BLOOD in the ejaculate is also called haematospermia or haemospermia. The true incidence is not known as many men do not examine their ejaculate. However, according to FJ Leary, it has been reported to be noted in one in every 5,000 new men presenting to a urology clinic.

The peak age of noticing blood in the ejaculate is between the ages of 30 and 40 years. If it occurs in men over the age of 40 years or if it is recurrent, it is usually due to a serious problem and should be evaluated by a urologist.

Can blood in the ejaculate be seen with other symptoms?

Blood in the ejaculate is usually an isolated symptom. However, it may be associated with blood in the urine, increased urinary frequency, burning during urination, and scrotal pain.

What are the common causes of blood in the ejaculate?

The cause of blood in the ejaculate is unknown in as many as 70 per cent of men. In fact, a single episode of blood in the ejaculate carries an extremely low risk of the presence of an underlying cancer. Some of these cases will not recur and some people question the need for evaluation in these individuals. It is felt that the undiagnosed causes may be due to prolonged periods of abstinence or vigorous sexual activity.

The commonest identifiable cause of this condition is infection or inflammation. Other urological causes include prostate cancer, benign enlargement of the prostate or testicular problems. Non-urological causes include bleeding disorders, liver disease and a condition called malignant hypertension.

Is blood in the ejaculate easy to treat?

The condition is not easy to treat because of the great difficulty in finding an underlying cause. Further evaluation is mandated in men over 40, associated urinary symptoms and recurrence of the symptom. The aim is to determine the cause of the symptom and exclude a malignancy.

What kinds of tests may be done?

The man’s urine and semen may be sent for microscopy and culture to determine the presence of an infection. A screen for a sexually transmitted infection may also be done. The prostate specific antigen (PSA) should be done in men over age 40 years to screen for prostate cancer. A trans-rectal ultrasound and/or prostate biopsy may be done if the PSA is elevated or abnormalities are felt on the digital rectal examination.

Further tests may be needed in high risk persons or those with other symptoms. This may include a cystoscopy, which is an endoscopic examination of the urethra and bladder that may be performed in an office setting with local anaesthesia. Recent evidence has suggested that an endo-rectal MRI may be used in recurrent cases.

Treatment of blood in the ejaculate

Treatment involves addressing the underlying cause, if found. Most cases are self-resolving before the patient even presents to the urologist.

Dr Belinda Morrison is a consultant urologist and lecturer at the University of the West Indies and Mona Institute of Medical Sciences, Mona, Kingston 6. Please send questions and comments to belinda.morrison02@uwimona.edu.jm.