Updated May 2023

Valentine is a 25-year-old nice-looking bloke who came to the clinic at 4 am because of pain in the testes.

It started nearly a week ago, but that night at work it had become excruciating.

The pain had calmed down after taking some paracetamol with aspirin, but he was still somewhat uncomfortable.

Additionally, he had passed blood and sperm after masturbation 2 nights before.

To say he was a bundle of nerves was putting it mildly.

Giving your Doc sexual information is important…

This was the first kind of its occurrence so we took a little peek at his sexual style.

Emphatically he assured me he had not been with a girl for 12 months at least – not since the last one – (I noticed he was a little hesitant).

I wondered to myself if I would be exceeding medical curiosity to ask what had caused the breakup.

Anyway, he also denied having had an STI – sexually transmitted infection (which I tend to take with a grain of salt because – people sometimes have ‘faulty recollections’).

So we proceeded to examine, and really –  everything down there seemed fine.

This brings us down to – why he had pain and blood in the semen and what to do next.

Causes of Bloody Semen

In most men, passing bloody semen is a scary experience.

As an aside – perhaps because women experience monthly periods, they are not as upset about the idea of passing blood from the vagina.

However, ladies – when bleeding from your vagina becomes IRREGULAR – read as heavier, associated with pain or change to your usual pattern – its the time to speak with your doctor.

According to NHS choices: It’s unusual to find blood in your semen when you ejaculate, but – it’s usually only temporary and the cause is rarely anything serious.

So what should we think when Haematospermia (bloody semen) happens?

One possible cause may be inflammation of the organ that produces semen material.

This organ is the prostate gland – and the condition is Prostatitis.

Other organs like the seminal vesicles could contribute to bloody semen.

The seminal vesicles are parts of the testes which produce fluid that makes up the semen.

In a young man like Valentine, conditions like sexually transmitted infections (STI) are important.

This is not to say STIs don’t happen in older guys, but they tend to occur more often in younger people.

More causes to consider:

• Following operations like
  • Vasectomy – cutting the tubes that transport sperm from the testis into the penis.
  • Prostate surgery/ biopsy
  • A test to look inside the bladder – called Cystoscopy.

Other less common causes are:

• High blood pressure,
• Cancer,
• or a bleeding condition when a person’s blood fails to clot properly;
• Medicines like anticoagulants

Your doctor will look for signs of these as they ask questions about your symptoms and when they examine you.

Treatment

Finally, the treatment will depend on the possible causes.

For Valentine, we agreed he would need an STI (sexually transmitted infection) screen.

In his case, there was no recent surgery or evidence of problems with his blood pressure.

I thought testing for infections like Herpes, Chlamydia, Gonorrhea, etc., could identify a cause for which he could start treatment.

If there is strong evidence of multiple sex partners or ‘at risk’ sexual behaviour or a partner with confirmed infection – treatment before the test would be considered.

And if his screen returns normal, but the pain persists, then he should be seen by a specialist to consider the less common causes and arrange further tests that will diagnose the problem.

If you have testicular pain or haematospermia, don’t ignore it – get it checked out by your Doctor.

Stay well.

Editing by AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising  Medical Practitioners on various healthcare conditions to provide evidence-based guidance and help promote quality healthcare. The advice in our material is not meant to replace the management of your specific condition by a qualified healthcare practitioner.
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