Further discussion on hematospermia: Qi deficiency and excessive fire scorching the seminal vesicle.

Qi deficiency and excessive internal heat lead to bloodshed in spermatorrhea.

A woman's first time usually involves "bleeding," which is the bleeding caused by the rupture of her hymen. In ancient times, "bleeding" referred not only to fallen flowers but also to the blood of a virgin, specifically the blood that falls during a woman's wedding night.

Actually, bleeding during the first sexual encounter isn't exclusive to women; men can experience it too, though less frequently. Men may also experience penile bleeding after their first sexual intercourse, but this is mostly benign and nothing to panic about. Applying pressure directly to the bleeding area with a clean gauze or towel for 10-20 minutes will usually stop the bleeding on its own. However, what's alarming is that some men experience persistent bleeding, with each ejaculation accompanied by blood. This is a medical condition known as hematospermia (blood in semen).

Hematospermia is a disease of the male reproductive system, mainly characterized by the ejaculation of red semen during intercourse. This disease often occurs concurrently with prostatitis, and its infection route is mostly direct spread from the urethra and prostate; secondly, it is caused by lymphatic infection and hematogenous infection. Due to bacterial invasion and inflammatory stimulation, the seminal vesicles become congested. During intercourse, the smooth muscles and blood vessels contract, resulting in a large number of red blood cells and pus cells mixed in with the semen.

Traditional Chinese medicine believes that hematospermia is mostly caused by insufficient kidney yin and excessive ministerial fire, which forces blood to flow erratically; or by excessive sexual activity, which damages blood vessels and causes blood to flow with semen; or by damp heat descending and steaming the seminal chamber, causing blood to flow erratically due to heat.

Generally, blood in semen is not easily noticed immediately unless there is significant bleeding; otherwise, it is difficult to detect during intercourse. Even if blood is found on the penis or clothing after intercourse, people often first assume it's due to the woman. However, if a condom is used during intercourse or withdrawal is used, blood in semen is less likely to be detected. When people suddenly notice a change in semen color, they inevitably feel anxious and preoccupied with wondering what might be causing it.

If semen suddenly changes from its normal milky white color to blood red, reddish-brown, or streaked with blood, it's obviously due to the presence of blood. Where does this blood come from? It's simply because of a pathological change in some tissue along the sperm's pathway, such as bleeding, inflammation, or even a tumor. Don't take hematospermia lightly; it could be a sign of a serious illness, and a thorough examination by a specialist is recommended. Clinically, hematospermia is not uncommon. After detailed clinical and laboratory examinations, the vast majority can be controlled or cured with treatment; only a very small number of patients with tumors require further treatment. Semen is primarily composed of seminal vesicles, with a small number of sperm, and secondarily of the prostate gland. Anatomically, the ejaculatory ducts connecting the seminal vesicles open at the urethral crest of the posterior urethra, surrounded by 10-20 prostatic duct openings. In fact, the seminal vesicles, prostate, and posterior urethra are interconnected, and inflammation can easily spread from one to the other two. Furthermore, the seminal vesicle walls are very thin, and once congested, the blood-filled walls are prone to bleeding. Therefore, the most common cause of hematospermia is seminal vesiculitis, followed by prostatitis, posterior urethritis, or posterior urethral congestion. It can also be caused by the spread of inflammation from nearby organs, leading to inflammation, swelling, congestion, and bleeding of the seminal vesicle wall. Generally, at least 70% of hematospermia cases in men under 30 are caused by inflammation.

If hematospermia is only occasional and no specific abnormalities are found during examination, it may be caused by the rupture of tiny blood vessels due to sudden congestion and mechanical impact in certain tissues during intercourse. There is no need to panic about this transient hematospermia; it will fully resolve after abstaining from sexual activity for one or two weeks. Bleeding caused by inflammation is mostly intermittent, but not lasting long. If hematospermia persists and worsens, the possibility of a tumor cannot be ruled out. In some patients, there is also a widespread bleeding tendency in other parts of the body, which is more likely a systemic hematologic disorder such as leukemia or thrombocytopenia, rather than a consequence of local lesions.

The most common causes of hematospermia are as follows:

1. Inflammation: The seminal vesicles and prostate are closely adjacent to organs such as the urinary tract and rectum, making them prone to infection. After infection, the inflammatory process can irritate the tubules and glandular mucosa, causing local congestion, edema, and bleeding. Pathogens causing infection include viruses, bacteria, mycobacteria, and parasitic infections. Inflammation can also be a result of trauma, foreign bodies in the urethra, or chemicals. Trauma may include stones within the prostate or seminal vesicles.

2. Obstruction or cyst: Obstruction of the ejaculatory duct can cause the proximal duct to dilate and expand, leading to rupture of mucosal blood vessels and bleeding, such as seminal vesicle cysts and prostatic cysts.

3. Tumors: Various benign tumors have been reported to cause hematospermia, such as ectopic prostatic tissue in the urethra, prostatic polyps, and hyperplastic urinary tract infections. Malignant tumors of the prostate, testes, and seminal vesicles can also cause hematospermia.

4. Vascular abnormalities: Varicose veins in the seminal vesicles, prostate, urethra, and bladder neck can also cause hematospermia. Additionally, vascular abnormalities in the reproductive system during puberty can lead to hematospermia, including arteriovenous malformations, prostatic hemangiomas, seminal vesicle abnormalities, and, rarely, spermatic cord hemangiomas. Depending on the nature of the lesion and the amount of blood present, hematospermia can be classified as: gross hematospermia, where the semen appears bloody or contains blood clots; and microscopic hematospermia, where red blood cells are only visible under a microscope.

What are the harmful effects of blood in semen on men?

First, hematospermia can lead to decreased sexual function. If hematospermia is not cured for a long time or the treatment is not ideal, it can also lead to a decline in the condition of other parts of the body. Coupled with the fear of the disease, it can affect male sexual function.

Secondly, hemospermia can kill sperm. During inflammation, the seminal plasma contains a large number of cells and white blood cells, and may also contain pus, significantly increasing its viscosity. This makes the ejaculated semen difficult to liquefy, preventing sperm from motility and allowing it to penetrate the cervix. The reduced volume of seminal plasma during inflammation also hinders sperm survival.

Finally, hematospermia can cause infertility. Because the sex organs involved in hematospermia have complex structures and poor drainage, it can easily become chronic, leading to secondary obstruction of the vas deferens and edema and obstruction of the ejaculatory duct orifice, resulting in dry ejaculation-the act of ejaculation without the expulsion of semen. This is the mechanism by which hematospermia causes infertility. Other causes of infertility include changes in seminal plasma composition during seminal vesiculitis. Bacteria consume nutrients in the seminal plasma, compete for oxygen, and excrete toxins and metabolic products, undoubtedly creating an extremely unfavorable environment for sperm and reducing fertility.

Since hematospermia can cause such serious harm, how should it be treated?

First, the underlying cause of hematospermia should be treated. For seminal vesiculitis and prostatitis, antibacterial and anti-inflammatory treatments can be used. During the acute phase, broad-spectrum antibiotics can be administered intravenously, followed by oral antibiotics once the condition stabilizes. Sitz baths with a 1:5000 potassium permanganate solution, local diathermy via the perineum or rectum, or hot compresses with a hot water bottle can all improve local microcirculation and promote inflammation resolution. Perform seminal vesicle and prostate massage once a week to encourage the drainage of fluid from the seminal vesicles. Once seminal vesiculitis is cured with active treatment, the hematospermia will disappear, and there will be no significant impact on fertility. Sexual activity should be stopped until the hematospermia disappears.

Traditional Chinese medicine classifies hematospermia into several categories, and different types require different treatments:

1. Deficiency of essence and excess of fire type. This is often caused by excessive sexual activity, which keeps the prostate and seminal vesicles in a state of congestion without relief, or frequent ejaculation may damage microvessels and cause bleeding. You can take Zhi Bai Di Huang Wan orally, 6-9 grams each time, twice a day, with 3 grams of amber dissolved in water each time.

2. Qi and Yin Deficiency Type. If the patient with hematospermia also has symptoms such as emaciation, spontaneous sweating, night sweats, and flushed cheeks, the treatment should focus on tonifying the lungs and kidneys. Maiwei Dihuang Pills can be given, 6-9 grams each time, twice a day, along with 4 tablets of Sanqi tablets each time.

3. Damp-heat damaging the collaterals type. If hematospermia is accompanied by scanty, dark urine, dribbling, and distending pain in the testicles, perineum, and lower abdomen, it is often seen in urinary tract infections caused by unprotected sex. While taking antibiotics as prescribed by a doctor, Er Miao Wan should be taken, 6 grams each time, twice a day.

4. Blood not circulating in the meridians type. If patients with hematospermia also have bleeding gums, or even pale lips and nails, petechiae on the skin, dizziness and vertigo, the treatment should focus on tonifying both Yin and Yang. Gui Pi Wan can be taken orally, 6-9 grams each time, twice a day, and one bottle of Compound Donkey-hide Gelatin Oral Liquid can be taken with each dose.