Disease Description (Causes and Symptoms)
- Definition: A condition in which blood is mixed into the semen during ejaculation (red, dark red, brown, etc.).
- Main causes and pathophysiology:
- Caused by bleeding from blood vessels in the lower genital and urinary tracts, including the prostate, seminal vesicles, urethra, urethral junction or ligation site, and ejaculatory ducts.
- Commonly occurs temporarily and resolves spontaneously in young men as idiopathic hematospermia (of unknown cause).
- Structural lesions such as inflammation (prostatitis, seminal vesiculitis, urethritis), stones, cysts, trauma, elevated blood pressure, blood-clotting abnormalities, and, rarely, prostate cancer may be causes.
- Main symptoms:
- Semen mixed with blood during ejaculation
- Symptoms that may sometimes occur together: difficulty urinating, urinary frequency, painful urination, perineal discomfort or pain, hematuria, and lower abdominal discomfort
- Although it is usually temporary and may improve on its own, additional evaluation is needed if it persists or recurs, or if other symptoms occur (fever, severe pain, gross hematuria, etc.).
Treatment Methods
- Principles of cause-based treatment: Treatment varies depending on the underlying cause
- Conservative observation: If there are no findings suggesting a specific cause and the bleeding is mild and temporary, observation is appropriate (most cases resolve spontaneously).
- Medication: If inflammation (such as prostatitis or urethritis) is the cause, appropriate antibiotics and anti-inflammatory drugs are administered (antibiotics are selected according to bacterial test results).
- Procedures/surgery: If structural lesions such as stones or cysts are the cause, the lesion is removed (e.g., stone removal or cystectomy).
- Other: If the cause of bleeding is a blood-clotting abnormality, consultation with the Department of Hematology and correction of coagulation function are necessary.
- Lifestyle management and precautions:
- If symptoms worsen after sexual intercourse or masturbation, abstaining from sexual activity for a certain period (as recommended by a doctor) is advised.
- Check for hypertension and use of anticoagulants — discuss medication adjustment if necessary.
- Visit a hospital immediately if fever, persistent bleeding, dark hematuria, or severe pain occurs.
- Possible complications:
- Repeated recurrence, progression to chronic prostatitis, rarely an effect on sperm quality (after severe inflammation or surgery), or delayed detection of an underlying disease (e.g., cancer)
Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)
- Items/materials to bring:
- A list of all medications currently being taken (including anticoagulants and antiplatelet drugs) or the medication packaging
- Past medical history and surgical history (including urinary tract- or prostate-related procedures)
- Copies of recent test results (urinalysis, blood tests, PSA, etc.) or test records, if available
- A photograph of the semen when symptoms occur (if possible), or a record of when symptoms occurred, their frequency, and changes in color
- A record of recent sexual history, possible exposure to sexually transmitted infections, history of trauma, and changes in urinary symptoms
- Items to confirm before the consultation (patients are advised to take notes themselves):
- When the symptoms first began and their course (frequency of recurrence)
- Accompanying symptoms: fever, urinary symptoms, pelvic pain, weight loss, etc.
- Whether you have hypertension or are taking anticoagulants
General Sample Questions to Ask the Doctor
- What are the most common causes of this symptom?
- What additional tests (chemistry tests, imaging, endoscopy, etc.) do you recommend? What are the reasons for and procedures involved in the tests?
- If the test results are negative, how long should I continue to be monitored? When should I return if it recurs?
- What is the expected duration of the prescribed medication (especially antibiotics), and what are its possible side effects?
- Do I need to adjust the anticoagulant or hypertension medication I am taking?
Examples of Disease-Specific Questions
- If I am in my 40s or older, or if my PSA is elevated, should I undergo testing for prostate cancer? (Related to prostate cancer risk assessment)
- Could this condition affect fertility (sperm count and motility)? If necessary, should I undergo a semen analysis?
(Note: If there are findings suggestive of malignant disease, such as persistent bleeding, repeated recurrence, older age, or elevated PSA, active imaging tests (transrectal ultrasound, MRI) or cystoscopy of the bladder and urethra are recommended.)