Dear Dr G,
I am a 40-year-old man and six months ago, I noticed blood in my ejaculate.
Don’t get me wrong, I was not involved in any form of kinky sex.
From what I recalled, it was just ordinary intimacy I had with my wife, and I noticed fresh blood in the condom during two occasions.
I went to see a specialist who assured me it was common, and he told me to ejaculate more.
Indeed, the more often I ejaculated, the less blood I noticed.
However, in the last three weeks, I noticed the same problem again.
I went back to the same doctor, again trying to assure me that there is nothing wrong.
I hate to put Dr G on the spot, but surely ejaculating fresh blood is not normal.
What are the common causes of blood in the ejaculate? Can this be cancer?
Do you think I had too much sex? Is there such a thing as too much sex?
What kind of tests should I do to ease my mind?
The blood in the semen is referred as hematospermia.
The condition is common among men, but many episodes perhaps go unnoticed, as men may not have the habit of inspecting their own ejaculates.
Although doctors may consider hematospermia of little significance, the condition is usually self-limiting.
The symptoms usually generate tremendous distress to men who experience it!
Hematospermia has actually been documented in medical literature for centuries.
Founders and giants of medicine such as Hippocrates, Galen and Morgagni had all reported the condition with the no significant concerns.
Most men may experience hematospermia occurring on several occasions over weeks or even months.
In some men, the symptoms may be intermittent and rather distressing when it is recurring.
Chronic hematospermia is usually referring to the bleeding that persists for more than 10 ejaculates, and this usually requires medical attention to evaluate the causes of the problem.
Men younger than 40 years old experienced blood in the semen usually caused by urogenital infections that require minimal intervention.
Men older than 40 with persistent hematospermia are usually investigated more extensively to exclude urogenital malignancy.
The most common cause of blood in the semen is inflammatory condition of the seminal vesicles or the prostate.
Whether the condition is bacterial or non-bacterial in origin, it is commonly resolved within one to two months.
In half of the cases, the etiology of the bleeding is completely unknown.
The concern of malignancy is apparent in men who see blood in ejaculate.
In reality, malignancy only accounts for 2% of all the cases of hematospermia.
In a study of long-term follow-up of 150 men with bloody semen, only six patients developed prostate cancer as none of them had carcinoma diagnosed at the time of initial evaluation.
Of course, men who had naughty “extra-curricular” activities in the past may be troubled by hematospermia when the curse of the sexually transmitted infection manifests itself.
A review of men with hematospermia presented to sexually transmitted infection clinic found 75% of them were positive of genital herpes, chlamydia and gonorrhea.
Obvious “cuming clean” to the doctors at the time of presentation would help to facilitate treatment.
The vast majority of men with hematospermia need no investigation or treatment.
For men who are anxious of the underlying medical issues - blood test, urine test, ultrasound or MRI imaging of the genital tracts - may be required.
In the presence of bacteria, the initiation of antibiotics over a period of time may also be necessary.
Otherwise, the frequent ejaculations to “flush out” the infected semen are encouraged instead.
Men who suffer from hematospermia may be confronted with a sense of guilt, either from the perception of too much sex in the past, or the worry of past mischief.
Indeed, the right approach of assurance is to get medical attention to rule out serious conditions.
Dr G is often put on the spot by distressed men who still experience “red climax” despite negative investigations.
His advice is: “Keep calm and carry on ejaculating. The red climax should fade with time!”
> The views expressed are entirely the writer’s own.
Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men’s health. The column “Ask Dr G” is a forum to help men debunk the myths and taboos on men’s issues that may be too “hard” to mention. You can send him questions at firstname.lastname@example.org