ABC in ‘Alarming Bloody Climax’

Dear Dr. G,

I am a 36-year-old man who is happily married and have no extra-marital affair.

My wife and I have an amazing sexual life since we were married 5 years ago.

We have sex regularly, almost every other day.

In fact, during the MCO, we even have sex twice a day while working from home.

Three months ago, I started noticing blood in my semen, after an intercourse that perhaps was more intense than normal.

My wife and I were shocked but were hoping the bleeding would disappear after

one week of abstinence.

Although the bleeding ceased for a while, the same problem of blood in my sperms continued intermittently over the last few weeks.

The strange thing is, I do not have any pain and the intensity of the climax remained unchanged. The bleeding may occasionally be bright red and sometimes brownish tinge.

The blood in the semen has dampened our enthusiasm in sex, we are not so keen on intimacy until the condition improves.

I am really hoping to put Dr. G on the spot on the issues of my Red Climax.

Why am I having blood in the semen? Is it because we had too much sex?

Is there such a thing as too much or too vigorous sex?

I read on the Internet that bleeding in ejaculation may be associated with cancer, am I too young to have cancer?

I really cannot understand why this has happened to me.

Will this Alarming Red Climax ever go away?

Regards

Bloody Bob

Blood in the semen is called hematospermia. Bloody ejaculation has been reported for centuries by the Ancient Greek Hippocrates around 400 B.C. Modern literature reported hematospermia occurs 1 in 5,000 patients at the urological outpatient clinic. This makes up around 1% of all urological symptoms. In fact, the exact prevalence of this condition is largely unknown, as most bleedings “cum” unnoticed. Bloody ejaculation may present on occasions as a small drop of blood mixed with the semen, otherwise copious fresh blood mixed with all ejaculates. Besides, much of the activities are nocturnal in nature and mild bleedings in darkness generally go unnoticed.

Blood in the ejaculate can occur at any age of sexually mature adults. Hematospermia is probably one of the most terrifying experiences for a man during sex. Most blood in the semen is idiopathic as no specific cause of hematospemia is determined in 70% of the cases. Although most bloody ejaculations have little or no medical significance, seeing blood in the semen usually raises alarm bells in most men and their partners. Hematospermias are generally self-limiting and require no investigation. However, persistent fresh bleeding (more than ten ejaculates or beyond two months) especially accompanied by painful symptoms may warrant more extensive diagnostic work-up.

Persistent hematospermia is usually caused by inflammation in the prostate or seminal vesicles, and the common cause of such inflammation is infection or prostatitis. Inflammation of the prostate constitutes around 40% of all causes. Most of the infections are “innocent” in nature, however STIs or Sexually Transmitted Infections need to be excluded in men with a history of sexual promiscuity.

Persistent redness in the ejaculate may also generate fear of serious conditions such as cancer. A recent study of 26,126 men at Northwestern University who underwent prostate cancer screening revealed 1,700 men who were diagnosed with cancer, and 14% had a history of hematopsermia. The data broadly reflect 3-5% of men with bloody ejaculate may be associated with prostate cancer. Therefore, older men with an increased risk of cancer may need to be investigated with PSA (Prostate Specific Antigen) blood test, (DRE) digital rectal examination and MRI scan.

The rupture of blood vessels in the prostate during vigorous sexual intercourse is another common reason for blood in ejaculation. This is particularly prevalent in men having sex after a long interval of abstinence. The vast majority of such hematospermia are self-limiting, but this can take up to three months. Medications such as antibiotics and prostate-shrinking remedies may help. Failing all, fulguration of the bleeding vessels in the prostate may be necessary to prevent further hemorrhage.

The German poet and philosopher, Albert Schweitzer, once said: “An optimist is a person who sees a green light everywhere, while a pessimist sees only the red stoplight. But truly wise person is colourblind”. Red is generally associated with danger and alert, especially when bleeding indicates something alarming may be happening. However, in the complexity of sexual health, this is a general rule with some exceptions, especially applicable for younger men presented with red ejaculate. Distressed men with Alarming Bloody Climax (ABC) often put Dr. G on the spot, pressing for answers and solutions. His response is when it “cums” to hematospermia: “Red alerts of ejaculates may make you a pessimist. But wise colourblind lovers usually get the green lights after assurance from the doctors”.