Hematospermia

　　The most common causes of hematospermia are as follows:

　　1. Inflammation

　　The seminal vesicle, prostate, and urinary tract, rectum, and other organs are closely adjacent, which is easy to cause infection. After infection, the inflammatory process can stimulate the tubules and glandular mucosa, causing local congestion, edema, and bleeding. The pathogens causing infection include viral, bacterial, mycobacterial, and parasitic infections. Inflammation can also be the result of trauma, urethral foreign bodies, chemicals, and trauma can include calculi in the prostate or seminal vesicle.

　　2. Obstruction or cyst

　　After the seminal duct obstruction, the proximal duct can expand and swell, leading to mucosal vascular rupture and bleeding, such as Wolffian duct cysts, seminal vesicle cysts, and prostate cysts.

　　3. Tumors

　　There have been reports that various benign tumors can cause hematospermia, such as ectopic prostate tissue in the urethra, prostate polyps, and hyperplastic urine, which can cause hematospermia. Malignant tumors in the prostate, testis, and seminal vesicle can also cause hematospermia.

　　4. Vascular abnormalities

　　Varicosities in the veins of the seminal vesicle, prostate urethra, and bladder neck can also be a cause of hematospermia. In addition, vascular abnormalities in the reproductive system during puberty can lead to hematospermia, including arteriovenous malformations, prostate hemangiomas, seminal vesicle hemangiomas, and rare varicoceles.

　　1. Killing sperm

　　During inflammation, due to the presence of a large number of cells and a large number of white blood cells in the seminal plasma, it may also contain pus, resulting in a significant increase in viscosity. The ejaculated semen is also not easy to liquefy, and the sperm cannot move forward and reach the cervix. The volume of seminal plasma during inflammation is too small, which is not conducive to the survival of sperm;

　　2. Decline in sexual function

　　If seminal pyuria is not cured for a long time or the treatment is not ideal, it may also lead to a decline in the condition of other parts of the body, as well as the psychological fear of the disease, affecting male sexual function.

　　3. Cause infertility

　　Due to the complex structure of the sexual organs that cause seminal pyuria, poor drainage, it is easy to become chronic, leading to secondary obstructive azoospermia, edema and obstruction of the ejaculatory duct orifice, resulting in dry ejaculation with only ejaculation action but no seminal fluid discharge.

　　1. Seminal pyuria has varying degrees

　　Severe cases can be seen with the naked eye that there is blood in the seminal fluid, known as 'gross seminal pyuria'; mild cases require microscopic examination to find red blood cells in the seminal fluid, known as 'microscopic seminal pyuria'.

　　2. Large amounts of blood seminal discharge may be accompanied by acute urinary retention and a series of sexual dysfunction

　　As for whether it affects fertility, it varies from person to person. Most seminal pyuria patients can still have children, while some patients may lead to infertility.

　　3. Seminal pyuria can also be acute or chronic

　　Acute cases often have systemic symptoms such as chills and fever; lower abdominal pain, frequent urination, urgency, dysuria, and difficulty in urination. Prolonged cases may turn into chronic, and the symptoms are easily confused with chronic prostatitis, and they often coexist; however, gross or microscopic seminal pyuria is a characteristic of seminal vesiculitis, which is not difficult to differentiate.

　　1. Taboos:Even after the blood seminal discharge is gone, one should rest for 1-2 weeks, and after recovery, sexual life should also not be too frequent or intense.

　　2. Taboos:Avoid drinking alcohol and spicy foods to prevent exacerbation of congestion; do not ride bicycles or horses for long distances.

　　3. Once a week:One-time seminal vesicle and prostate massage helps to expel inflammatory secretions.

　　4. Hot water bath:Take a bath once a day for 15-20 minutes at a water temperature of 41-42°C (one course of treatment lasts for 30 days, followed by a 10-day rest before the next course).

　　5. Antibiotics:such as penicillin, gentamicin, kanamycin (injected intramuscularly, local iontophoresis, etc.).

　　6. Hemostatic drugs:It is also very necessary to treat symptoms with corresponding medications such as vitamin K and tranexamic acid.

　　1. Step-by-Step Ejaculation Examination

　　For patients with blood seminal discharge, some hospitals may also require step-by-step ejaculation examination. Through the examination of blood seminal discharge, not only can it be determined whether there are red blood cells and leukocytes in the seminal fluid, but it can also preliminarily estimate the condition of accessory glands and the source of blood seminal discharge.

　　2. Seminal Fluid Bacterial Culture + Drug Sensitivity Test

　　For certain necessary patients, seminal fluid bacterial culture + drug sensitivity test can be performed, and appropriate antibacterial drugs can be selected by the doctor.

　　3. Prostate Examination

　　Rectal examination can check for enlargement, tenderness, and nodules of the prostate. It is noteworthy that sometimes, during the process of prostate massage to obtain seminal fluid, due to excessive force, red blood cells may also appear in the seminal fluid, which does not necessarily indicate that the prostate has a lesion.

　　4. Routine Seminal Fluid Examination

　　Understanding whether seminal fluid contains leukocytes; if leukocytes are present, it indicates inflammation of the prostate and seminal vesicles. If the number of leukocytes exceeds 20 per high-power field, it is considered seminal pyuria. Sometimes, due to a high number of red blood cells in the seminal fluid, it is difficult to distinguish leukocytes. One can check the seminal fluid again after blood seminal discharge stops. Sometimes, if the abstinence period is too long, the seminal vesicles remain congested for a long time, leading to an increase in leukocytes in the seminal fluid.

　　5、精囊液检查

　　5. Seminal Vesicle Fluid Examination

　　After urination, massage the seminal vesicle and collect seminal vesicle fluid for examination. When seminal vesicle hemorrhage occurs, seminal vesicle fluid may appear old-fashioned coffee-colored fluid. In seminal vesicle inflammation, the number of white blood cells in seminal vesicle fluid increases.

　　6. Ultrasound Examination

　　It is best to have a color Doppler ultrasound to understand whether the seminal vesicle is enlarged, cystic, or has calculi.

　　7. Cystoscopy 

　　1. Mainly light food, pay attention to dietary regularity.

　　2. Diet should be reasonable according to the doctor's advice.

　　3. There are no great taboos for this disease in diet, a reasonable diet is enough.

　　The principles of treatment for hematospermia are basically the same (except for tumors, tuberculosis, and other conditions that require special treatment),对症治疗 can be used, such as hemostatic drugs. During the acute hemorrhage period, sexual activity should be strictly avoided. After the hematospermia disappears, it is still advisable to rest for 1-2 weeks, and sexual activity should not be too frequent or intense after recovery; it is forbidden to drink alcohol and spicy刺激性 food to avoid exacerbating the degree of congestion; do not ride a bicycle or horse for long distances; the prostate massage method can be used to let the seminal vesicle contain the liquid with cells be discharged as soon as possible, once a week seminal vesicle and prostate gland massage is helpful to expel inflammatory secretions; physical therapy and hot bath can be done to accelerate the regression of inflammation, hot sitz bath once a day, for 15-20 minutes, water temperature 41-42°C (30 days as a course, rest for 10 days before the next course); antibiotics such as penicillin, gentamicin, kanamycin (muscle injection, local iontophoresis, etc.); hemostatic drugs such as vitamin K, Angiostatin, and other symptomatic treatment are also very necessary. Physical therapy and traditional Chinese medicine treatment can also be adopted. When post-urethritis occurs, post-urethral fluid infusion therapy can be performed. As long as the treatment is appropriate, it will not affect sexual activity and fertility, so there is no need to worry. But one should not be indifferent, otherwise it may delay treatment and affect fertility. A small number of hematospermia is caused by seminal vesicle tuberculosis or prostate tuberculosis, and should be treated according to anti-tumor methods. A very small number of hematospermia is caused by seminal vesicle tumors or post-urethral tumors, and it is necessary to seek the advice of a specialist doctor.