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Blood in Semen

Keywords for searching: blood, bloody, clots, semen, ejaculate, hematospermia Want more information? Five years of online discussion and a lack of scientific consensus means there are different viewpoints on almost everything that can be discussed here. To learn those conflicting points, click on search, and enter the terms you are wondering about.
Not infrequently, prostatitis patients are shocked to notice blood or blood clots in their semen. On a number of occasions in recent years, frightened patients have written to the newsgroup or webmaster wondering what this means. A typical doctor's reaction is that blood in semen is not uncommon in prostatitis and is not necessarily a cause for alarm.
In writing to patients, your webmaster has commented that blood in semen might be viewed about the same way one would view blood in nasal mucus when one had a bad cold or sinus infection. It certainly is a sign of problems, but it's not thing to go into a panic about. Good medical care is called for in any case.
Blood in semen is also seen after the beginning of a series of prostate drainages. The pressure of the drainages, and the "popping" of clogged acini, can result in some temporary bleeding as tiny blood vessels are ruptured. Again this is worth noting, but not cause for undue alarm. Bring it up to your doctor, but don't be surprised if he or she says not to worry about it.
Below are several exchanges of comments about blood in semen from 1997 exchanges on the newsgroupsci.med.prostate.prostatitis , the main forum for discussing these issues. The names and E-mail addresses have been deleted, but the messages are archived so you could find them if you want. (Mispellings in the texts remain intact, but some messages have been shortened for clarity.)


From: (Name and address deleted)

My doctor gave me a vigorous prostate message where I got a tablespoon of EPS. However, I noticed I have been seeing blood in my ejaculate. Is this normal?

Subject: Re: Blood in Semen
From: (doctor, name deleted)(address deleted)
Dear (Name deleted)

I have seen bloody EPS and semen in many of my patients and should resolve after successful eradication of the infection. Cancer which is rare should be ruled out and your doctor is aware of these.

By the way, have you felt an almost relief of pressure or pain or freer urination after the drainage of a tablespoonful of EPS.

(doctor, name deleted)

Subject: Blood in Semen
From: (first patient,name and address deleted)

No, actual my abdomenal pain is worse. My epidiymus has also become swollen after the prostate massage.

Subject: Re: Blood in Semen
From: (second doctor, name and address deleted)
(first correspondent) wrote:

My doctor gave me a vigorous prostate message where I got a tablespoon of EPS. However, I noticed I have been seeing blood in my ejaculate. Is this normal?

Yes, a small blood vessel was possibly injured. I would not worry about it unless the blood does not clear up in a few days.

Best,

(second doctor, name and address deleted)

Subject: Re: Blood in Semen
From:(first doctor)

Worsening of symptoms after a bloody massage suggest a mild form of acute prostatitis and/or exacerbation of semen infection.

(First doctor)

From: (second patient, name and address deleted)
To:(first doctor)
Subject: Blood in Semen

I have CP (and associated erectile dysfunction). Having seen three different Urologists myself and noted similar futile experiences by so many others on the newsgroup, I am now just waiting for some research to be done before seeking treatment.

I have had 2 Cystoscopys, each followed by a Biopsy. These tests, along with Ultrasound tests have not found any sign of cancer. My PSA remains constant at about 5.7, I assume because of the infection.

I would prefer to just wait until research determines an appropriate treatment for CP, rather than to undergo more tests that could do more harm than good. My question is whether I should be overly concerned about bloody semen. Although the semen is usually rich in blood content, tests have never found any blood in my urine.

Can I afford to wait a year for more research to be done? I am just asking for an opinion and will take responsibility for my own decisions.

Thanks

(name deleted)

Dear (name deleted),

The diagnosis of CP and seminal vesiculitis is relatively simple. Be happy that your tests for cancer of the prostate is negative. I presumed that cystoscopy done to you also ruled out bladder neck constriction.

Bloody semen is associated with CP and/or semen infection. Your semen should be cultured as well as EPS. Any doctor can do this for you and prescribe the proper antibiotics based on cultures and/or empirically.

(first doctor)

Subject: Blood clots in urine
From: (doctor, name and address deleted)
John wrote;

A correspondent with prostatitis has blood clots in his urine. They appear periodically. He has a variety of examinations that haven't revealed their source. Does anyone have any suggestions?

Blood clots periodically appearing in the urine from one who has had a variety of examinations ruling out bladder or kidney sources, is part of the manifestations of prostate and/or semen infection,

If his prostate has been found normal based on urologists criteria of an infection and/or semen infection, those areas may still be infected and the most likely source of blood.

Subject: Re: blood then none then blood then none
From: (doctor, name and address deleted)
From:(patient 3)
To: (doctor 1)
Subject: blood then none then blood then none

hi doc i find it strange i get blood when i have intercorse and i get none when i masterbate i do feel some minor very minor pain and some stinging afterwards for a few min's but goes away and no blood in seman or urine that i can see but when i have intercourse i have bloody discharge and urine very bloody will find a dr who can get your info and try your treatment will keep you advised

thanks again doctor

(name and address deleted)

blood came back after one day had one ejac... was ok then nxt day had one blood all over place but this time i noticed it wasn.t as much and cleared out of the urine quicker will talk to dr abt the drugs you said and will have to do prostat massage myself dont know about stains dr around here dont have time to go thur all that very busymaybe have to find better dr ...

thanks again dr.
Dear (patient 3)

I have already posted recently the procedures to diagnosed a genitourinary tract infection including semen. By having the proper diagnostic procedures should settle the diagnosis and you should be less confused.


(Comment by a urologist on the newsgroup sci.med.prostate.prostatitis on 1/3/98):
What this sounds like is not necessarily prostatitis, but is hemospermia--defined as the presence of blood in the ejaculate. Hemospermia is an almost always benign self-limiting condition that differs from prostatitis in that it has usually no lower urinary tract symptoms, sexual disturbances, or pain. It usually goes away, but if it persists should be worked up to rule out prostate cancer (DRE and PSA) and possibly a TRUS to r/o a cystic abnormality or the like. Drug use should be examined to rule out something that may cause a bleeding phenomenon, and bleeding/clotting parameters should be examined. Again, if blood in the ejaculate is the only symptom, I don't think that you can be said to have prostatitis--I hope this helps.

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