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By Dr Pius Musau
Given the nature of intimacy, very few people ever come to know of a condition called heamatospermia, or simply blood in semen.
Sperms constitute three to five per cent of an ejaculate, while the rest are secretions from the accessory gland prostate and seminal vesicles.
Bloody semen is a condition of unknown prevalence in the society and usually scaring to those who notice it on themselves.
It affects men of varied ages and depending on the age bracket, will usually be a sign of an underlying problem.
The common causes suggest a problem in the sites of production of the semen, or the passage from those sites. Up to half the cases end up idiopathic, meaning that no known cause is established.
Common causes of blood in semen
• Trauma: this could be accidental or as a result of health care interventions. Injuries involving the testes, the perineum or the urethra are just as likely to cause it as are prostate biopsies and urethral catheterisation.
• Infections and inflammatory conditions of the prostate, seminal vesicles and the urethra. The leading ones are HIV, cytomegalovirus, genital herpes, chlamydia and urogenital TB.
• Pre-existing medical conditions like hypertension, kidney failure and sickle cell disease.
• Vascular or blood disorders that may suggest liver failure or use of anticoagulants and/or non-steroidal painkillers.
• Growths in the prostate or seminal vesicles; key ones being cysts and prostate cancer.
Most causes are self-limiting and so will be transient in nature; lasting less than two weeks. Persistence beyond two months makes the condition a chronic problem, requiring elaborate investigations and subsequent treatment.
Diagnosing the problem
Patients below 40 years of age will predominantly have infections or trauma as the underlying causes. Those with hypertension, organ failures and sickle-cell disease or on medications will be easy to identify from history and physical examination.
The older patient may require intensive evaluation to rule out malignancies or degenerative conditions that may be responsible for the problem. These are the patients who will be taken through the rigours of comprehensive history, physical examination and an assortment of investigations to get a definite diagnosis on which treatment will be based.
Treatment
About half of the cases will have no known medical cause and will thus be treated symptomatically after a dose of reassurance.
The other half will be treated in accordance with the identified cause and available modes of treatment.
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