Dear Dr. G,

I am a 30-year-old man who is happily single and not so active sexually.

I occasionally masturbate, but generally not keen to do so.

A month ago, I suddenly had some sexual urges and masturbated.

To my shock horror, I noticed a lot of blood in my semen.

I wanted to check whether the blood in my ejaculates was persistent, so I masturbated again several days later.

Sadly, the same problem of blood in my sperm continued over the last two weeks.

In fact, the blood concentration has not diminished.

The strange thing is, I did not experience any pain associated with the bleeding.

I visited a urologist who performed a thorough check-up, including blood tests, MRI and examination of the penis with an endoscope.

He assured me everything would resolve in due course.

Although the blood in the semen has caused significant anxiety in me, I don’t think I have contracted any sexually transmitted infections.

However, I am worried the red alert is an early sign of cancer.

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 I don’t ejaculate frequently?

Is there such a thing as too little sex?

I read on the Internet that bleeding in ejaculation can also be caused by chlamydia or gonorrhea. Do you think I should check for these?

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


Red Richard

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 ejaculates. Such “red ejaculation” has been reported for centuries, even in Ancient Greek Hippocrates’ era, around 400 B.C. The exact prevalence of this condition is largely unknown, as most bleeding “cums” unnoticed. Perhaps, much of the activities are nocturnal in nature and mild bleedings in darkness are generally unobserved. In a recent survey, hematospermia occurs in one out of every 5,000 patients at urological outpatient clinics that make up around 1% of urological symptoms.

Although hematospermia is probably one of the most terrifying experiences a man can encounter during sex, in reality, the symptoms have little medical significance, as it is generally not related to serious illness. Blood in the ejaculate can occur at any age of sexually matured adults, and is mostly self-limiting and requires no investigation. However, persistent fresh bleeding (more than 10 ejaculates or beyond two months) especially accompanied by painful symptoms may warrant 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 causes.

Most of the infections are “innocent” in nature, though sexually transmitted infection (STI) 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 persistent redness in ejaculate is bound to trigger fears of serious conditions such as cancer. A recent Northwestern University study was conducted on 26,126 men who underwent prostate cancer screening. Out of the 6.5% detected with prostate cancer, 14% had a history of hematospermia. This translates to 3%-5% of men with bloody ejaculate being associated with prostate cancer.

Ruptured 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. Occasionally, fulguration of the bleeding vessels in the prostate may be necessary to prevent hemorrhage.

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