Seeing red and feeling blue

Dear Dr G,

I am in my late 20s and have an active sexual life. My partner and I have sex regularly – sometimes even twice a day.

Three months ago, I noticed blood in my semen after a more-intense-than-normal bout of passion.

My partner and I were shocked and slowed down the frequency and intensity of sex, hoping the bleeding would disappear but the bleeding has continued. This has sadly dampened our sexual enthusiasm.

There is no pain associated with the bleeding. I went to a urologist, who gave me a thorough check including blood tests, MRI and even a camera up my penis.

He reckons I suffered from acute prostatitis which requires a long course of antibiotics.

To put Dr. G on the spot, why am I having blood in the semen? Is it because of too much or too vigorous sex?

Am I at greater risk of prostate cancer because of this?

Regards,

Red Richard

Blood in the semen is called hematospermia, which presents as a small drop of blood in the semen or copious amounts of blood in the ejaculate.

Its occurrence has been reported way back in history, back in ancient Greece around 400 BC and it is probably one of the most terrifying experiences for a man.

Its symptoms have little medical significance and are generally not related to serious illness.

The exact prevalence of this condition is largely unknown as it usually goes unnoticed.

A recent survey at a urological outpatient clinic shows hematospermia affects one in 5,000 patients and makes up around 1% of urological symptoms and can occur in sexually matured adults of any age.

It is mostly self-limiting and requires no investigation.

However, persistent fresh bleeding (more than 10 ejaculates or beyond two months) – especially if accompanied by pain – may warrant more extensive diagnostic work-up.

The most common cause of the bleeding is inflammatory conditions in the prostate and seminal vesicles, such as acute prostatitis, which constitutes around 40% of all causes.

Most of the infections are innocent in nature, although a STI (sexually transmitted infection) is probable for men with a history of sexual promiscuity. However, no specific cause of hematospermia is determined in around 15% of the cases.

Of course, the condition can cause cancer fears. In a recent Northwestern University study of 26,126 men, 14% had a history of hematospermia and 6.5% were detected with prostate cancer. This translates to 3-5% of men with bloody ejaculate may be associated with prostate cancer. Therefore, all men above 40 are investigated with blood tests, 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 the semen. This is particularly prevalent in men having sex after a long period of abstinence. The vast majority of such hematospermia are self-limiting, but this can take up to three months. Medication such as antibiotics and prostate-shrinking remedies may help. Occasionally, fulguration of the bleeding vessels in the prostate may be necessary to prevent haemorrhage.