Dear Dr. G,

I am a 26-year-old who is happily attached and I have an amazing sexual life!

Since I met my partner, we have sex almost every other day and during the movement control order we might even have sex twice a day.

As the frequency increased, we also became more adventurous and sex became

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

My partner and I were shocked, but were hoping the bleeding would disappear as we progressed.

Sadly, the same problem of blood in my semen seems to continue intermittently over the last few weeks, and by blood I mean fresh blood!

The strange thing is that I do not have any pain at all with the bleeding, and I have been to a urologist and have had a thorough check-up – including a camera up my penis. He has assured me everything would resolve itself in due course.

As the blood in the semen has dampened our enthusiasm for sex, we are not so keen to continue 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 can also be caused by chlamydia or gonorrhea, can this be my naughty past haunting me?

I really cannot understand why the doctor still cannot find the cause of my blood in the semen, despite having undergone such extensive tests. Are we missing something here? Will this red climax ever go away?

Red Rodger

Blood in the semen is called Hematospermia, which presents as a small drop of blood mixed with the semen or copious fresh blood in all ejaculate.

The exact prevalence of this condition is largely unknown, as most bleeding comes unnoticed.

Perhaps, much of the activities are nocturnal in nature and mild bleeding in darkness is generally unobserved.

However, a recent survey shows that hematospermia occurs in 1 in every 5000 patients at urological outpatient clinics and that makes up around 1% of urological symptoms.

Although hematospermia is probably one of the most terrifying experiences a man can have during sex, the symptoms have little medical significance as it is generally not related to a serious illness.

Blood in the ejaculate can occur in any age of sexually-mature adults, and is mostly self-limiting and requires no investigation. However, persistent fresh bleeding (more than ten ejaculates or beyond two months) especially accompanied by painful symptoms may warranta more extensive diagnostic work-up.

Hematospermia is usually caused by inflammatory conditions in the prostate and seminal vesicles.

The most common cause of such inflammation is an infection resulting in prostatitis, which constitutes around 40% of all cases and most of the infections are “innocent” in nature, though a sexually transmitted infection is probable for men with a history of sexual promiscuity. However, no specific cause of hematospemia is determined in around 15% of the cases.

Of course, with the persistent redness in ejaculate, the fear of a serious condition such as cancer is looming.

In a recent Northwestern University study of 26,126 men who underwent prostate cancer screening, 14% of the 6.5% men who were found to have prostate cancer had a history of hematopsermia.

This means that 3%-5% of men with bloody ejaculate may be associated with prostate cancer and therefore, all men above the age of 40 are investigated with a blood test, a digital rectal examination and a 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 and occasionally, fulguration of the bleeding vessels in the prostate may be necessary to prevent haemorrhage.

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 colour-blind”.

Red is generally associated with danger and warning, especially when bleeding as this can indicate that something alarming is 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 unexplained symptoms of red climax often put Dr. G on the spot, pressing for answers and solution.

His response is when it comes to hematiospermia: “Despite getting an all clear from your doctor, and the red alerts of ejaculates are still making you a pessimist.

Switch off the lights, be a true wise colour-blind lover, and soon enough you will be seeing green lights everywhere!”

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