Having dark semen is a sign of blood mixing in with the semen. This condition is known as hematospermia. It has many possible causes, including urethral stricture and a prostate infection. In the majority of men, the cause is unknown and the condition clears on its own without explanation. Diagnosing the cause of dark semen requires a physical examination and medical tests performed by a urologist.
Dark semen, whether light tinges of color in otherwise healthy looking semen or semen that has undergone a complete color change, is due to hematospermia. Due to bleeding within the urinary or reproductive tracts, red blood cells are expelled through the urethra. Darker blood indicates that the blood originated from the testes or prostate, while lighter blood suggests a cut somewhere along the urethra. Many medical conditions can cause hematospermia and thus dark semen.
Physical trauma to the urethra can cause urethral stricture and dark semen. Vigorous sexual activity or accidental injury creates micro tears along the urethra, causing bleeding. Changes in semen color along with possible painful ejaculation appear shortly after this trauma. Though the cuts soon clot, the urethra becomes slightly narrower at the place where the bleeding occurred. The pressure of future ejaculation on this narrow area(s) can reopen wounds, leading to more bleeding.
Inflammation of the prostate can cause bleeding similar to that of a urethra stricture. In this case, infection or an undiagnosable reason causes minute bleeding. Blood originating from the prostate tends to make semen darker than blood from the urethra. This difference is due to how prostate blood, once released, has longer to oxidize before leaving the body. Like with urethra stricture, the severity of the cuts influence the degree to which semen color is affected.
For most men, dark semen is idiopathic, meaning the cause is unknown and/or undiagnosable. It occurs only once for no discernible reason and quickly disappears. If an individual should go to see a urologist, the urologist finds nothing wrong.
Even if dark semen is idiopathic, a man with this condition should consult a urologist to try to diagnose the underlying cause of hematospermia. After a general physical, a number of tests may be necessary to locate the point of bleeding. These tests can include prostate exam, ultrasound and/or inserting a fiber optic camera through the urethra. The latter is especially useful in diagnosing urethral strictures. Even if it is impossible to explain or stop episodes of bleeding, the patient will be able to understand how bleeding affects his overall health and reproductive capability.
Clinical Assessment of Hematospermia
Once semen acquires the dark hue associated with hematospermia, there are a few personal factors to consider before coming up with a course of action. Blood oozing out of any location in the human body triggers anxiety in the brain, but it is necessary to maintain a composed tone to avoid making rash decisions. Before visiting a urologist, here are some things to consider.
Assess for Recurrence
In a vast majority of males, dark semen might be a once-in-a-lifetime ordeal. After trauma in the genital area, any of the ducts can suffer damage, causing bleeding into the seminal fluid coursing within it.
A single episode of dark semen is acceptable and often disappears as quickly as it appears. However, when there are several recurrent episodes, patients should be cautious to prevent irreversible damage such as infection and infertility. You should see a qualified urologist to expedite recovery.
Common Causes for Recurrent Dark Semen
As earlier stated, physical trauma to the conducting systems of the genitourinary tract is the main cause of dark semen. Blood vessels delivering blood to the prostate gland, the seminal vesicle, the vas deferens, or epididymis may rupture, oozing out their contents into their associated vessel.
The body’s repair mechanisms manage the damaged blood vessels through blood clotting. However, when these strictures experience high pressure, such as in coitus or extreme urination, they may be irritated, causing a recurrence of the red tinge in semen.
Weakened luminal walls may also contribute to recurrent hematospermia, as these sensitive locations are susceptible to irritation, predisposing them to bleed from slight mechanical trauma.
Factor in Age
In youth and developing children, increased physical activity predisposes them to hurt their groin area when at play. Strenuous activity observed in young adults during intercourse may also damage the gonadal ducts. In such individuals, the darkening of their semen is largely considered normal.
For individuals over the age of 40, or docile people, symptoms associated with hematospermia can be concerning. There is a higher probability that these people may be suffering from undiagnosed underlying conditions that may pose a health hazard to them. Such conditions include:
- Tumors and polyps
- Blood vessel complications
- Elevated blood pressure
- Liver disease
- Leukemia
- Testicular cancer
- Prostate cancer
- Prostate enlargement
It is however important to note that the prevalence of associated health conditions is relatively rare even among older men.
What Are the Symptoms Related to Hematospermia?
As much as the dark or reddish appearance of semen is a tell-tale sign of hematospermia, it may be accompanied by several other symptoms that will help a physician make an informed diagnosis.
When the bleeding was caused by trauma to the groin region, dark semen may be associated with pain in the groin area and sometimes in the surrounding abdominal region.
If the damage occurred along the length of the urethra, the dark tinge may also be conferred to urine leading to hematuria. In this case, passing urine may be painful, with pain ranging anything from a sharp acute pain to a slow, burning sensation that gets worse with more acidic urine.
In addition to the pain experienced during urination, hematospermia may be accompanied by:
- Pain in the bladder
- Pain during ejaculation
- Penile discharge
- Distended bladder
Tests and Evaluation of Hematospermia
To diagnose hematospermia, the urologist has to rule out the possibility of Sexually Transmitted Infections (STIs/STDs), liver damage, blood coming from a sexual partner for example during periods, or prostate cancer among many other conditions.
To do this, the urologist will carry out tests for STIs that are specific to the infection being tested. They may conduct a urinalysis to determine the components of urine and detect abnormalities that may indicate renal or hepatic failure. A condom test rules out the possibility of the blood in the sperm coming from a sexual partner, while a PSA test detects prostate cancer. Lastly, the physician may perform an ultrasound or cystoscopy to identify abnormalities in the conducting ducts of the sex organs.
In most circumstances, dark semen offers no reason for concern, but in some rare severe cases, patients may need to visit a medical practitioner for proper evaluation. If a patient’s hematospermia is not self-limiting, they should seek medical attention immediately.