleed.

Bottom Line: Scrutinize your genitals to discover much about your health.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in your email in box go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback:  

Co-creator of Private Gym pelvic floor muscle training program for men: 

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic muscle strength and tone. This FDA registered program is effective, safe and easy-to-use. The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximal opportunity for gains through its patented resistance equipment.