Opinion
3 min

There’s blood in my cum, doc

Sounds scary but generally benign

Dear Dr Ren,

I am 36 and have had half a dozen ejaculations where blood was present in my semen. The first time that this happened to me I was in university and I thought it was due to overuse. Years passed before it happened again.

Now it has begun to happen more regularly, several months apart. There’s a lot of blood the first time, then just a little bit for a few times and then nothing for several months again. My doctors have found nothing worrisome. My PSA tests are normal.

Still, this can’t be normal, can it? What tests should I be asking for? What can I do to stop or prevent this from happening?

Thank you,
Bloody Cum

***
Dear Bloody Cum,

Hematospermia — blood in your ejaculate — is a fairly common condition, and generally quite benign, much like finding a bit of blood in your snot when you blow your nose. Alarming, but insignificant.

If it’s happened to you once, it will likely occur again. Some men are simply prone to this. That said, I validate your concern and congratulate you for conferring with your physician. About half the time, we just don’t know why blood appears in someone’s cum. There can be, though, some causes we want to rule out. These are:

•    benign or malignant tumours of the prostate, bladder, testes or seminal vesicles

•    infections (including, but not limited to, chlamydia, herpes, trichomoniasis and cytomegalovirus)

•    prostatitis, epididymitis or urethritis

•    polyps in the urethra

•    ejaculation-duct obstructions

•    cysts, hemorrhage or abnormalities of the seminal vesicles

They sound scary, but they’re easily diagnosed and treated.

Commonly performed diagnostic tests are a urinalysis and cultures to identify any sexually transmitted or other infections. If indicated, an ultrasound or MRI may reveal tumours or other abnormalities. In some cases, a semen analysis may be ordered.

You see, semen originates from multiple organs, including the testicles, epididymis, vas deferens, seminal vesicles and prostate. Most of the semen comes from the seminal vesicles and prostate, and it is probably from these two organs that most hematospermia originates.

If doctors are being particularly thorough, or if any of your lab tests return as suspicious, treatment with antibiotics for a presumptive diagnosis of prostatitis (inflammation of the prostate gland) is given, since some studies have shown that about a quarter of men with bloody semen have prostatitis. However, the benefit of this treatment is questionable, and over-prescription of antibiotics is problematic in itself.

In most cases, if blood in the semen is not associated with any infection or other abnormality, no treatment is given, and the condition usually resolves on its own, as you have found in your case.

Under no conditions (except in the case of an STI) would your experiencing blood in your cum put your sexual partners at any risk.

As to your question about what you can do to stop or prevent this from happening, you would need to know what was causing it to happen in the first place, and that is unlikely. Just relax.

That’s the rather unsexy medical information about blood in your semen. Perhaps equally as relevant would be a discussion about the importance of your paying attention to the cues your body gives you about its rhythms and alerts.

You tell me, for instance, that your first occurrence of bloody cum was when you were in university and quite sexually active. Now in your mid-30s, you note a more regular recurrence. Have you paid attention to your sexual cadence? Does this coincide with your taking new lovers? Or perhaps with an increase in solo sex? Your body doesn’t care how it comes, you know, but it does note frequency.

If you happen to be someone whose body is sensitive to these “seminal bleeds,” you would be wise to monitor whether your ejaculatory frequency triggers them, not because you are necessarily causing yourself harm, but because it behooves us to know and understand how our bodies work. This becomes even truer as we age, when spotting change can alert us to potential problems. Early detection is the key to recovery.

In fact, this sensitivity can serve as a reminder to you to monitor your naughty bits generally. Our reproductive organs comprise the only system not fully functioning at birth nor lasting till death. Prostates wear out before our medically extended life spans and therefore require a bit of extra pampering and monitoring. “Men of a certain age” need to be seeing their doctors annually for PSAs and digital exams to catch any early changes of the prostate gland. Check your balls regularly, too, for smoothness and roundness.

I must say that your response to your situation is so completely appropriate (checking with your doctor, writing for additional information) that I have no doubt you will approach upcoming health challenges with equal wisdom. At 36, you have decades ahead of you to experience all sorts of sexual adventures, and of course you will want to keep your body in its best physical condition to enjoy those experiences to their fullest. You set a good example.