Why is semen dark red?

Sperm color is dark red, which may be what we call hematospermia. Hematospermia is relatively common in clinical practice. Common causes are seminal vesiculitis, prostatitis, or other reproductive diseases, as well as malignant tumors.

1. Hematospermia

Blood is mixed in the semen. Medically, it is called hematospermia. The normal color of semen is light grayish white. It can be light yellow and slightly viscous after abstinence for a while. It becomes liquid after about 20 minutes of discharge from the body, which is called semen liquefaction. Among the main components of semen, seminal vesicle fluid accounts for 50%-80%, prostatic fluid accounts for 15%-30%, and there are also a small amount of epididymal fluid and sperm, bulbourethral gland fluid and paraurethral gland fluid. Therefore, when there is bleeding in any part of the seminal vesicle, prostate sac, ejaculatory duct, and posterior urethra, the semen will be brown; bleeding in the posterior urethra is mostly fresh blood, and the semen is red or pink. The appearance of hematospermia can be intermittent, or it can last for several months or even years. There may be no other symptoms except hematospermia, or it may be accompanied by ejaculation pain, initial hematuria or dysuria.

2. Causes

There are three causes: pathological, functional and idiopathic. Pathological causes include: ① Inflammation, with seminal vesiculitis and prostatitis being the most common, and often both coexisting, mostly bacterial infections, and mycoplasma infection should also be considered. ② Cysts, stones, tuberculosis or filariasis of the seminal vesicle or prostate. ③ Varicose blood vessels or hemangiomas, flesh perforations, etc. on the posterior urethra or hypertrophic prostate. ④ Malignant tumors of the seminal vesicle, prostate, and posterior urethra should be considered in people over 40 years old. The functional aspect is mainly due to long-term sexual restraint, excessive swelling of the seminal vesicle, and excessive indulgence. Due to multiple contractions of the seminal vesicle, the blood vessels in the seminal vesicle mucosa rupture and bleed. Idiopathic hematospermia refers to some hematospermia of unknown cause.

3. Diagnosis

In addition to paying attention to the medical history, the vulva should be examined, especially the anus. Under normal circumstances, the seminal vesicle cannot be felt, and can only be touched when the seminal vesicle is swollen. Malignant tumors of the seminal vesicle or prostate can touch the seminal vesicle or prostate and feel hard. If it is suspected to be inflammation, prostate massage should be performed, and prostate fluid should be squeezed out for microscopic examination or bacterial culture. At the same time, it can be understood whether it is prostate bleeding. Do a semen test again, and pay attention to the number of white blood cells in the semen? A large number of white blood cells is often an inflammation, or at least it can be said that there is inflammation; very few white blood cells may be caused by rupture and bleeding in some parts of the seminal tract, such as rupture of varicose ducts, and B-ultrasound examination of the prostate, seminal vesicle and bladder. It can show whether there are organic lesions in the seminal vesicle, prostate and bladder. If there is a suspicion of lesions in the posterior urethra or bladder, a urethrocystoscopy should be performed, which can directly see the lesions in the posterior urethra, spermatophore, prostate and bladder, such as congestion, varicose blood vessels, polyps, granulomas and tumors, and even bleeding lesions. When doing vasocontrast imaging, puncture into the vas deferens is required, which may cause secondary vas deferens obstruction, so it is generally rarely used, unless the anal examination touches the seminal vesicle and there is an abnormality, or antibiotics need to be injected into the seminal vesicle every day after imaging.